As part of Centers for Disease Control and Prevention's (CDC) Prevention Research Center (PRC) Vaccine Confidence Network (PRC VCN), 26 academic institutions were funded to increase COVID-19 vaccine confidence and uptake in their communities. Six sites (in communities located in Alabama, Illinois, Massachusetts, New York, South Carolina, and Texas) formed a workgroup to identify emergent themes, and share challenges and opportunities across projects. This essay describes their efforts to engage trusted messengers in vaccine activities, and discusses strategies to develop and sustain these types of partnerships in the future. All sites recruited trusted messengers with strong community relationships to engage in multiple activities to promote COVID-19 vaccine confidence and uptake. CDC and the PRCs provided data-driven, evidence-based training and support to enable trusted messengers to fully participate in the projects. We posit that trusted messengers are essential partners for informing public health campaigns, developing effective messages, and building trust with local communities. Flexible federal funding and local coordination are essential for creating and sustaining trusted messenger approaches that combine community needs and data-informed evidence to promote timely public health responses.

Introduction: Diffusion of innovations (DOI) theory can explain adoption of new technologies, like COVID-19 vaccines. We used an adapted version of DOI theory to guide efforts to adapt and implement evidence-based interventions to support COVID-19 vaccination for youth and families. Methods: Guided by community partner input, we triangulated data on infection and vaccination rates with qualitative focus group and interview data, and a synthesis of literature on evidence-based interventions for vaccine promotion to adapt interventions. Results: Implemented in three phases, we relied on trusted messengers to share vaccine narratives and tailored the degree of interaction between trusted messengers and adopters. We began broadly in the form of a community-wide communications campaign and progressively narrowed in focus towards direct engagement with trusted messengers. Discussion: DOI framework can be used to plan for and implement interventions as demonstrated by our two-year project to respond to the ever-evolving context of the COVID-19 pandemic.

Food policy councils (FPCs) play a critical role in mitigating the impacts of COVID-19 in their com­munities. This study examines the characteristics of councils that use, develop, or do not use racial or social equity frameworks, and explores how frame­work use relates to COVID-19 responses and part­nerships. Survey data represent 193 FPCs across the United States. Survey questions addressed the following: (a) use of a racial or social equity frame­work; (b) demographic information (e.g., geograph­ical focus, organization type, U.S. region); (c) bud­get and funding, connection/partnership, groups supported, food policy priorities; and (d) COVID-related actions. Means, chi-square tests, and analysis of variance (ANOVA) were used to describe the association among these factors and FPCs’ racial equity framework use. Results indi­cated that 38% of FPCs use a racial or social equity frame­work to guide their work. Having a full-time posi­tion was the only variable significantly associ­ated with using a racial or social framework. FPCs that use a racial equity framework reported more policy work (e.g., raising funds with community partners, advocating for community food system policies) and were more likely to work with Black, Latinx, and people with disabilities than councils that did not report using a framework. Further­more, councils using a racial or social equity frame­work reported policy priorities related to healthy food access and local food processing and have connec­tions with state-elected officials and social justice groups. Integrating full-time positions dedi­cated to advancing racial and social equity efforts in food policy councils can enhance policy advocacy, strengthen community partnerships, and may increase engagement with marginalized groups such as Black, Latinx, and people with disabilities.

Despite the availability of COVID-19 vaccines for youth since 2021, vaccine hesitancy has resulted in suboptimal uptake. Public health campaigns that empower local youth ambassadors as trusted messengers who share their personal narratives related to getting vaccinated hold promise for promoting COVID-19 vaccination. We used a seven-step approach to develop, implement, and evaluate a youth-led ambassador campaign to promote COVID-19 vaccine uptake in communities experiencing COVID-19 disparities in Worcester, MA. The seven steps included (1) engaging with key partners; (2) determining a community of focus; (3) identifying trusted sources; (4) determining campaign components; (5) training the vaccine ambassadors; (6) disseminating the campaign; and (7) evaluating the campaign. We trained nine youth as vaccine ambassadors. Ambassadors were guided through self-reflection of motivations for COVID-19 vaccination and the resulting personal narratives became the campaign messaging. English/Spanish vaccine messages developed by youth ambassadors were disseminated through social media platforms (n = 3), radio (n = 2), local TV (n = 2), flyers (n = 2,086), posters (n = 386), billboards (n = 10), and local bus ads (n = 40). Qualitative youth feedback indicate participation in the campaign was a positive and empowering experience which reinforces the importance of engaging youth in public health messaging. Youth empowerment through personal narratives (and storytelling) holds promise for future public health campaigns.

