Bridging Research, Accurate Information and Dialogue (BRAID): A Novel Strategy to Build Community Trust.

BACKGROUND: Efforts to promote COVID-19 vaccination uncovered the effects of longstanding structural racism and perpetuated the erosion of community trust in science and public health institutions. Rebuilding trust is a priority to overcome barriers to vaccine uptake. Bridging Research, Accurate Information and Dialogue (BRAID) is a model that combines several evidence-based approaches to nurture trusting relationships with community experts, leading to the dissemination of accurate, timely, and acceptable COVID-19 vaccine messages. OBJECTIVE: To describe an innovative community-engaged participatory research model with the potential to build trust and spread accurate health information through social networks. METHODS: BRAID provided safe spaces for a series of facilitated conversation circles involving trusted community experts and invited clinicians and scientists. Community experts were encouraged to share their experiences, raise concerns, and ask pandemic-related questions in an informal setting. Community experts were empowered to codesign and coproduce accurate health messages acceptable to their communities. To gain insight into the process of building trust, dialogues involving 22 community experts were transcribed and coded, and post survey data from 21 participants were analyzed. CONCLUSIONS: BRAID is a manualized community engagement model that aims to build the trust needed to improve COVID-19 vaccine uptake in historically marginalized communities. Through BRAID, participants developed increased trust in health systems and research. By empowering community experts to share information through their established social networks, BRAID has the potential to amplify the reach and impact of communications regarding health topics that are controversial and divisive, such as COVID-19 vaccination.

Factors Influencing the Referral of Patients with Prediabetes to a Diabetes Prevention Program in the Bronx, New York.

INTRODUCTION: Disparate engagement in the Diabetes Prevention Program (DPP) may occur as early as the point of referral for certain subgroups, including Black and Hispanic men. We aimed to determine patient demographic and provider characteristics associated with referrals to a health system DPP in the Bronx, New York. METHODS: Patient and health system characteristics for DPP-eligible patients seen in primary care between July 1, 2015, and December 31, 2017, were obtained through the electronic health record. Generalized mixed-effects modeling was used to test the association between referral rate and clinical and sociodemographic variables. RESULTS: Of 26,727 eligible patients, 66% were female, 46% were Hispanic, and 39% were non-Hispanic Black. Only 10% (n = 2,785) of eligible patients were referred to DPP. In the adjusted analyses, lower odds of referral were observed for men versus women (OR = 0.60; 95% CI, 0.52-0.66), for non-Hispanic White versus Hispanic patients (OR = 0.53; 95% CI, 0.40-0.71), and for uninsured patients versus Medicaid patients (OR = 0.66; 95% CI, 0.54-0.80). The odds were higher for patients in the highest versus lowest hemoglobin A1c (OR = 2.49; 95% CI, 2.27-2.72) category; for those in the highest versus lowest body mass index categories (OR = 1.61; 95% CI, 1.45-1.79); for middle-aged patients (aged 45-64 y) versus those aged 18-26 y (OR =1.63; 95% CI, 1.33-2.00); and for patients being seen by a family versus an internal medicine physician (OR = 1.65; 95% CI, 1.22-2.22). CONCLUSION: We identified under-referral for men and highlighted other patient and health system factors associated with referral rates. Interventions to address bias in referrals and increase referrals for men at high risk for diabetes, not typically represented in DPP, are recommended.

What matters to us: Bridging research and accurate information through dialogue (BRAID) to build community trust and cultivate vaccine confidence.

Despite higher rates of SARS-CoV-2 infections and mortality, vaccine uptake in Black and Latinx populations remained disproportionately low, including in the Bronx, New York. In response, we used the Bridging Research, Accurate Information, and Dialogue (BRAID) model to elicit community members' COViD-19 vaccine-related perspectives and informational needs and inform strategies to improve vaccine acceptance. We conducted a longitudinal qualitative study over 13 months (May 2021-June 2022), with 25 community experts from the Bronx including community health workers, and representatives from community-based organizations. Each expert participated in 1-5 of the 12 conversation circles conducted via Zoom. Clinicians and scientists, attended circles to provide additional information in content areas identified by the experts. Inductive thematic analysis was used to analyze the conversations. Five overarching themes, related to trust, emerged: (1) disparate and unjust treatment from institutions; (2) the impact of rapidly changing COVID messages in the lay press (a different story every day); (3) influencers of vaccine intention; (4) strategies to build community trust; and (5) what matters to community experts [us]. Our findings highlighted the influence of factors, such as health communication, on trust (or lack thereof) and vaccine intention. They also reinforce that creating safe spaces for dialogue and listening and responding to community concerns in real time are effective trust-building strategies. The BRAID model fostered open discussion about the factors that influence vaccine uptake and empowered participants to share accurate information with their community. Our experience suggests that the model can be adapted to address many public health issues.

Impact of Locus of Control on Patient-Provider Communication: A Systematic Review.

