Social media-based digital health surveillance, defined as the systematic collection and interpretation of user-generated data for the timely dissemination of findings so that action can be taken, has made substantial strides with the advent of artificial intelligence and natural language processing (NLP) methods that allow researchers to produce scalable insights from unstructured data. Multi-sector community health networks increasingly rely on these platforms to advance priorities such as obesity and health equity, yet common NLP methods in this space (e.g., topic modeling and sentiment analysis) characterize content by how often a topic is posted and collapse distinct communicative framings into single themes – producing minimal actionable insight and confirming what a network already produces rather than what resonates, and leaving engagement an underexploited signal. As part of our partnership with community networks – aimed at increasing the use of evidence-based policies to address obesity and health inequities – we leveraged Facebook and developed digital health surveillance methods that connect communication framing to audience engagement, generating actionable feedback for the networks. We collected 33,979 Facebook posts from 152 pages across four anonymized U.S. networks (two midwestern, two southeastern states) between February 1, 2022 and January 31, 2023. We proposed a two-stage framework that first used large language models to classify each post into one of four communication approaches – Individual Behavior; Policy or Environmental Approaches; Other Organizational or Program Information; Irrelevant – grounded in the socioecological model and the PSE framework. We then applied engagement-based topic modeling, with "likes" normalized across a sliding temporal window per network to account for temporal fluctuations and follower-base growth. Engagement patterns and raw posting volume diverged in ways not predictable from posting alone. Three of the four networks exhibited at least one rank reversal between volume and engagement, localized to specific communication-approach categories rather than appearing uniformly. Additionally, engagement consistently aligned with each network's local audience composition rather than with topics alone. In a predominantly African American network, COVID-related and community-helping content dominated engagement; in a rural network anchored by a VA medical center, veteran support and insurance content led; and in a metropolitan academic and hospital network, health-care-policy content drew roughly 9.5× more engagement per post than annual reports despite far lower posting volume. What networks post most frequently is not necessarily what their audiences engage with most, and effective communication is fundamentally dependent on the local context of the specific community each network serves. By leveraging these findings as feedback to our community partners, this framework moves digital health surveillance beyond collecting and summarizing digital data toward translating it into timely, actionable, and translational feedback – ensuring findings reach those who have the right to know so that action can be taken.

INTRODUCTION:The engagement of youth in the design of services that promote and increase the uptake of essential services to reduce HIV and other sexually transmitted infections is vital to sustaining these preventive services. The study objective is to identify strategies for sustaining HIV prevention services among Nigerian youth, in partnership with community-based organizations, through a crowdsourced open call and designathon in Nigeria. MATERIALS AND METHODS:From February to March 2024, Nigerian youth (ages 14-24) submitted ideas to an open crowdsourcing call on how community-based organizations in Nigeria might sustain HIV self-testing and youth-friendly preventive services for at-risk youth. The submissions were scored in each domain: relevance, novelty, scalability, replicability, potential for sustainability, and promotion of equity and fairness, with an integer score of 1 (low) to 3 (high)(S1). Ten teams were selected to participate in the 72-hour designathon. Both quantitative and qualitative analysis was conducted. The study used thematic analysis and the PEN 3-Cultural Model to categorize qualitative data into six themes. Descriptive statistics were used to calculate participants' demographic characteristics. RESULTS:One hundred and seventy-eight participants submitted entries; 161 were online entries, and 17 were received via WhatsApp. The majority of participants were female (57.1%) and aged 19-23 years (55.0%), with a mean age of 21.7 (±4.1). Most participants were from the southwest of Nigeria (53.8%), had secondary education (68.9%), and were students (67.9%). About one-third of teams (31.1%) indicated collaborating with non-governmental organizations as a promising way to sustain preventive services. Six themes emerged: Adapted Intervention Design and Delivery, Youth Engagement and Education, Organization Setting, Socio-cultural and Community Context, Community Leadership Through Training and Financial Resources, and Sustainment Through Community Collaboration. CONCLUSION:The crowdsourcing contest open call and designathon engaged youth from diverse backgrounds, and it is a practical way to generate solutions from key stakeholders affected by the community's prevailing health issues. Developing service delivery strategies that engage, educate, and collaborate with youth on HIV prevention could be sustainable. However, this will not be conclusive without implementing them over time to test their feasibility and sustainability.

