Using a cross-sectoral partnership to improve colorectal cancer screening and follow-up among African Americans in the United States: A protocol and preliminary results

Preventive Medicine Reports · 2026-03-17

Objective: Improving colorectal cancer (CRC) screening through cross-sector partnerships using nontraditional public service sites may reduce disparities among African Americans. This study evaluated the impact of the Black Equity, Access, and Testing for Cancer (BEAT Cancer) program on screening uptake among African American adults reached through these partnerships. Methods: From October 2023 to April 2024, racially concordant community health workers approached African American adults at the County Treasurer's Office and Department of Motor Vehicles in Omaha, Nebraska. Of 3563 individuals approached, 596 were eligible, and 336 enrolled (9.4%). Participants received a fecal immunochemical test (FIT) kit, an educational brochure, text/phone reminders, and navigation support. Outcomes included FIT return, test positivity, and completion of follow-up colonoscopy after abnormal results. Results: Among 336 enrolled participants, the mean age was 57 years; 56.8% were male, and 44.9% reported not having a primary care provider. Overall, 118 (35.1%) returned the FIT kit for testing; 21 (17.9%) had abnormal results, and 8 of 21 (38.1%) completed follow-up colonoscopy. Conclusions: The BEAT Cancer program demonstrated initial promise in CRC screening completion among African American adults with limited access to care, highlighting the potential of cross-sector collaborations with nontraditional public service settings to increase CRC screening uptake.

A Delphi study to prioritize implementation strategies to increase the adoption of screening and referral for brain injury among survivors of intimate partner violence and sexual assault within community-based organizations

BMC Public Health · 2026-01-24

Women who experience intimate partner violence (IPV) are at a high risk for injuries to the head, neck, and face that can result in a traumatic brain injury (BI). Despite increasing evidence of the high risk for BI in this vulnerable population, IPV-BI screenings remain critically under-implemented in community-based organizations (CBOs) serving IPV survivors. The aim of this community-engaged dissemination and implementation project was to co-identify implementation strategies to increase the adoption of IPV-BI screening and referral within intimate partner violence (IPV)-serving CBOs. We used a modified Delphi method to prioritize 47 CBO relevant strategies from the Expert Recommendations for Implementation Change compendium to increase the adoption of BI screening and referral among IPV-serving CBOs. In Round-1, 14 Community-campus advisory board (CAB) members, including representatives from 10 CBOs prioritized relevant strategies in a virtual meeting. In Round-2, 62 CBOs staff members responded to a survey to refine a subset of prioritized strategies to 6–8 primary strategies that could be tested across the CBOs. CAB participants identified 21 strategies as particularly relevant to CBOs including 4 educational, 2 technical assistance, 5 staff and leadership, 4 management and evaluation, and 6 organizational workflow strategies. Survey responses indicated 7 of the 21 strategies were most consistently rated as relevant and feasible. The final list of 7 strategies included training opportunities, ongoing consultation, developing implementation plans, establishing local screening and referral protocols, soliciting survivor feedback, promoting adaptability, and tailoring strategies to CBO contexts. This study highlights the importance of creating tailored implementation strategies within IPV-serving CBOs to enhance the adoption of brain injury screening and referral protocols. The identified strategies offer valuable insights into optimizing support for IPV survivors and advancing public health interventions.

The association of an exercise and rehabilitation clinical workflow algorithm on sedentary behavior and performance status from time of breast cancer diagnosis and throughout care

Breast Cancer Research and Treatment · 2026-04-17

Exercise is Medicine for Underserved Populations: Integrating Physical Activity Screening on a Community Mobile Health Unit

Translational Journal of the American College of Sports Medicine · 2026-04-01

Introduction: Exercise is Medicine (EIM) is a physical activity (PA) promotion strategy designed for use in clinical and community settings. Purpose: The purpose of this feasibility study was to test the integration of the Physical Activity Vital Sign into a mobile health unit (the Wellness Bus) and examine the potential of the EIM process to support promotion of other behavioral and psychosocial outcomes. Methods: Using an integrated research–practice partnership approach, the My Own Health Report tool, including the Physical Activity Vital Sign, was added to the Wellness Bus intake process to examine feasibility, prevalence of meeting recommended behavioral guidelines, and differences across demographic subgroups. Prevalence differences across subgroups were analyzed using robust Poisson regression. Interviews and rapid qualitative analysis of Wellness Bus staff ( n = 4) perceptions of feasibility were thematically coded using the Practical Robust Implementation and Sustainability Model. Results: Over 3 months, all 389 Wellness Bus visitors (84% Hispanic/Latino, 46% females, 67% uninsured) completed the full assessment, and over 90% provided valid responses to PA questions. Most participants did not meet PA (75% inactive or insufficiently active) or dietary recommendations based on fruit and vegetable (59%) or sugary beverage (52%) intake. Participants who were female, Hispanic/Latino, or uninsured were less likely to meet PA guidelines (all P ’s < 0.05). Qualitative data indicated that the tool was acceptable to staff and integrated well into the workflow, with suggestions for improved referral processes and resource linkage. These findings highlight both the feasibility of implementation and the need for structured health behavior supports. Conclusion: This study demonstrates how an integrated research–practice partnership and Practical Robust Implementation and Sustainability Model-informed strategy enabled the integration of EIM screening into a mobile health unit’s workflow. Future research should prioritize building referral linkages to evidence-based PA programs to fully realize the potential of EIM for underserved populations.

