Shannon M. Christy

Purpose: Racial and ethnic minority populations remain underrepresented in clinical trials because of restrictive eligibility criteria, systemic inequities, bias, and patient-level barriers. Educational interventions may improve awareness and participation, yet culturally tailored video–based approaches remain underused. Methods: We developed three brief culturally tailored educational videos about clinical trials in thoracic oncology for Black patients (English) and Hispanic/Latino patients (English and Spanish). Eligible patients were aged 18 years or older, had stage I to IV lung cancer, had Eastern Cooperative Oncology Group 0-2, self-identified as Black or Hispanic/Latino, and were proficient in English or Spanish. Participants completed prevideo and postvideo surveys evaluating knowledge, attitudes, and willingness to participate. Feasibility was assessed by recruitment, survey completion, and satisfaction. Acceptability, attitudes, and willingness were measured with brief surveys. Clinical trial enrollment within 1 year was also evaluated. Results: From April to September 2024, 54 patients were approached and 30 (56%) enrolled; all completed the prevideo and postvideo surveys. More than 90% reported high satisfaction. Mean knowledge scores improved ( P < .001), including understanding of preclinical studies ( P = .012), placebo use ( P = .001), and clinical trial registration ( P = .012). More than 90% agreed that clinical trials are useful and important for drug development and improved outcomes. Barriers persisted in approximately half of the participants, including concerns about consent complexity, random assignment, costs, and provider communication. Willingness to participate increased ( P = .04). Within 1 year, 17 patients (57%) had a trial available and eight (47% of eligible; 27% overall) enrolled. Conclusion: Culturally and linguistically tailored educational videos were feasible, acceptable, and associated with improved knowledge and willingness to participate. Larger studies are needed to determine whether integrating such interventions can increase minority enrollment in thoracic oncology trials.

Introduction: We aimed to develop an educational intervention booklet for promoting hepatitis C virus (HCV) and colorectal cancer (CRC) screening; and to assess intervention satisfaction, screening intentions, and changes in individuals’ HCV/CRC knowledge and health beliefs in a pilot test of the educational booklet. Methods: We developed a preliminary HCV/CRC education booklet informed by the Preventive Health Model with input from a community advisory board. During Study 1, feedback about the booklet was gathered through qualitative methods using individual interviews (n=13) with participants recruited from two community health centers. Interview questions addressed education material attraction, clarity, preferred delivery channels, and ability to promote action. Rapid qualitative analysis was utilized, and the booklet was revised based on feedback. For the pilot trial (Study 2), 26 participants were recruited, completed baseline quantitative surveys assessing HCV/CRC knowledge and health beliefs, and were provided the booklet to review. Approximately 7-14 days later, participants (n=19) completed a follow-up survey which assessed knowledge, health beliefs, screening intentions, and intervention satisfaction, which were examined using descriptive statistics. Results: In Study 1, a theory-informed booklet was produced and utilized in Study 2. From baseline to follow-up in Study 2, there was an increase in participants’ objective CRC/HCV knowledge ( p p <0.005, respectively) and there were changes in several CRC/HCV health beliefs. Most participants agreed that they learned new information (90%), and that the information was easy to follow (89.5%) and understand (89.5%). All participants (100%) reported that the information was very/somewhat helpful. Participants’ reported intentions to complete CRC screening and HCV screening in the next 6 months were 71% and 40%, respectively. Conclusion: Findings suggest that the team was able to produce a theory-informed educational intervention booklet which led to changes in health beliefs and knowledge. Practice Implications: Bundling education about multiple cancer screening behaviors is feasible.

Community-engaged research (CEnR), a collaboration between academics and community partners, is an effective approach in addressing the social drivers of health (SDOH) and health disparities in local communities. Yet, CEnR training is often not a standard component of training programs in research or clinical programs. To meet the need for CEnR training, we developed and implemented a workshop to increase CEnR knowledge and skills among clinician-scientists and early-stage investigators (ESIs), and create opportunities for ongoing mentorship and professional development. In this manuscript, we discuss the organization of this workshop, learning objectives, supporting activities, and follow-up methods to facilitate a successful and engaging training experience. The workshop was developed through collaborative efforts with experts in CEnR, Community-Based Participatory Research (CBPR), cancer disparities, and SDOH. The workshop focused on (1) an introduction to CEnR and the opportunity for attendees to develop their own CEnR research ideas; (2) varied presentations, interactive activities, experiential learning, and discussion topics to fulfill the workshop’s learning objectives; (3) year-long opportunities for professional development and continued mentorship; and (4) evaluations of the workshop. Twenty-four ESIs and 11 clinician-scientists participated in the workshop. Using survey methods and descriptive statistics, the workshop was evaluated positively by participants. This manuscript provides guidance for both in-person and virtual workshop formats, from inception to implementation, and recommendations for other workshop facilitators. The impact of these workshops has the potential to have positive downstream implications for community-engaged research.

