Purpose Early career researchers (ECRs) are crucial to scientific advancement, but ECRs, particularly those from underrepresented groups, face unique challenges as they establish careers. Given the disruptions of the COVID-19 pandemic, this study aimed to identify the pandemic’s professional and personal impacts on ECRs. Method This national cross-sectional survey study assessed the effects of the COVID-19 pandemic among ECRs by gender, sexual orientation, race, and ethnicity. Between September and December 2021, the authors invited the 4,440 ECRs with National Institutes of Health training awards in 2020 to complete an online survey with measures assessing career, personal life, and demographics. Results Of 4,440 eligible ECRs, 1,524 (34.3%) completed the survey and 1,458 (32.8%) met inclusion criteria. Most respondents reported negative impacts to in-person conference cancellations (1,355 [93.1%]), research productivity (K award, 1,148 [87.4%]; overall, 1,192 [81.8%]), career trajectory (891 [61.2%]), and mental health (1,189 [88.1%]). Respondents with childcare responsibilities commonly reported negative impacts (801 [80.1%]). On average, respondents reporting negative impacts identified with more underrepresented groups than those reporting nonnegative impacts for certain measures, such as research productivity (K award, 0.92 vs 0.73, P < .001; overall, 0.92 vs 0.79, P = .01) and mental health (0.92 vs 0.81, P = .03). In free responses, respondents expressed stress as they balanced overwhelming demands of emerging careers and personal lives. Despite setbacks, many respondents cited new opportunities, including new projects (1,156 [79.3%]), new collaborators (926 [63.5%]), and increased flexibility (894 [61.3%]). Conclusions The pandemic had significant, largely negative, and unequal impacts on ECRs. Underrepresented ECRs were particularly susceptible to pandemic disruptions, potentially exacerbating existing challenges. Individual- and organizational-level interventions are critical to rejuvenate and sustain the early career research pathway. These interventions will foster the success of the next generation of biomedical scientists and the future of scientific advancement.

Purpose:To understand how institutions can support faculty during crises in biomedical research, this study examined early career researchers (ECRs) experiences with institutional supports during the COVID-19 pandemic and their perspectives on how institutions can support professional recovery. Subjects and Methods:This national, cross-sectional study evaluated professional and personal-related institutional supports offered to ECRs during the COVID-19 pandemic, the impact of these supports, and additional supports needed for professional recovery. An online survey was distributed electronically in fall 2021 to all individuals with F32 or K-level awards through the National Institutes of Health in 2020. Descriptive statistics, chi square tests, and thematic analysis summarized findings. Results:Among 4,440 ECRs contacted, 1,587 ECRs (35.7%) responded to the survey, and 1,527 (34.4%) met inclusion criteria. Most respondents reported their institutions offered programs or services during the COVID-19 pandemic (81.3%, n=1241), including professional support(s) (76.8%, n=1172) and personal support(s) (43.6%, n=666). The most impactful support was mentoring programs, with 49.9% (n=402/806) reporting that it had positive impact, followed by personal assistants (48.4%, n=60/123) and bridge funding (for research: 42.4%, n=156/358; for salary: 41.7%, n=115/276). For coaching programs, bridge funding for salary, and elder care services, respondents indicated significant differences in the impact between expanded or new supports versus continued existing supports. Regarding institutional supports needed to support professional recovery, responses fell into six themes: caregiving support, mental health support, financial support, work support, career development support, and employment support. Conclusion:This study provides novel insights into ECRs' perspectives on the supports offered by institutions during the COVID-19 pandemic and additional areas of need for professional recovery. Institutions must invest in relevant, effective, and accessible supports for ECRs to help them persist in scientific careers, particularly during periods of disruption and uncertainty.