Weight Program Fidelity Measure

PsycTESTS Dataset · 2025-01-01

The Development and Use of AI Chatbots for Health Behavior Change: Scoping Review (Preprint)

2025-06-25

<sec> <title>BACKGROUND</title> Artificial intelligence (AI) chatbots are technologies that facilitate human-computer interaction through communication in a natural language format. By increasing cost-effectiveness, interaction, autonomy, personalization, and support, mobile health interventions can benefit health behavior change and make it more natural and intuitive. </sec> <sec> <title>OBJECTIVE</title> This study aimed to provide an up-to-date and practical overview of how text-based AI chatbots are designed, developed, and evaluated across 8 health behaviors, including their roles, theoretical foundations, health behavior change techniques, technology development workflow, and performance validation framework. </sec> <sec> <title>METHODS</title> In accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework, relevant studies published before March 2024 were identified from 9 bibliographic databases (ie, PubMed, CINAHL, MEDLINE, Embase, Web of Science, Scopus, APA PsycINFO, IEEE Xplore, and ACM Digital Library). Two stages (ie, title and abstract screening followed by full-text screening) were conducted to screen the eligibility of the papers via Covidence software. Finally, we extracted the data via Microsoft Excel software and used a narrative approach, content analysis, and evidence map to synthesize the reported results. </sec> <sec> <title>RESULTS</title> Our systematic search initially identified 10,508 publications, 43 of which met our inclusion criteria. AI chatbots primarily served 2 main roles: routine coach (27/43, 62.79%) and on-demand assistant (12/43, 27.91%), while 4 studies (4/43, 9.30%) integrated both roles. Frameworks like cognitive behavioral therapy (13/24, 54.17%) and behavior change techniques, such as goal setting, feedback and monitoring, and social support, guided the development of theory-driven AI chatbots. Noncode platforms (eg, Google Dialogflow and IBM Watson) integrated with social messaging platforms (eg, Facebook Messenger) were commonly used to develop AI chatbots (23/43, 53.49%). AI chatbots have been evaluated across 4 domains: technical performance (17/43, 39.53%), usability (17/43, 39.53%), engagement (37/43, 86.05%), and health behavior change (33/43, 76.74%). Evidence for health behavior changes remains exploratory but promising. Among 33 studies with 120 comparisons, 81.67% (98/120) showed positive outcomes, though only 35.83% (43/120) had moderate or larger effects (Hedges g or odds ratio or Cohen d&amp;gt;0.5). Most involved nonclinical (36/43, 83.72%) and adults (23/43, 53.49%), and a few were randomized controlled trials (14/43, 32.56%). Benefits were mainly seen in physical activity, smoking cessation, stress management, and diet, with limited evidence for other behaviors. Findings were inconsistent regarding the influence of long-term effects, intervention duration, modality, and engagement on health behavior change outcomes. </sec> <sec> <title>CONCLUSIONS</title> The exploratory synthesis provides a roadmap for developing and evaluating AI chatbots in health behavior change, highlighting the need for further research on cost, implementation outcomes, and underexplored behaviors such as sleep, weight management, sedentary behavior, and alcohol use. </sec>

2101-LB: Recruitment Strategies to Increase the Reach of the National Diabetes Prevention Program in Rural Populations

Diabetes · 2025-06-13

Introduction and Objective: Despite a higher prevalence of prediabetes, the reach of the National Diabetes Prevention Program (DPP) has been challenging in rural areas. This study examines the preliminary utility of different recruitment strategies to improve proportion and representativeness (i.e., reach) of rural participants that enroll in the National DPP. Methods: Two Cooperative Extension sites in rural Kansas were allocated to a bundle of passive recruitment strategies (social and mass media, print advertising) or an active population health management strategy (PHM) with a rural health clinic for patient identification. Participant demographics were obtained by self-report at baseline. We calculated and compared time to enrollment (i.e., number of working days from start of recruitment to the last participant consented). Proportional reach was calculated as the number of participants enrolled divided by the number screened eligible. Results: To date, 29 adults with prediabetes have enrolled (Table). The PHM strategy screened 24 participants, enrolling 15 of 16 eligible (94%) over 52 days (8.8 per month). Passive bundled strategies screened 61 participants, enrolling 14 of 25 eligible (56%) over 36 days (11.9 per month). Conclusion: Testing mechanisms to improve reach in rural settings is essential. These findings highlight the need for context-specific recruitment strategies to enhance the dissemination of the National DPP. Disclosure G. Wagner: None. P. Estabrooks: None. B. Forseth: None. T. Michaud: None. A. Rice: None. F. Steger: None. C. Holmes: None. E. Johannes: None. L. Koon: None. R. Montgomery: None. J. Donnelly: None. A. Gorczyca: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (R01DK132362)

Timing of resistance exercise and cardiometabolic outcomes in adults with prediabetes: a secondary analysis

Journal of Applied Physiology · 2025-01-07

In this secondary analysis, there was no difference between AM and PM exercisers in blood glucose, insulin, body composition, or muscular strength following 12 wk of supervised exercise. However, examining within-group changes, glucose area under the curve (AUC) was significantly reduced in PM exercisers, but not in AM exercisers.

