PRCIS:This study identified patient-level factors as key barriers and facilitators to glaucoma medication adherence, varying by sex and neighborhood disadvantage (ADI), suggesting that targeted interventions could improve glaucoma medication adherence outcomes. PURPOSE:To identify the barriers and facilitators to glaucoma medication adherence for participants in the Support, Educate, Empower Personalized Glaucoma Coaching Program pilot study and assess any differences by demographics. MATERIALS AND METHODS:This was a mixed-methods study of participants who reported glaucoma medication adherence of ≤80.00%. Patient (age, sex, and race) and neighborhood [Area Deprivation Index (ADI)] factors were obtained, and participants completed a semistructured interview. Patient interviews were transcribed and analyzed using the modified Penchansky and Thomas framework to assess barriers and facilitators to glaucoma medication adherence, and participant numbers were computed for each theme. RESULTS:Of the 44 participants, 52% were 65 years or older, 45% were female, 45.5% were Black, and 34% lived in high-ADI neighborhoods. The most cited theme by participants for barriers and facilitators to medication adherence was patient-level factors (52% and 48%, respectively). Difficulty with the medication schedule was a leading barrier (48%), while the location of eye drops in the home (25%) was a leading facilitator. Patient-level barriers and facilitators differed by sex and ADI. CONCLUSION:Patient-level barriers and facilitators to glaucoma medication adherence were most frequently mentioned. Patient-level facilitators differed by sex and ADI; patient and neighborhood factors should be considered when assessing glaucoma medication adherence, as it may differ by these factors. In this cohort of glaucoma patients with poor medication adherence, patient-level factors served as more significant barriers compared with those related to health care in the US. Consequently, targeted interventions addressing these individual barriers could potentially improve medication adherence outcomes.

The Healthier Black Elders (HBE) program in Flint, MI established to advance health research engagement among Black older adults. Black adults are twice as likely to develop Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) than their White counterparts. The HBE Community advisory board partnered with local research and aging services stakeholders to ascertain whether Black older adults in Flint, MI identify a need for tailored AD/ADRD educational programming, access to cognitive assessments and research studies on cognitive health. Sixty (60) community-dwelling participants (Mean age 67, 68% women) were recruited from the existing participant research pool of Black of older adults ( N  = 400, age 55+) overseen by the community advisory board of HBE Flint program. Six focus groups were conducted in a local senior center and facilitated by a trained community outreach specialist and research assistant. Focus groups were audio recorded and transcribed without identifying information. Participants were provided lunch but no incentives. A semi-structured interview protocol focused on participants’ familiarity with AD/ADRD, stigma and concerns, interest in education, interest in and experience with cognitive assessments and research participation; as well as desired program components. Two study staff uninvolved with data collection conducted multi-stage qualitative coding using a grounded theory approach; identifying key themes. Key themes revealed a lack of health literacy about cognitive aging and perceptions of social stigma surrounding cognitive impairment. Participants were specifically interested in both resources for caregiving as well as how to prepare themselves for impacts to financial, health, and daily living should they be diagnosed with AD/ADRD. Participants expressed that any community-focused curriculum should address skills for voicing concerns about cognitive changes to a healthcare provider and among family members. Finally, participants were broadly interested in and open to participating in free AD/ADRD cognitive assessments that provided actionable information; many participants were familiar with aging research and enthusiastic about participating in studies vetted by HBE or other trusted community entities. Black older adults in Flint welcome knowledge, programming, and research engagement on AD/ADRD; stakeholders should work with the community to address cognitive aging needs.

The “Infrastructure for REsearch in Aging, Cancer and Health” (I-REACH) brings together a national coalition to increase the proportion of scientists conducting research at the crossroads of aging, disparities and cancer who are better prepared to improve the health of older cancer survivors. I-REACH developed an innovative and interdisciplinary eight module curriculum that integrates expertise across four academic hubs (Georgetown University, Wayne State/University of Michigan, UCLA, and University of Maryland). This expansive curriculum is designed to be hybrid in format, with pre-recorded lectures, live mentoring sessions, a resource library, and opportunities for early career scientists to present and receive feedback on their interdisciplinary work and pilot funding. In addition to a robust focus on cancer and aging biology, cognitive health, interventions, and social determinants of health, I-REACH also notably incorporates the lived experiences of older cancer survivors and caregivers throughout the curriculum. Scientists are mentored to conduct person-centered research that addresses stakeholder needs more effectively. Preliminary evaluation data demonstrates improvements in scholar research self-efficacy, collaborative partnerships, and grant development success. I-REACH offers a replicable model for training programs addressing complex health challenges requiring multidisciplinary approaches and meaningful stakeholder participation, with valuable insights for institutions developing similar initiatives.