Purpose: The National Institutes of Health (NIH) policy on sex as a biological variable (SABV) was implemented in 2016 to encourage researchers to consider both sexes within their study design. However, there continues to be ongoing debate regarding the utility of this initiative. This study aimed to evaluate opinions of the SABV policy among study section members and how these varied by self-reported sex. Method: An 18-question survey was sent via email in 2023 to 20,803 study section members who participated in a review session from May 15 to July 15 in 2020, 2021, 2022, or 2023. Survey questions were based on a previously published study surveying study section members from 2016 to 2017 to allow for comparison of results. Results: A total of 3,699 individuals responded to the survey (17.7%). Among respondents, 52.1% self-identified as male, and 69.8% conduct basic/translational research. Fewer respondents received resources to learn about the policy in 2020-2023 compared to 2016-2017 (n = 2,147, 58.0% versus n = 848, 73.0%, p < 0.001). More respondents in 2020-2023 felt that considering SABV would improve the rigor and reproducibility of NIH-funded research compared to 2016-2017 (n = 2,630, 71.1% versus n = 654, 56.3%, p < 0.001). However, only 2,358 (63.7%) respondents felt it was important for all NIH-funded research to consider SABV within experimental design, similar to 2016-2017 (n = 766, 66.0%, p = 0.2). Fewer male respondents compared to female respondents felt considering SABV would improve rigor and reproducibility (n = 1,325, 68.8% versus n = 1,285, 74.6%, p < 0.001), and fewer male compared to female respondents felt it was important for all NIH-funded research to consider SABV within their experimental design (n = 1171, 60.9% versus n = 1170, 67.9%, p < 0.001). Conclusions: Since the implementation of the SABV policy, diverse perspectives continue to exist among study section members. Continued efforts are required in order to understand how sex can be incorporated into research for the benefit of all people.

Rationale: Stock albuterol in schools provides access to potentially life-saving medication for individuals experiencing respiratory distress. Such programs have specific protocols to ensure guideline-based care; however, prior research suggests low compliance with stock inhaler protocols. This study examines the association between compliance and characteristics of respiratory events in Illinois’ stock inhaler program (RESCUE). Methods: The RESCUE program included delivery of albuterol metered-dose inhalers and dissemination of protocols to Illinois public schools. Per the protocol, staff were trained to administer medication in increments of four puffs (‘compliant’ doses). School nurses reported use of RESCUE-provided undesignated albuterol (‘events’) in an online platform, including information about individual receiving medication, asthma documentation, event processes, and outcomes. Analyses included Pearson's Chi-squared, Fisher's exact, and Wilcoxon rank-sum tests. Results: Among 2,171 Illinois schools registered for RESCUE in 2023-2024, a total of 656 respiratory events required students to use stock inhalers (mean(SD)=11(3.4) years). In most events, students had an asthma diagnosis on file at school (63%) and returned to class post-event (76%). On average, students were administered 2.71 puffs (SD=1.28) of albuterol. Medication was administered in compliance with the RESCUE protocol in 19% of events, while 60% were non-compliant and 21% did not report dose (Table). Of events with compliance data available (n=517), there was no significant difference in staff role administering medication for compliant versus non-compliant events (94% vs. 93% registered nurses, p=0.8). A greater proportion of compliant events occurred in schools with elementary grades versus middle/high schools (76% vs 58%, p<0.001); however, there was no difference in student age between compliant and non-compliant events (mean 10.7 vs 11.2 years, p=0.2). Compliant events had fewer students with documented asthma diagnoses versus non-compliant events (47% vs 68%, p<0.001). For outcomes, fewer students returned to class when doses were compliant versus non-compliant (64% vs 79%, p<0.001). When assessing alternate outcome (if stock inhaler unavailable), school staff reported more students would have required EMS transport in compliant versus non-compliant events (37% vs 24%, p=0.003). Conclusions: In Illinois, we observed low compliance to a school stock albuterol protocol that recommended four puffs for respiratory distress, similar to other states. This low compliance may represent varied approaches to albuterol dosing. Students with established asthma diagnoses may have used dosing from their care plan. Additionally, students receiving more puffs may have had more severe symptoms given staff-reported need for EMS. Further research is needed to optimize implementation of school stock albuterol protocols.