Enhancing Advance Care Planning in Primary Care: A Three‐Year Implementation Study in Nebraska

Journal of the American Geriatrics Society · 2025-04-16 · 2 citations

BACKGROUND: Despite the benefits of discussing patients' preferences on care decisions, the uptake of advance care planning (ACP) in the U.S. is low. This study aimed to (1) identify barriers to ACP implementation, (2) implement two strategies (onsite ACP coordinator and Lightning Report facilitation-a rapid process improvement involving prompt feedback synthesis and timely action), and (3) track ACP outcomes (reach, implementation, and effectiveness). METHODS: This study took place at two primary care sites participating in the Nebraska Geriatric Workforce Enhancement Program from 2020 to 2023. We conducted a multi-stage evaluation mixed-methods study guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Qualitative data from clinic staff interviews and focus groups were collected to identify implementation barriers, develop an optimal workflow, and educate providers and patients (implementation). Quantitative data from electronic medical records (EMR) were collected at baseline and every six months thereafter to assess ACP outcomes, including reach (patient-provider discussion of ACP) and effectiveness (ACP document completion). We mapped barriers to implementation strategies, mechanisms, and ACP outcomes based on PRISM domains. RESULTS: From 2019 to 2021, ACP outcomes remained consistent: Clinic A (reach: data not available; effectiveness: 20.5%-20.2%) and Clinic B (reach: 2.3%-2.6%; effectiveness: 1.8%-1.9%). After implementing the ACP coordinator and Lightning Report in 2022, moderate-to-high improvements were observed: Clinic A saw a 10-percentage point increase in reach (43.6%-53.6%) and a 2.5 increase in effectiveness (20.2%-22.8%). Clinic B experienced a significant 25.3-percentage point increase in reach (2.6%-27.9%) and a 16.5 increase in effectiveness (1.9%-18.4%). We also updated the clinic workflow to integrate the ACP initiative into standard practice (implementation). CONCLUSIONS: The introduction of an ACP coordinator, along with the Lightning Report approach, may enhance ACP reach, effectiveness, and implementation in primary care settings for older patients.

Association between physical activity, performance scores, and clinical trial enrollment in cancer survivors

BMC Cancer · 2025-08-26 · 1 citations

BACKGROUND: To investigate the association between patient-reported habitual physical activity (PA) and physician-assessed physical performance scores, specifically the Eastern Cooperative Oncology Group (ECOG) score, and experimental therapeutic clinical trial enrollment in adult cancer survivors. METHODS: This was a secondary data analysis of patient-reported and clinical cancer data from the Total Cancer Care (TCC) cohort at the Huntsman Cancer Institute between 2016 and 2022. Patients completed a modified Godin questionnaire to assess average weekly PA (MET/hrs-week) for the previous 12 months. A demographics questionnaire collected information on sex, race, ethnicity, education level, and income status. ECOG performance scores were retrieved from the medical record and classified as either "Good" (ECOG of 0 or 1) or "Poor" (ECOG of 2, 3 or 4) physical function. Binary logistic regressions were used to assess the relationship between PA levels (total PA, moderate-vigorous PA, and light PA) and ECOG ratings, and PA levels and clinical trial enrollment (yes/no). Models were adjusted for demographics and cancer characteristics. RESULTS: Patients who completed the TCC questionnaire packet (n = 603) were primarily female (51%), non-Hispanic (95%), white (95%) with an average age of 61.9 ± 15.5 years. The top three cancer types represented were Head and Neck (30%), Thyroid (24%), and Lung (24%); all cancer stages were represented. Higher PA levels were linked with increased odds of having a good ECOG rating in unadjusted models (OR 1.01, 95% CI 1.00 to 1.02), but not in adjusted models (OR 1.01, 95% CI 0.99 to 1.03). Higher levels of light PA were linked with greater odds of having good ECOG rating in unadjusted and adjusted models (OR 1.05, 95% CI 1.00 to 1.11; OR 1.072, 95% CI 1.01 to 1.13; respectively). Statistically significant associations were not observed between moderate-vigorous PA and ECOG rating, and PA and clinical trial enrollment. CONCLUSIONS: Patient-reported light PA may serve utility in physician decision making of ECOG rating. More work is needed identifying patient centered subjective and objective tools to complement physician-assessed ECOG scores considering the implications of ECOG in cancer treatment decisions and eligibility for clinical trials.