PRÉCIS:In semistructured exit interviews, participants in a personalized glaucoma coaching program reported improved self-efficacy in managing their disease. Coaching was frequently cited as catalyst to enhancing medication adherence, emphasizing its role in team-based care. PURPOSE:To assess patients' experience with coaching to motivate improved adherence to glaucoma self-management. METHODS AND MATERIALS:Participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program completed exit interviews after participating in a 6-month coaching program. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using interpretivist grounded theory. Thematic saturation was reached after coding 30 interviews; 32 were included. Themes were identified, a codebook was generated, and 2 researchers coded the transcripts (NLC, DTD) and a third adjudicated any disagreements (EF). Main outcomes measures were defined as themes and the number of participants who expressed a theme. RESULTS:Of the 32 participants interviewed in this study, 59% (n=19) identified as male, 41% (n=13) identified as female, 50% (n=16) identified as Black, 34% (n=11) identified as White, and 6% (n=2) identified as Asian. Major themes surrounding coaching included how coaching promoted change in eye drop use, knowledge learned from the coach, feeling accountable to the coach, the coach being accessible, how coaches demonstrated empathy, how the coach collaborated to help people develop a sense of control and efficacy over glaucoma self-management, and how coaches built rapport. Additional themes were program satisfaction, fear of vision loss as a motivator to improve glaucoma self-management, and constructive feedback for the program. CONCLUSION:This qualitative assessment of the SEE personalized glaucoma coaching program demonstrated that high-quality coaching and rapport building may help patients with previously low medication adherence feel more motivated and in control of their glaucoma.

Recent discourse has identified significant issues surrounding the lack of diversity in autism-related research. However, recent efforts have called for the regular use of diversity advisory boards (DAB) in autism-related research to improve the inclusivity of underrepresented and marginalized groups included in the growing autism scholarship. This article outlines the development and implementation of a DAB to support the design and evaluation of an innovative intervention, WorkChat: A Virtual Workday. Specifically, WorkChat focuses on improving knowledge and practicing conversational skills with virtual customers, coworkers, and supervisors to support workplace interactions for autistic transition-age youth. Here, we share guidelines for developing, utilizing, and maintaining a DAB, as well as recommended practices and future implications for implementing DABs in autism services research while using the WorkChat DAB as a case study. The goal is to support the further use of DABs as a means of significantly improving the inclusion of underrepresented and marginalized identities including racial, gender, and sexual minorities, and individuals with disabilities in autism services research.Lay AbstractAutism research often does not include enough people with different identities such as different races, genders, and sexualities. Sometimes, support for autistic individuals does not help everyone equally. They often work better for white, straight autistic males. This article will talk about how we are trying to make autism research more diverse. We will share how we are using a group of diverse advisors to help with research. We will also talk about how to use these advisor groups in the future for autism research.

In celebration of the recent 50th anniversary of the founding of the NIA, the presentation will outline the history and contributions of one of the originally funded Resource Centers on Minority Aging Research and highlights key contributions from the Community Liaison and Recruitment Core of its work in Detroit and Flint, Michigan. Since its inception, this Center has offered community engaged health events, Lunch & Learns, that provide opportunity for older community members to interact with researchers, service providers, and emerging scholars, obtain health screenings from a local university’s mobile health unit and build community among peers. Through these engagement activities where health information is disseminated, trust is fostered as well. The participants are also invited to participate in research studies if interested. This steadfast approach at the program’s Lunch & Learn programs has contributed to sustained attention to best practices for the science of inclusion. This presentation offers a conceptual model of ways to move the science of inclusion forward including values that must be held to be effective and components that will foster the science of inclusion’s possibilities of sustainability. The presentation will end with a discussion of contextual challenges that may affect this conceptual model now and in the future.