In the United States (US), only 47% of young adults (18-26 y old) had initiated the human papillomavirus (HPV) vaccine in 2022. Provider recommendation is the strongest predictor of HPV vaccination; however, limited studies have explored methods for training providers on making HPV vaccine recommendations to young adults. The purpose of this study was to obtain provider feedback on education materials for effective HPV vaccination recommendations to patients ages 18-26. Guided by the Theory of Planned Behavior and Health Belief Model, an HPV vaccine training was developed for primary care providers. Fifteen US primary care providers were recruited in 2022 for semi-structured interviews. Participants reviewed and provided feedback on the draft training. Data were analyzed using thematic analysis. Overall, feedback on the education materials was favorable. Participants noted learning new and useful information and appreciated the diversity of people throughout the training. General feedback included flexibility in the training format and timing due to busy schedules and providing incentives to encourage participation. There were mixed feelings toward participating in a role-play activity. Recommendations included using clear language and opportunities to make the training more persuasive. Future research is needed to refine the intervention based on provider suggestions and test the effectiveness of the intervention for improving provider recommendations for young adults.

Despite an effective human papillomavirus (HPV) vaccine, uptake among sexual and gender minority (SGM) young adults remains suboptimal, including among Hispanic/Latino SGM. This study aimed to describe awareness/knowledge, health beliefs, attitudes, clinician recommendation receipt, and HPV vaccine intentions among unvaccinated Spanish-speaking Hispanic/Latino SGM young adults assigned male at birth in Florida and Puerto Rico. Participants completed a cross-sectional online survey between August 2021 and August 2022. Eligibility criteria included being 18-26 years old, male sex assigned at birth, identifying as Hispanic/Latino, identifying as gay, bisexual, or queer, speaking Spanish, living in Florida or Puerto Rico, and having access to the internet. Survey items assessed previous healthcare experiences, HPV vaccine awareness, knowledge, beliefs, attitudes, discussions, clinician recommendation receipt, and vaccine intentions. Descriptive analyses were performed. Among the 102 unvaccinated participants, all (100%) identified as gay and/or bisexual. Most participants self-reported male gender (96%), being of Puerto Rican descent (92%), and living in Puerto Rico (86%). Only 18.6% of participants reported having received a clinician recommendation for the HPV vaccine. HPV vaccine knowledge was low (Mean=3.2; Standard Deviation [SD] = 2.6; Range: 0-9), attitudes were neutral (Mean=2.5; SD = 0.7; range=1.0-4.3), and perceived barriers were moderate (Mean=2.4; SD = 1.0; range=1.0-4.7). Approximately 35% reported being very likely to seek additional HPV vaccination information in the next year. Approximately one-in-nine (11.8%) reported being very likely to receive the HPV vaccine in the next year, whereas approximately one-third (30.4%) reported being very likely to receive the vaccine at some point in the future. Findings suggest potential modifiable and multilevel targets for future interventions to promote HPV vaccination among Spanish-speaking Hispanic/Latino SGM young adults assigned male at birth. Such multilevel interventions could address specific knowledge gaps, beliefs, and attitudes among patients and promote clinician recommendations in order to improve HPV vaccination rates among Hispanic/Latino SGM young adults.

Objectives: Hepatitis C virus (HCV) screening rates are low in the United States and may be lower among populations experiencing social vulnerability. Little is known about these potential disparities. The current study examined HCV screening prevalence across time, spatial distribution, and social vulnerability among adults in Florida. Methods: We used data on clinical encounters from the OneFlorida+ data repository to examine the prevalence of HCV screening among adult patients in Florida (N = 1 380 811) from August 1, 2015, through July 31, 2021, by birth cohort (1924-1944, 1945-1965, 1966-1985, and 1986-1997) and risk group (average vs high risk of HCV infection based on behavioral and medical factors). Among patients with a recorded 9-digit zip code (n = 853 965), we conducted spatial analyses, and we used the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) to examine screening disparities. Results: The 1945-1965 birth cohort had the highest likelihood of HCV screening (7.9% among average-risk patients and 24.2% among high-risk patients); those in the 1924-1944 birth cohort had the lowest likelihood (2.0% among average-risk patients and 8.6% among high-risk patients). High-risk patients in almost every geographic area were more likely than average-risk patients to be screened. Screening prevalence was highest in north and northeastern Florida. Among all patients, screening tended to be most likely among those with the highest socioeconomic status and with either the least or most social vulnerability. Conclusions: HCV screening rates were low in Florida across all study years and birth cohorts. Spatial and SVI analyses revealed geographic disparities by region and social vulnerability groups. Interventions are needed to support HCV elimination.

Young adults (18–26 years) are at high risk of human papillomavirus (HPV) exposure. Yet, HPV vaccine uptake is suboptimal among young adults. Provider recommendation is frequently the most influential factor in HPV vaccine acceptance. Evidence-based strategies are needed to facilitate provider recommendations for young adults. To inform provider-level strategies for recommending the HPV vaccine to young adult patients, the current study aims to understand current practices and barriers and facilitators to both recommending the HPV vaccine for young adults and for young adults to receive the HPV vaccine. Primary care providers (e.g., physicians, nurses; n = 15) in the United States completed a semi-structured interview guided by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed thematically using Nvivo. Most participants identified as female (80%), White (67%), and non-Hispanic (93%). Participants reported varying their HPV vaccine discussions based on visit type (acute vs. wellness) and if the patient is new or established in their practice. Participants reported barriers to HPV vaccination in young adults across several CFIR domains including outer setting (e.g., transient living situation), inner setting (e.g., lack of availability of vaccine in clinic), individual (e.g., sex differences), and process (e.g., burnout). Facilitators included considering the HPV vaccine as a high priority and scheduling future vaccine appointments at the current visit. Evidence-based interventions to increase HPV vaccine uptake among young adults are needed. Healthcare providers identified multilevel barriers to both recommending and delivering the HPV vaccine to their young adult patients.