Growing evidence shows there is heterogeneity in patient communication preferences and a need to tailor communication approaches accordingly. However, little is known about the psychosocial factors that influence communication preferences. Among them is locus of control (LOC), a belief about who or what determines outcomes, including health. Although LOC theory was developed over 60 years ago as a personality theory, its relevance in healthcare has increased over the past two decades. There is a paucity of empirical evidence on patient or provider LOC as it influences communication quality and outcomes in healthcare settings. We conducted a systematic review to collate the current state of the literature.We carried out a comprehensive search of PubMed MEDLINE, Embase, PsycInfo, and Cochrane Library databases to retrieve relevant peer-reviewed articles. A total of 1152 publications were identified. Our final review included 17 articles that underwent data extraction and quality assessment.The included studies found evidence of LOC associations with several patient and provider communication-related outcomes including satisfaction with care; medical decision-making and communication preferences; adherence; and patient-provider rapport. As opposed to generalized approaches to communication, assessing patient LOC may allow clinicians to tailor their approaches to match patients' LOC. Our findings provide a starting point and highlight the need for future studies.

Virtual Summer Undergraduate Mentorship Program for Students Underrepresented in Medicine Yields Significant Increases in Self-Efficacy Measurements During COVID-19 Pandemic: A Mixed Methods Evaluation.

Purpose: The barriers that Black and Hispanic/Latinx students underrepresented in medicine (URiM) face while seeking biomedical careers have been identified, including lack of career preparation and social support. Yet it is unclear how the COVID-19 pandemic has impacted their decisions and progress toward their occupational goals. Methods: Adapting to the precautions necessitated by the COVID-19 pandemic, the authors conducted a mixed-methods evaluation of our 2020 virtual summer URiM biomedical mentoring program, using both quantitative and qualitative pre- and post-program questionnaires to measure the students' perceptions of their preparation and self-efficacy for applying to health professional schools. Results: Themes were extracted from qualitative data through thematic analysis. When students were asked how the COVID-19 pandemic affected them, two themes and subthemes emerged: (1) loss of supportive environment, (1.1) challenging learning environment, (2) derailed or uncertain future, and (2.2) COVID-19 hitting home. When students were surveyed about their online experience at the end of the program, the themes (3) supportive community and (4) inspired and reinforced goals appeared. In addition, quantitative data examined through statistical analysis revealed that the students' career self-efficacy improved significantly after program participation. Conclusion: Our results indicate that the COVID-19 pandemic has further challenged URiM students with pre-existing career obstacles. The outcomes also demonstrate that it is possible to virtually provide URiM students with socioemotional support and increase their career self-efficacy. Overall, frequent evaluations are encouraged to better understand the dynamic challenges of URiM students, improve the design of health career "pipeline" programs, and diversify the physician workforce to address racial health inequities.

Dreams Realized: A Long-Term Program Evaluation of Three Summer Diversity Pipeline Programs.

Purpose: Pipeline programs are a well-known approach to enhancing health care workforce diversity and reducing health disparities. Few evaluations of pipeline programs include long-term outcome; fewer still, if any explore perceptions of students after completing such programs, to elucidate factors that contribute to successful entry into the health professions. The authors conducted a program evaluation of three summer diversity pipeline programs in the Bronx, NY, investigating both long-term outcomes and participants' hindsight perspectives of the impact of these programs on their career trajectories. Methods: Investigators conducted a cross-sectional, long-term, mixed-methods survey study. The primary and secondary outcomes for the quantitative analysis were matriculation into biomedical programs to pursue MD or PhD degrees and Master's degrees, respectively, and associated demographic factors. Free-text questions explored the most valuable and influential components of the programs; responses were analyzed qualitatively. Results: Of 147 respondents, 107 (73%) were on-track or had entered a doctoral or master's program, achieving either the primary or secondary outcomes, respectively. Components cited as most valuable included clinical experience, mentorship, career exposure, and research opportunities. Three themes were identified from the free-text responses: (1) Dreams realized; (2) Professional identity formation; and (3) Addressing systemic inequities. Conclusions: These three pipeline programs achieved career outcomes similar to published data. Participants' insights highlight the value of relationships, direct exposure to the health professions, and the importance of such programs to address systemic barriers faced. Results can inform criteria both for participant selection, as well as benchmarks used to define individual and programmatic success.

Cooking, healthy eating, fitness and fun (CHEFFs): qualitative evaluation of a nutrition education program for children living at urban family homeless shelters.

OBJECTIVES: We assessed the feasibility of a 15-week nutrition education, physical activity, and media literacy program for children living in urban family homeless shelters. METHODS: We developed a qualitative monitoring tool to evaluate program process and impact at 2 shelter sites in the Bronx, New York, from 2009 to 2012. Facilitators recorded indications of participants' understanding of intended messages and demonstrations of changes in attitudes and behaviors. Comments, insights, and actions were recorded as they occurred. Facilitators also documented barriers to delivery of content and activities as intended. We used content analysis to examine data for patterns and identify themes. RESULTS: A total of 162 children participated at the 2 shelter sites. Analysis of qualitative data yielded 3 themes: (1) children's knowledge and understanding of content, (2) children's shift in attitudes or intentions, and (3) interpretations through children's life experience. Food insecurity as well as shelter food service and policies were important influences on children's choices, hunger, and sense of well-being. CONCLUSIONS: Children's experiences highlighted the need to advocate for shelter policies that adequately provide for children's nutritional and physical activity requirements and foster academic development.