Purpose The neighborhood and built environment social determinant of health domain has several social risk factors (SRFs) that are modifiable through policy efforts. We investigated the impact of neighborhood-level SRFs on presenting glaucoma severity at a tertiary eye care center. Design A cross-sectional study from August 2012 to May 2022 in the University of Michigan electronic health record (EHR). Participants Patients with a diagnosis of any open-angle glaucoma with >= 1 eye care visit at the University of Michigan Kellogg Eye Center and >= 1 reliable visual field (VF). Methods Participants who met inclusion criteria were identified by International Classification of Diseases ninth and tenth revision codes (365.x/H40.x). Data extracted from the EHR included patient demographics, address, presenting mean deviation (MD), and VF reliability. Addresses were mapped to SRF measures at the census tract, block group, and county levels. Multilevel linear regression models were used to estimate the fixed effects of each SRF on MD, after adjusting for patient-level demographic factors and a random effect for neighborhood. Interactions between each SRF measure with patient-level race and Medicaid status were tested for an additive effect on MD. Main Outcome Measures The main outcome measure was the effect of SRF on presenting MD. Results In total, 4428 patients were included in the analysis who were, on average, 70.3 years old (standard deviation = 11.9), 52.6% self-identified as female, 75.8% self-identified as White race, and 8.9% had Medicaid. The median value of presenting MD was -4.94 decibels (dB) (interquartile range = -11.45 to -2.07 dB). Neighborhood differences accounted for 4.4% of the variability in presenting MD. Neighborhood-level measures, including worse area deprivation (estimate, beta = -0.31 per 1-unit increase; P < 0.001), increased segregation (beta = -0.92 per 0.1-unit increase in Theil's H index; P < 0.001), and increased neighborhood Medicaid (beta = -0.68; P < 0.001) were associated with worse presenting MD. Significant interaction effects with race and Medicaid status were found in several neighborhood-level SRF measures. Conclusions Although patients' neighborhood SRF measures accounted for a minority of the variability in presenting MD, most neighborhood-level SRFs are modifiable and were associated with clinically meaningful differences in presenting MD. Policies that aim to reduce neighborhood inequities by addressing allocation of resources could have lasting impacts on vision outcomes.

Objectives There is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living with comorbid depression. This study aims to identify barriers and facilitators to mental healthcare utilisation among this population, guided by the theoretical domains framework (TDF).Design This qualitative study involved 30 interviews with older African American adults diagnosed with T2D. The interview questions were aligned with TDF domains to capture participant perspectives on barriers and facilitators to mental healthcare use.Setting Interviews were conducted via telephone by a licensed clinician trained in social work. Each session lasted 60–90 min and was transcribed and analysed.Participants The study included 30 African American adults (15 males and 15 females), aged 60 and above, living in an urban area in the Midwest.Primary and secondary outcomes The primary outcome was the identification of themes from participant responses, analysed using thematic content techniques and categorised into TDF constructs. Demographic data served as the secondary outcome.Results Nine key themes were identified, categorised under major TDF domains and constructs. Significant barriers included (1) systemic racism (‘knowledge’), (2) normalisation of depressive symptoms (‘beliefs about consequences’), (3) perceived stigma (‘beliefs about consequences’) and 4) costs of medications and healthcare (‘environmental context and resources’). Facilitators to seeking mental healthcare included (1) empowerment (‘beliefs about capabilities’), (2) perceived benefits of mental health exams (‘beliefs about consequences’), (3) positive provider experiences (‘reinforcement’), (4) recognition of depressive symptoms as a motivator (‘goals’) and (5) support networks (‘social influences’).Conclusion and implications Key findings highlight that fostering positive patient–provider relationships and enhancing self-recognition of depressive symptoms can significantly encourage mental healthcare utilisation among older African Americans with T2D. These findings suggest that future interventions should focus on strengthening these relationships and improving self-awareness to better mental health outcomes.

Abstract Background Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, especially those over 55 years of age. Although there is ample evidence around the efficacy of peer-led diabetes self-management and support (PLDSMS) programs in improving diabetes health outcomes, Black men living with T2D experience several barriers to meaningful participation in peer-led programs and program developers face barriers to implementation. This qualitative study aimed to identify perspectives from collaborators on barriers and facilitators that impact the implementation of a PLDSMS intervention for older Black men with T2D. Methods Qualitative data were collected as part of the Michigan Men’s Diabetes Project. We used the Tailored Implementation in Chronic Diseases (TICD) Checklist to construct the semi-structured interview guide. TICD domains served as themes. Codes were later generated as a team (N = 3) from chunks of related text. Eight 1-on-1 semi-structured interviews (two researchers, three peer leaders, one community collaborator, two certified diabetes care and education specialists) were conducted between April 13–22, 2022 via Zoom. We engaged in thematic content analysis and used the rigorous and accelerated data reduction (RADaR) technique and Rapid analysis. Results Themes included guideline factors; individual collaborator factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; and use of technology. Guidelines for implementing a PLDSMS program for Black men with T2D are lacking. For effective implementation, collaborators need interpersonal and session facilitation skills, flexibility, and cultural awareness. Although Black men with T2D may initially be apprehensive about participating in a PLDSMS program due to lack of knowledge, masculine norms, and stigma, these programs offer a safe space, a sense of brotherhood, and transparency. Having a physician champion is key in supporting organizational changes needed to implement PLDSMS programs in health systems, particularly as PLDSMS is not currently a billable service. Conclusions The PLDSMS program is culturally relevant in engaging older Black men with T2D. In addition to building trust among participants, successful development and implementation of a peer support program requires flexibility and tailored communication strategies. Findings can be used to inform future iterations of PLDSMS programs.