Introduction: Innovative strategies are needed to improve pediat-ric COVID-19 vaccination rates. We describe the process for devel-oping a clinic-based intervention, CONFIDENCE, to improve pediatric COVID-19 vaccine uptake and present results of our beta-test for feasibility and acceptability.Method: CONFIDENCE included communication training with providers, a poster campaign, and parent-facing educational materi-als. We assessed feasibility and acceptability through interviews and measured preliminary vaccine intention outcomes with a pre-post parent survey. Interviews were analyzed using rapid qualitative methods. We generated descriptive statistics for variables on the parent survey and used Fisher's exact test to assess pre-post differences.Results: Participating providers (n = 4) reported high levels of fea-sibility and acceptability. We observed positive trends in parents' (n = 69) reports of discussing vaccination with their provider and the parental decision to accept COVID-19 vaccination.Discussion: Our next steps will be to use more rigorous methods to establish the efficacy and effectiveness of the CONFIDENCE intervention. J Pediatr Health Care.

Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent -focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Partic-ipants were child-parent/guardian (Kindergarten to 6th grade at baseline) dyads (n = 247) recruited through schools located in socioeconomically disadvantaged neighborhoods in Worcester, MA, USA. Using a quasi -experimental design, the study tested the impact of Healthy Kids & Families, a theory-based, low-intensity, parent-focused, CHW-delivered intervention to improve children's weight, healthy eating and physical activity. The attention-control comparison condition was a positive parenting intervention. The primary outcome was change in child body mass index (BMI) z-score at 24 months. Secondary outcomes included number of positive child and parent changes in selected diet and physical activity behaviors targeted by the intervention and change in parent BMI. Outcomes were assessed following the intent-to-treat principle and using multivariable gener-alized linear mixed models. Compared to the attention-control comparison condition, the Healthy Kids & Families intervention led to a greater reduction in children's BMI z-score (beta =-0.17, 95 %CI:-1.92 to-0.36; p = 0.057) and a greater number of positive behavior changes among children (beta = 0.57, 95 %CI: 0.08-1.06; p = 0.02) at 24 months. There was no significant change in parent outcomes. The Healthy Kids & Families inter-vention shows promise for obesity prevention among children in socioeconomically disadvantaged communities.

[This corrects the article DOI: 10.1016/j.pmedr.2022.102086.].

To identify frequency and correlates of hypertension in a low income, ethnically diverse, sample of children as well as to assess parental awareness of hypertension. This cross-sectional study included parent-child dyads (n = 228), from which physical measurements of the child, and parent reported survey measures were collected. Child’s blood pressure percentile was determined via 2017 American Academy of Pediatrics (AAP) clinical practice guidelines and categorized as normal (< 90th percentile), elevated (≥ 90th percentile to < 95th percentile), or hypertensive (≥ 95th percentile). Bivariate multinomial logistic regression models assessed the relative risk ratio for potential correlates of blood pressure categorization and frequency distribution of parental awareness of blood pressure status was examined. Median child age was 8.1 years (IQR 6.5–9.9). Half were female, 61.8

Vaccine hesitancy is a long-standing public health issue. The present work describes parental perceptions of COVID-19 vaccination for 5- to 11-year-old children, to aid in vaccination efforts. Parents of 5- to 11-year-old children residing in Worcester, Massachusetts, were recruited through community partner outreach to participate in semi-structured focus groups. Focus groups were conducted via Zoom in English (n = 4) and Spanish (n = 3) with a total of 67 parents. Rapid qualitative analysis was used. Most participants were female and of Hispanic ethnicity. Themes included: (1) Trusted sources and influential types of information (e.g. personal COVID-19 vaccine stories from peers and healthcare providers), (2) Motivations for vaccination: health (i.e. protecting children, families, and communities from COVID-19), (3) Motivations for vaccination: social, emotional, and educational (i.e. mitigating related negative effects of COVID-19), (4) Drivers of vaccine hesitancy (e.g. frustration, uncertainty, and confusion), (5) Differentiating vaccine acceptance, hesitancy, and resistance, (6) Needed information. Although this context may be unique to parents of 5- to 11-year-old children from Central Massachusetts, especially those who may be Spanish-speaking, or of Hispanic ethnicity, this work reinforces the need for effective and persistent communication to combat vaccine hesitancy. In describing parents' perceptions toward COVID-19 vaccination in their 5- to 11-year-old children, we contextualize vaccine hesitancy and highlight opportunities for existing evidence-based communication strategies to increase vaccine confidence and uptake in pediatric populations.