Evidence suggests disparities associated with race and ethnicity (R E) in assessment in graduate medical education (GME). How these disparities manifest across competencies and training time and intersect with disparities associated with other factors such as gender is unclear. Examine the association of R E and gender with clinical performance assessment in GME. Longitudinal analysis of resident clinical performance assessments. Assessment data of residents at seven internal medicine (IM) residency programs, 2014 to 2019 (9346 evaluations of 664 residents). Residents underrepresented in medicine (URiM) were identified using self-reported R E. Standardized scores were calculated for the Accreditation Council for Graduate Medical Education competencies (patient care [PC], medical knowledge [MK], practice-based learning and improvement [PBLI], systems-based practice [SBP], professionalism [PROF], and interpersonal communication and skills [ICS]). Cross-classified mixed effects regression assessed differences in standardized competency ratings with R E over time and the interaction of R E and gender while controlling for time of year and setting; resident gender, post-graduate year (PGY), and IM in-training examination percentile rank; and faculty gender, educational role, specialty, rank, and years of experience. URiM resident scores were lower than non-URIM residents across competencies (difference in standardized scores between URiM and non-URiM residents [se] PC − 0.126 [0.035], p < 0.001; MK − 0.118 [0.035], p < 0.001; PBLI − 0.122 [0.042], p = 0.004; SBP − 0.128 [0.034], p < 0.001; PROF − 0.075 [0.036], p = 0.036; ICS − 0.124 [0.039], p = 0.002). The interaction between resident R E, gender, and PGY was significant in PBLI (estimate − 0.15 [0.06], p = 0.02) and SBP (− 0.11 [0.05], p = 0.04) indicating smaller gains over time for URiM women. There were significant differences associated with R E with lower scores for URiM residents across competencies. There was a significant interaction with resident gender and R E over time in PBLI and SBP. Findings may reflect bias in faculty assessment, effects of non-inclusive learning environments, or structural inequities in assessment.

Background Limited research has explored the performance of health centers (HCs) compared to other primary care settings among children in the United States. We evaluated utilization, quality, and expenditures for pediatric Medicaid enrollees receiving care in HCs versus non-HCs. Methods This national cross-sectional study utilized 2012 Medicaid Analytic eXtract (MAX) claims to examine children 0–17 years with a primary care visit, stratified by whether majority (> 50%) of primary care visits were at HCs or non-HCs. Outcome measures include utilization (primary care visits, non-primary care outpatient visits, prescription claims, Emergency Department (ED) visits, hospitalizations) and quality (well-child visits, avoidable ED visits, avoidable hospitalizations). For children enrolled in fee-for-service Medicaid, we also measured expenditures. Propensity score-based overlap weighting was used to balance covariates. Results A total of 2,383,270 Medicaid-enrolled children received the majority of their primary care at HCs, while 18,540,743 did at non-HCs. In adjusted analyses, HC patients had 20% more primary care visits, 15% less non-primary care outpatient visits, and 21% less prescription claims than non-HC patients. ED visits were similar across the two groups, while HC patients had 7% lower chance of hospitalization than non-HC. Quality of care outcomes favored HC patients in main analyses, but results were less robust when excluding managed care beneficiaries. Total expenditures among the fee-for-service subpopulation were lower by $239 (8%) for HC patients. Conclusions In this study of nationwide claims data to evaluate healthcare utilization, quality, and spending among Medicaid-enrolled children who receive primary care at HCs versus non-HCs, findings suggest primary care delivery in HCs may be associated with a more cost-effective model of healthcare for children.

To evaluate the Advancing Community Health and Individual leadership through a noVel Educational (ACHIEVE) program uniting Chicago high school and undergraduate students (scholars) and community organizations to empower youth to meaningfully impact communities while enhancing organizational capacity. Between 2020 and 2022, the ACHIEVE program engaged cohorts of youth in classroom-based learning and community-based projects targeting health and education disparities. Pre and post-program surveys were administered to scholars to assess knowledge about disparities, skills, and self-efficacy. Semi-structured interviews were conducted with community organization leaders to examine programmatic impact. Descriptive and thematic analyses were performed. Across four cohorts (March 2020; September 2020-May 2021; September-November 2021; March-May 2022), 85 students participated in the ACHIEVE program. Scholars supported 19 community-based projects that increased awareness of local issues and resources and evaluated programs. Scholars reported advancement in their knowledge and skills as well as interest in sustaining their community engagement. Leaders shared several benefits at the organizational and community levels from collaborating with scholars. The ACHIEVE program enabled bidirectional learning between scholars and organizations. It also demonstrated that youth can contribute positively to addressing disparities while supporting local organizations and communities.