Background:High blood pressure (hypertension) disproportionately affects African American/Black (Black) women. Previous research suggests that self-managing hypertension may be challenging, yet mobile applications (apps) can help to empower patients and increase medication adherence. We developed questions to test the usability of evaluating the WHISE (Wellness, Hypertension, Information Sharing, Self-Management, Education) mobile app for Black women with hypertension. Methods:Fifteen participants completed usability testing; five were potential app users (Black women with hypertension); each invited two of their peers to participate. Each testing session (n=5) included a brief overview of the app, time for participants to complete surveys and have an active discussion about the app (concurrent and retrospective think-aloud, concurrent and retrospective probing, per usability.gov), and observation of participants' body language during the session. Testing sessions were designed to familiarize participants with the app's features and examine their navigating ability. Results:The app received overwhelmingly positive feedback, with 80% of participants finding it to be a valuable tool in hypertension management. Participants praised the app's user-friendliness and educational value, with one stating, 'It is a good educational piece for helping people manage hypertension, at least to understand its basics.' Another participant highlighted the potential for community support, saying, 'Having a community, having some people to be accountable, to check in with and see how things are going, could encourage and motivate people to be more diligent about managing their hypertension.' Some participants also provided constructive feedback, suggesting font size adjustments (73%) and color scheme changes (60%) for certain screens. Conclusions:Based on the feedback we received, we were able to mitigate the participants' concerns about font size and color and create tutorial videos to guide future users in using the app. We completed these changes prior to deploying the app in our randomized clinical controlled trial.

Abstract The Healthier Black Elders Center (HBEC) is the community outreach core for the Michigan Center for Urban African American Aging Research. Established in 1997, this center offers health education to older adults in Detroit and expanded to Flint, Michigan in 2021 and maintains a research registry of over 1100 older Detroiters and over 200 older Flint residents. HBEC Detroit launched a consulting program in 2020 with the Community Advisory Board (CAB) members to offer personal and professional perspectives regarding research. Through this program, CAB members have 1) disseminated knowledge about community engaged research approaches 2) offered feedback on comprehensibility and ease of use to individual researchers on instrument content and research design as well as 3) offered insights beyond the academy (technology and philanthropic sectors). This program has created opportunities for older Black adults to provide direct feedback on product, funding initiatives and research design. This presentation will provide an overview of the initiatives, recruitment, and retention strategies of a long-established center. This presentation will showcase the Consulting program as a way to engage leaders in its center’s work as well as provide learning and growth for its Detroit members. This presentation will also highlight the process of tailoring, adapting, and launching the HBEC program for the Flint community.

This article profiles a program in Detroit, MI, funded by the National Institute on Aging, called the Michigan Center for African American Aging Research and its key offshoot the Healthier Black Elders Center (HBEC). Board members of its Community Advisory Board weigh in on key programming and offer perspectives and recommendations on health and social issues. The HBEC Consulting Program is a blend of formal volunteering and paid work through consulting fees. The article also outlines next steps for HBEC.

Returning citizens struggle to obtain employment after release from prison and navigating job interviews is a critical barrier they encounter. Implementing evidence-based interview training is a major gap in prison-based vocational services. We conducted a randomized controlled trial (RCT) to evaluate the feasibility and initial effectiveness of Virtual Reality Job Interview Training (VR-JIT) within two prisons. Forty-four male returning citizens were randomized to receive service-as-usual (SAU) with VR-JIT (SAU + VR-JIT, n = 28) or SAU ( n = 16). Participants reported VR-JIT was highly acceptable and usable. SAU + VR-JIT, compared with SAU, had significant improvements (with large effect sizes) in interview skills, interview training motivation, and interview anxiety (all p < .05; [Formula: see text] > .15), and greater employment by 6-month follow-up (odds ratio [OR] = 7.4, p = .045). VR-JIT can potentially help fill a major gap in prison-based services. Future research is needed to validate VR-JIT effectiveness and evaluate VR-JIT implementation strategies within prisons.