We explored perspectives of clinicians in central and western Massachusetts about efforts to vaccinate pediatric patients against COVID-19 as well as best practices and challenges for vaccine delivery. We conducted semi-structured qualitative interviews (n = 16) with family practice and pediatric clinicians between late October and early December 2021. Our interviews addressed: process for vaccination and vaccine promotion, parental receptivity to COVID-19 vaccination, receptivity to other pediatric vaccines, resources needed to support vaccine promotion, and best practices developed to encourage hesitant parents. Using a multi-prong recruitment strategy we invited clinicians to participate in telephone interviews, which were audio-recorded and transcribed. We used rapid qualitative analysis to produce summary templates for each interview which were ultimately combined into a matrix summary. The majority of participants (n = 10) were offering the vaccine in their own clinics, while the remainder cited challenges related to staffing, logistics, and space that prevented them from offering the vaccine. Clinicians reported parents fall into three groups: vaccine-accepting, hesitant but potentially accepting, and refusers. Strategies they identified that worked to encourage hesitant parents were sharing personal vaccine stories, acknowledging parents’ fears about the vaccine, and being persistent with the most hesitant parents. Yet resources are needed including educational materials and training in how to have these conversations. While challenges related to staffing and space will be difficult to overcome for clinics to be able to offer vaccination on-site, our results highlight the importance of developing effective messaging strategies and training clinicians in how to integrate them into routine practice.

One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. ClinicalTrials NCT03028233 . Registered January 23,2017. The trial was retrospectively registered.

OBJECTIVES:To develop and validate a Weight Literacy Scale in English and Spanish for adults. METHODS:The two-phase study utilized quantitative and qualitative methods. Phase 1 of the study consisted of developing an initial survey (English and Spanish versions) assessing weight literacy based on a review of the literature; conducting semi-structured interviews with content experts (N = 9) to refine survey items; and conducting in-person cognitive interviews with 20 study participants (N = 10 English-speaking and N = 10 Spanish-speaking adults) for survey pre-testing. Survey items were modified based on Phase 1 findings. Phase 2 consisted of a psychometric study of the Weight Literacy Scale developed in Phase 1. Procedures included administering the Weight Literacy Scale to 200 study participants (N = 100 English-speaking and N = 100 Spanish-speaking adults), a quantitative survey assessing dietary and physical activity behaviors and sociodemographics, measuring participants' height and weight, and assessing the scale's validity and internal reliability. A subset of Phase 2 participants (N = 71) completed the weight literacy scale at two-weeks follow-up to assess test-retest reliability. Participant recruitment and study procedures took place in community settings in central Massachusetts for both study phases. Weight literacy scale scores were calculated as the sum of total correct items. Three rounds of factor analysis were performed to identify items for elimination. The Kuder Richardson's Coefficient of reliability was calculated. Correlations between the Weight Literacy Scale scores and related measures (body mass index and weight status, dietary behaviors, physical activity behaviors, and confidence in filling out medical forms) were examined. RESULTS:The final scale included 31 items and demonstrated strong internal consistency (Kuder Richardson Coefficient = 0.90), reasonable construct validity, and acceptable test-retest reliability (ρ = 0.72). CONCLUSION:The Weight Literacy Scale is a reliable and valid research instrument to assess weight literacy among English- and Spanish-speaking adults.

BACKGROUND:Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery.OBJECTIVE:The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults.METHODS:User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods.RESULTS:Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra "next page" click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status.CONCLUSIONS:We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients' use.

Patient Navigators are trained, lay health care workers who guide patients in overcoming barriers to health care access and utilization. Little evidence exists regarding reach and impact of Patient Navigators for chronic disease management. This study evaluated a Patient Navigator program aimed at optimizing health care utilization among ethnically diverse patients with diabetes and/or hypertension at a community health center (CHC). Trained Patient Navigators contacted eligible patients who had not seen a primary care provider (PCP) for ≥6 months. Outcomes included number of patients reached by Patient Navigators and seen by PCPs after Patient Navigator contact. Distributions and frequencies of outcomes pre- and post-call were compared. A total of 215 patients had ≥1 call attempt from Patient Navigators. Of these, 74 were additionally contacted via mailed letters or at the time of a CHC visit. Among the 45 patients reached, 77.8% scheduled an appointment through the Patient Navigator. These patients had higher rates of PCP visits 6 months post-call (90%) than those not reached (42.2%) (p < 0.0001). Findings emphasize the value of direct telephone contact in patient health care re-engagement and may inform the development of future Patient Navigator programs to improve reach and effectiveness.

OBJECTIVE To test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA1c. Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach. RESULTS A significant difference in HbA1c change between the groups was observed at 4 months (intervention −0.88 [−1.15 to −0.60] versus control −0.35 [−0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention −0.46 [−0.77 to −0.13] versus control −0.20 [−0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA1c change at 12 months. CONCLUSIONS Literacy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.