Abstract Background Community health worker (CHW) interventions have demonstrated positive impacts globally, with the COVID-19 pandemic further highlighting the potential of CHWs at the frontline to support prevention, outreach, and healthcare delivery. As the workforce expands, understanding the work and capabilities of CHWs is key to design successful interventions. This study examines the perspectives of experienced CHWs in Chicago about their current work and strategies for success. Methods As part of a community-academic partnership in Chicago, semi-structured interviews were completed with individuals who held positions aligned with CHW. Interviews were conducted between January and April 2022. Questions focused on participants’ work and factors contributing to their effectiveness to gain insights into workforce strategies for success to be applied in healthcare and community settings. De-identified transcripts were analyzed using inductive reasoning with codes organized into themes and subthemes under two domains identified a priori. The themes informed a logic model focused on the early stages to support the success of CHWs in their role. Results Fourteen individuals participated in the study. The two predetermined domains in this study were: current work of CHWs and strategies for CHWs to be successful. Five themes were identified about CHWs’ current work: providing services, building alliances with clients, establishing and maintaining collaborations, collecting data, and experiencing challenges in role. From their perspectives, all these responsibilities enhance client care and support workforce sustainability efforts. Five themes emerged about strategies for the success of CHWs: background of CHWs, champions to support work of CHWs, materials to perform work of CHWs, preparation for CHW role, and characteristics of CHWs. Participants described key traits CHWs should possess to be hired, individuals who can champion and advocate for their work, and specific materials needed to fulfill responsibilities. They reported that training and familiarity with the community were integral to developing and refining the qualities and skills necessary to be effective in their role. Conclusion CHWs play an increasingly important role in enhancing healthcare delivery and improving health outcomes. This study offers a framework for policymakers, communities, and organizations to utilize for preparing CHWs to succeed in their roles.

ObjectiveOur goal is to examine gaps in self-carry, asthma emergency protocol, and stock inhaler policy knowledge in Illinois schools.DesignA 30-item REDCap cross-sectional survey developed by a team of stakeholders was disseminated. Questions assessed policy knowledge, awareness, and practices regarding asthma emergency protocols, self-carry, and stock inhalers.SampleParticipants were Illinois school nurses belonging to a governmental organization listserv.MeasurementsAnalysis utilized Chi-square tests, descriptive statistics, and t-tests.ResultsNurses reported 36% of students on average self-carried asthma medication. Thirty percent of nurses were not aware of their emergency asthma policy and only 60% reported having an emergency asthma protocol in their school(s). Fifty-four percent of nurses were aware of stock inhaler programming. Of the 10.3% who reported a stock inhaler program, a lower frequency reported calling 911 for asthma emergencies. Perceived school asthma prevalence varied from 0%-87%.ConclusionsOur survey demonstrates large variation in knowledge and implementation of school-based asthma health policy. This is likely due to variations in health policy education dissemination. Future efforts should focus on the dissemination and implementation of school-based asthma health policies to improve their more universal adoption and better support school-based asthma management.

Background Because children spend much of their time in schools, schools can play an important role in asthma education for the one in 12 affected children in the United States. School-based asthma education programs are commonly repeated annually, however few studies have evaluated the impact of repeated participation in asthma education in school-based programs. Methods This observational study evaluated the impact of Fight Asthma Now© (FAN), a school-based asthma education program for children in Illinois schools. Participants completed a survey at the start and end of the program, including demographics, prior asthma education, and 11 asthma knowledge questions (maximum knowledge score = 11). Results Among 4,951 youth participating in the school-based asthma education program, mean age was 10.75 years. Approximately half were male and Black. Over half reported no prior asthma education (54.6%). At baseline, repeat attendees had significantly higher knowledge versus first-time attendees (mean: 7.45 versus 5.92; p < 0.001). After the program, both first-time and repeat attendees had significant knowledge improvements (first-time: mean = 5.92◊9.32; p < 0.001; repeat: mean = 7.45◊9.62; p < 0.001). Conclusions School-based asthma education is effective for increasing asthma knowledge. Notably, repeated asthma education in school leads to incremental benefits for knowledge. Future studies are needed to understand the effects of repeated asthma education on morbidity.

Introduction:While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health. Methods:This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes. Results:Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work. Discussion:This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.

Objective: Proper use of inhaled medications is essential for management of asthma, as inhaled therapies are recommended as first-line for both prevention and treatment of asthma symptoms. Optimizing adherence requires identifying and understanding multiple layers of systemic complexity to obtaining and using these therapies and offering specific solutions to address these barriers. Bronfenbrenner's socio-ecological model provides a framework for examining multilevel systems - both internal and external - that contribute to the management of childhood asthma. The four levels in this model consist of factors related to the individual, interpersonal relationships, organizational entities, and societal structures and rules. This narrative review identifies influences and factors related to asthma inhaler adherence by each level and offers evidence-based solutions to each obstacle.Data Sources: We conducted PubMed searches to identify relevant articles for barriers and solutions impacting asthma control at each level of the socio-ecological model.Study Selection: Common barriers to asthma control at each model level were identified. Pertinent studies for each barrier were identified and reviewed by the writing group for inclusion into the narrative review.Results: For each level of the socio-ecological model, three primary issues were identified based on the literature review. Approaches for addressing each issue in an evidence-based, systematic fashion are presented.Conclusion: Understanding the obstacles and potential interventions to achieve proper use of inhaled medications is a critical step necessary to develop and implement systematic solutions aimed at improving asthma control and morbidity for the more than 6 million affected children in the United States.