BACKGROUND:The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women.OBJECTIVE:This substudy aimed to examine health social networks and describe the peers' characteristics, as reported by a convenience sample of Black women with hypertension.METHODS:In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network.RESULTS:Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants' health social network size (number of peers named) and their systolic blood pressure levels.DISCUSSION:The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.

Background: Glaucoma is a chronic disease that affects 3 million Americans. Glaucoma is most often asymptomatic until very late in its course when treatment is more difficult and extensive peripheral vision loss has already occurred. Taking daily medications can mitigate this vision loss, but at least half of people with glaucoma do not take their prescribed medications regularly. The purpose of this study is to improve glaucoma medication adherence among those with medically treated glaucoma and poor self-reported adherence using the Support, Educate, Empower personalized coaching program. Methods/design: This study is a two-site randomized controlled trial enrolling 230 participants with poor self-reported glaucoma medication adherence. The trial has two arms, an intervention arm and a control arm. Participants in the intervention arm receive personalized glaucoma education and motivational interviewing-based coaching over 6 months from a trained non-physician interventionist for three in-person sessions with between visit phone calls for check-ins where current adherence level is reported to participants. Participants also can elect to have visual, audio, text or automated phone call medication dose reminders. Participants in the control arm continue usual care with their physician and receive non-personalized glaucoma educational materials via mail in parallel to the three in-person coaching sessions to control for glaucoma knowledge content. All participants receive a medication adherence monitor. The primary outcome is the proportion of prescribed doses taken on schedule during the 6-month period. The secondary outcome is glaucoma related distress. The exploratory outcome is intraocular pressure. Discussion: The personalized education and motivational-interviewing-based intervention that we are testing is comprehensive in that it addresses the wide range of barriers to adherence that people with glaucoma encounter. Leveraging a custom-built web-based application to generate the personalized content and the motivational-interviewing-based prompts to guide the coaching sessions will make this program both replicable and scalable and can be integrated into clinical care utilizing trained non-physician providers. Although this type of self-management support is not currently reimbursed for glaucoma as it is for diabetes, this trial could help shape future policy change should the intervention be found effective.

Abstract Black older adults are underrepresented in health research. Community members representing diverse aging-focused organizations in Flint, Michigan desired more accessible health discoveries, and formed a Community Advisory Board (CAB) in partnership with three local universities. With a grant from the National Institute on Aging (NIH), the CAB sought to promote research engagement through free community health programming and launching a Participant Research Pool (PRP) to connect Black older adults with non-invasive IRB-approved health research at participating universities. Despite extensive recruitment efforts by this academic-community partnership, including monthly virtual health seminars, a new website, tailored print and video promotional materials, a minority aging newsletter, and a community research symposium, the PRP remains severely under-enrolled after a year. An evaluation of recruitment strategies revealed a need for more frequent in-person programming, leveraging the social and professional networks of CAB members, increased intentionality in community partnerships, and more intensive and traditional modes of advertising to reach and recruit the target population. Lessons indicate that Black older adults in the community trust this research endeavor but require tailored and consistent outreach to engage with the participant research pool.

Previous literature has indicated that Black men are twice as likely to develop type 2 diabetes compared to their non-Hispanic White counterparts and are also more likely to have associated complications. Furthermore, Black men have lower access to quality health care, and masculinity norms have been shown to hinder them from seeking the limited care that is available. In this study, we aim to investigate the effect of peer-led diabetes self-management education and long-term ongoing support on glycemic management. The first phase of our study will consist of modification of existing diabetes education content to be more appropriate for the population of interest, Then, in the second phase, we will conduct a randomized controlled trial to test the intervention. Participants randomized to the intervention arm will receive diabetes self-management education, structured diabetes self-management support, and a more flexible ongoing support period. Participants randomized to the control arm will receive diabetes self-management education. Diabetes self-management education will be taught by certified diabetes care and education specialists, while the diabetes self-management support and ongoing support period will be facilitated by fellow Black men with diabetes who will be trained in group facilitation, patient-provider communication strategies, and empowerment techniques. The third phase of this study will consist of post-intervention interviews and dissemination of findings to the academic community. The primary goal of our study is to determine whether long-term peer-led support groups in conjunction with diabetes self-management education are a promising solution to improve self-management behaviors and decrease A1C levels. We will also evaluate the retention of participants throughout the study, which has historically been an issue in clinical studies focused on the Black male population. Finally, the results from this trial will determine whether we can proceed to a fully-powered R01 trial or if other modifications of the intervention are necessary. Trial registration: Registered at ClinicalTrials.gov with an ID of NCT05370781 on May 12, 2022.