The use of co-design in developing physical activity interventions for older adults: a scoping review.

BACKGROUND: Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults. METHODS: We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims. RESULTS: Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability. CONCLUSIONS: There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field. TRIAL REGISTRATION: osf.io/vsw2m.

The use of co-design in developing physical activity interventions for older adults: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the available evidence on the use of co-design in developing physical activity interventions for older adults. INTRODUCTION: Remaining physically active throughout life is important for maintaining independence and quality of life. Co-design is an effective way to engage end users in health-related policy development and health care interventions; however, the definition and operational use of co-design varies widely. This scoping review will summarize the available evidence on how co-design is used to engage older adults in physical activity interventions and identify areas for future research. INCLUSION CRITERIA: Studies must have at least one participant aged 60 years or older and include concepts related to co-design and physical activity to be eligible for inclusion. Eligible studies must be original, peer-reviewed research. METHODS: MEDLINE, Embase, CINAHL, and AMED databases will be searched from inception to February 18, 2021. Following duplicate removal, titles and abstracts will be screened and selected according to predefined inclusion criteria by two or more independent reviewers. Kappa level of agreement will be calculated between reviewers for selection of titles and abstracts. The remaining full texts will be screened against inclusion criteria, and reasons for exclusion will be reported. Data will be extracted from included studies by two or more independent reviewers according to the Participant, Concept, Context framework. Information pertaining to the aims of this scoping review and the study methodology will be extracted and presented in tabular format, accompanied by a narrative summary. SCOPING REVIEW REGISTRATION NUMBER: Open Science Framework Registration (osf.io/vsw2m).

Prevent and Protect: A Vaccination Initiative for Uninsured Patients at a Student-Run Free Clinic.

Lower vaccination rates in uninsured adults may be related to prohibitive costs of and limited access to vaccines. To compare Tdap and pneumococcal vaccination rates of a student-run free clinic to national averages. A retrospective chart review of 236 adult patients from 05/2017 to 06/2019 was conducted. Vaccine eligibility was determined according to CDC guidelines at the time of the patient visit and according vaccination history by review of medical records. Percent up-to-date was determined by dividing the number of up-to-date individuals by the total number of patients eligible for the vaccine. BRIDGE Healthcare Clinic vaccination rates were near or surpassed national averages. The percent of up-to-date individuals was 63.1% for Tdap, 90% for pneumococcal vaccines in adults 65 or older, and 86.5% for pneumococcal vaccines in high-risk adults 18-64 years. This compares with 2017 national averages of 63.4%, 69%, and 24.5%, respectively (Center for Disease Control and Prevention (CDC) Vaccination coverage among adults in the United States, National Health Interview Survey. Retrieved February 8, 2018 from https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html#pneumo , 2017). Of the 197 vaccines provided during the course of this study, 184 were provided by the BRIDGE Healthcare Clinic. In conclusion, with the appropriate funding and stewardship, student-run free clinics play a resourceful role in increasing access to preventative health care for uninsured patients.

Assessment of impact of a skin cancer education session on cosmetology students' knowledge and preparedness to assess future clients for skin lesions.

BACKGROUND: Approximately 50% of cutaneous melanomas go undetected by patient self-inspection, and lesions that go unnoticed are usually located on the scalp, head, and neck. Cosmetologists are able to examine areas difficult to see on self-inspection. OBJECTIVES: The purpose of this study was to design and conduct an educational skin cancer screening presentation for cosmetology students and assess preparedness to discuss skin cancer with future clients. METHODS: This cross-sectional study conducted and analyzed in 2017 assessed the efficacy of a skin cancer education presentation among cosmetology students. Students completed a pre-/poststyle quiz aimed at assessing skin cancer knowledge. The difference in pre- and postknowledge quiz was analyzed using paired samples t test. RESULTS: A total of 194 students from seven cosmetology schools participated. Before the presentation, 43.4% felt underprepared to check for unusual lesions on future clients while 17.7% felt some level of preparedness. After, 3% felt underprepared while 51% felt prepared. There was a statistically significant difference in the skin cancer knowledge quiz total score before (M = 7.87, SD = 1.493) and after (M = 9.23, SD = 1.037) the educational presentation (P < 0.0001). CONCLUSIONS: This study shows most cosmetology students in the Tampa Bay area appear to be interested in learning more about skin cancer and agree that curricula should include skin cancer topics. Results of this study were limited to the Tampa Bay area and may not represent national trends. However, skin cancer presentation and screening-related content could be included in cosmetology curricula to help better prepare cosmetologists to screen for suspicious skin lesions.

Enhancing Adherence to Cervical Cancer Screening Guidelines at a Student-Run Free Clinic.

Women who lack health insurance have much lower rates of cervical cancer screening and higher rates of cervical cancer than insured women. The current screening rate for insured patients is 86.9%, while the rate for uninsured women is 68.2%. Student-run free clinics may help increase the rates of cervical cancer screening in uninsured women. As screening rates in this setting are uncertain, this study was performed to determine rates of cervical cancer screening at a student-run free clinic, and therefore determine its effectiveness in increasing screening rates in uninsured women. A retrospective chart review was conducted among female patients ages 21-64 at a student-run free clinic to determine how many patients were up-to-date with cervical cancer screening per American Cancer Society (ACS) guidelines. A total of 239 women were included in the retrospective chart review. At their most recent visit, 87.9% of clinic patients were up-to-date on cervical cancer screening. This screening rate is higher than both the reported uninsured (68.2%) and insured (86.9%) national screening rates in the United States. Although there are multiple barriers that prevent uninsured patients from undergoing cervical cancer screenings, screening rates at our student-run free clinic are higher than national screening rates. This higher screening rate can be attributed to a standardized screening system, access to resources including Pap tests provided by community partners, and the clinic's ability to longitudinally follow patients. However, there remain areas for improvement, such as reducing no-show rates and ensuring that staff screen for cervical cancer at each visit.

Addressing Breast Cancer Screening Disparities Among Uninsured and Insured Patients: A Student-Run Free Clinic Initiative.

Mammography rates among the uninsured are less than half of those among insured patients as reported by American Cancer Society (Breast cancer facts & figures 2017-2018, American Cancer Society, Inc., Atlanta, 2017). This may stem from high costs of and limited access to a usual place for health care, which may portend delayed breast cancer diagnoses and poorer outcomes among uninsured women. Student-run free clinics provide opportunities for uninsured patients to establish a medical home, thereby increasing access to preventative health care. The purpose of this study is to determine the rates of breast cancer screening at a student-run free clinic and compare them to national averages. A retrospective chart review was conducted using patients of BRIDGE Healthcare Clinic who were women ages 40-75 years between January 2012 and March 2018. Medical records were reviewed for demographics, date of mammogram, and screening results. A total of 194 women 40 years or older were included in the review. Overall, of the 157 women who were 45 years or older at their most recent visit, 75.5% were up-to-date according to guidelines set forth by the American Cancer Society. These values are well above the reported national rates in insured and uninsured women (21%, 53%, respectively) as reported by American Cancer Society (Breast cancer facts & figures 2017-2018, American Cancer Society, Inc., Atlanta, 2017). Of the patients who obtained screening mammograms, 84.5% utilized BRIDGE Healthcare Clinic's program. Volunteer providers are often the sole source of health care for a substantial portion of uninsured patients, who may have unmet preventative health needs. As such, the findings of this study suggest that student-run free clinics play an important role in increasing uninsured patients' access to mammograms. The breast cancer screening program described herein may serve as an example for implementation by other student-run free clinics.