Background: The presence of workplace bias around child-rearing and inadequate parental leave may negatively impact childbearing decisions and sex equity in hepatology. This study aimed to understand the influence of parental leave and child-rearing on career advancement in hepatology.Methods: A cross-sectional survey of physician members of the American Association for the Study of Liver Diseases (AASLD) was distributed through email listserv in January 2021. The 33-item survey included demographic questions, questions about bias, altering training, career plans, family planning, parental leave, and work accommodations.Results: Among 199 US physician respondents, 65.3% were women, and 83.4% (n = 166) were attendings. Sex and racial differences were reported in several domains, including paid leave, perceptions of bias, and child-rearing. Most women (79.3%) took fewer than the recommended 12 paid weeks of parental leave for their first child (average paid leave 7.5 wk for women and 1.7 for men). A majority (75.2%) of women reported workplace discrimination, including 83.3% of Black and 62.5% of Hispanic women. Twenty percent of women were asked about their/their partners' pregnancy intentions or child-rearing plans during interviews for training. Women were more likely to alter career plans due to child-rearing (30.0% vs. 15.9%, p = 0.030). Women were also more likely to delay having children than men (69.5% vs.35.9%).Conclusions: Women reported sex and maternity bias in the workplace and during training interviews, which was more frequently experienced by Black and Hispanic women. As two-thirds of women had children during training, it is a particularly influential time to reevaluate programmatic support to address long-term gender disparities in career advancement.

Background: Most children with asthma have poor inhaler technique, with detrimental morbidity effects. Guidelines recommend clinicians provide inhaler education at every opportunity, yet resources are limited. A low-cost, technology-based intervention-Virtual Teach-to-Goal (V-TTG)-was developed to deliver tailored inhaler technique education with high fidelity. Objective: To evaluate whether V-TTG leads to less inhaler misuse among children with asthma who are hospitalized vs brief intervention (BI, reading steps aloud). Methods: A single-center randomized controlled trial of V-TTG vs BI was conducted with 5-to-10-year-old children with asthma hospitalized between January 2019 and February 2020. Inhaler technique was assessed pre and post-education using 12-step validated checklists (misuse: < 10 steps correct). Results: Among 70 children enrolled, mean age was 7.8 years (SD = 1.6). Most (86%) were Black. Most had an emergency department visit (94%) or hospitalization (90%) in the previous year. At baseline, nearly all children misused inhalers (96%). The proportion of children with inhaler misuse decreased significantly in V-TTG (100%->74%, P = .002) and BI (92%->69%, P = .04) groups, with no difference between groups at both time points (P = .2 and .9). On average, children performed 1.5 more steps correctly (SD = 2.0), with greater improvement with V-TTG (mean [SD] = 1.7 [1.6]) vs BI (mean [SD] = 1.4 [2.3]), though not significant (P = .6). Concerning pre and post technique, older children were significantly more likely than younger children to show more correct steps (mean change = 1.9 vs 1.1, P = .002). Conclusion: A technology-based intervention for tailored inhaler education led to improved technique among children, similarly to reading steps aloud. Older children saw greater benefits. Future studies should evaluate the V-TTG intervention across diverse populations and disease severities to identify the greatest impact.

The benefits of breastmilk and lactation are well established for both infants and women. National organizations recommend exclusively breastfeeding for the first 6 months of life and continued breastfeeding for the first 1-2 years of life. For physicians, childbearing years often coincide with key periods of training and their early career. Physician mothers have high rates of initiating breastfeeding but low success in maintaining breastfeeding. Breastfeeding discontinuation among physicians is a well-described, multifactorial issue that has persisted for decades. Reasons for discontinuation include inadequate access to pumping rooms, insufficient workplace and coworker support, and constrained schedules. Pumping is viewed as a burden to teammates and superiors, and physicians are often required to make up time spent pumping. Vague or absent policies to support breastfeeding by accreditation organizations and institutions create workplace conflict and impose additional stress on breastfeeding physicians, who devote significant time, energy, and mental reserves navigating clinical responsibilities, workplace relationships, and licensing requirements to pump. The authors propose several recommendations to improve the environment, support, and resources for breastfeeding physicians with a focus on what individuals, institutions, and professional organizations can do. Creating lactation policies that allow breastfeeding physicians equitable participation in the workplace is a matter of reproductive justice. Improving the collective awareness and support for breastfeeding trainees and physicians is a critical step in recruiting, retaining, and supporting women in medicine.

BACKGROUND:With rising time constraints, health care professionals increasingly depend on technology to provide health advice and teach patients how to manage chronic disease. The effectiveness of video-based tools in improving knowledge, health behaviors, disease severity, and health care use for patients with major chronic illnesses is not well understood. OBJECTIVE:The aim of this study was to assess the current literature regarding the efficacy of video-based educational tools for patients in improving process and outcome measures across several chronic illnesses. METHODS:A systematic review was conducted using CINAHL and PubMed with predefined search terms. The search included studies published through October 2021. The eligible studies were intervention studies of video-based self-management patient education for an adult patient population with the following chronic health conditions: asthma, chronic kidney disease, chronic obstructive pulmonary disease, chronic pain syndromes, diabetes, heart failure, HIV infection, hypertension, inflammatory bowel disease, and rheumatologic disorders. The eligible papers underwent full extraction of study characteristics, study design, sample demographics, and results. Bias was assessed with the Cochrane risk-of-bias tools. Summary statistics were synthesized in Stata SE (StataCorp LLC). Data reporting was conducted per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. RESULTS:Of the 112 studies fully extracted, 59 (52.7%) were deemed eligible for inclusion in this review. The majority of the included papers were superiority randomized controlled trials (RCTs; 39/59, 66%), with fewer pre-post studies (13/59, 22%) and noninferiority RCTs (7/59, 12%). The most represented conditions of interest were obstructive lung disease (18/59, 31%), diabetes (11/59, 19%), and heart failure (9/59, 15%). The plurality (28/59, 47%) of video-based interventions only occurred once and occurred alongside adjunct interventions that included printed materials, in-person counseling, and interactive modules. The most frequently studied outcomes were disease severity, health behavior, and patient knowledge. Video-based tools were the most effective in improving patient knowledge (30/40, 75%). Approximately half reported health behavior (21/38, 56%) and patient self-efficacy (12/23, 52%) outcomes were improved by video-based tools, and a minority of health care use (11/28, 39%) and disease severity (23/69, 33%) outcomes were improved by video-based tools. In total, 48% (22/46) of the superiority and noninferiority RCTs and 54% (7/13) of the pre-post trials had moderate or high risk of bias. CONCLUSIONS:There is robust evidence that video-based tools can improve patient knowledge across several chronic illnesses. These tools less consistently improve disease severity and health care use outcomes. Additional study is needed to identify features that maximize the efficacy of video-based interventions for patients across the spectrum of digital competencies to ensure optimized and equitable patient education and outcomes.

BackgroundCommunity health workers (CHWs) are trusted community members who provide health education and care. However, no consensus exists regarding whether community health worker-based interventions are effective within the school setting.ObjectiveTo determine outcomes and best practices of school-based community health worker interventions.Data SourcesPubMed, CINAHL, and SCOPUS databases.Study Eligibility CriteriaThis systematic literature review examined articles that described an intervention led by community health workers, targeted children and/or parents, and took place primarily within a Kindergarten-12th grade school setting. Articles were excluded if they described an intervention outside the United States.ParticipantsCommunity health workers, children, and/or their parentsInterventionsSchool-based community health worker programsResultsOf 1875 articles identified, 13 met inclusion criteria and were included in the final analysis. Of these, 5 described a statistically significant primary outcome. Seven articles provided details regarding community health worker recruitment, training, and roles that would enable reproduction of the intervention.LimitationsThis review focused on interventions in the United States. Bias of individual studies had a wide range of scores (9–21). Heterogeneity of studies also precluded a meta-analysis of primary outcomes.Conclusions and Implications of Key FindingsThe utilization of Community health workers in school-based interventions for children and/or parents is promising. This review identified a lack of detail and uniformity in program presentation, specifically with Community health worker recruitment, training, and roles. A standardized reporting mechanism for Community health worker interventions in schools would better allow for reproducibility and scalability of existing studies.