Sustaining evidence-based HIV prevention interventions remains a challenge, particularly among at-risk youth in Africa. The 4 Youth by Youth (4YBY) sustainment study is a hybrid type 2 cluster randomized controlled trial that evaluates the sustainability and cost-effectiveness of a crowdsourced approach to sustaining a package of evidence-based HIV prevention services. The study will be conducted across 40 community sites, supported by 18 community-based organizations (CBOs) providing HIV prevention services in Nigeria. Given their longstanding engagement with young people, CBOs serve as key partners in assessing long-term sustainability strategies for the 4YBY intervention, which has proven effective in increasing HIV prevention service uptake among youth. This protocol describes a cluster randomized controlled trial that will be conducted across 40 sites, all randomized into two arms. Half of the sites (20) will be assigned to receive the standard 4YBY intervention (4YBY-S), while the other 20 sites will receive the standard 4YBY intervention plus an enhanced sustainability strategy (4YBY-S + 4YBY-E). While the 4YBY-S group will continue implementing core intervention activities, the 4YBY-E group will receive additional sustainability-focused support. The Enhanced Sustainability Strategy in the 4YBY-E arm consists of four key components. First, “People” involves identifying and training sustainability teams within CBOs to champion intervention longevity. Second, “Learning”, where bi-weekly collaborative sessions will be established to foster knowledge-sharing and problem-solving among stakeholders. Third, “Adaptation Monitoring” will focus on continuously tracking and modifying intervention strategies to better align with local needs. Finally, “Nurturing Coaches” includes dedicated coaches who will provide technical assistance, conduct audits, and offer feedback to strengthen sustainability efforts. Evaluation will be guided by Youth Participatory Action Research (YPAR), the PEN-3 Cultural Model, Proctor’s Implementation Outcomes Framework, and the Consolidated Framework for Implementation Research (CFIR). The study hypothesizes that sites receiving the enhanced sustainability strategy (4YBY-S + 4YBY-E) will exhibit greater sustainability of core intervention components, defined as the continued delivery, adaptation, and integration of the intervention within community-based organizations—compared to sites receiving only the standard 4YBY intervention (4YBY-S). Additionally, the 4YBY-S + 4YBY-E arm is expected to achieve a higher uptake of HIV prevention services at 24 months, reflecting both the intervention’s effectiveness and its long-term viability within community settings. This protocol represents one of the first cluster randomized controlled trials evaluating intervention sustainment strategies for a youth-led, evidence-based HIV prevention program in Africa. Findings will advance implementation science by establishing a threshold for sustainable strategies and identifying the key factors that support the long-term integration and continuation of HIV prevention services for at-risk youth. The results critically impact scaling up community-led interventions and shaping policy frameworks to strengthen the global HIV response. The protocol was registered with clinicaltrials.gov under registration NCT07072481.

Introduction:Universal School Meals (USM) serve as a first line of defense for students facing hunger in marginalized communities. Despite this, school meal uptake remains low across the district due to several barriers in the inner and outer school setting. Community- and school-led interventions and strategies are an underutilized approach for enhancing USM implementation and student uptake but may yield a more sustainable impact on addressing food insecurity. The aims of this study are to 1) engage in a structured implementation mapping process with a diverse array of school and district representatives grounded in implementation science and health equity frameworks, and 2) understand the key constraints and supports of implementation mapping from the lens of policy implementers and recipients. Methods:We recruited 4 schools (2 intervention, 2 waitlist) to engage in the mapping process. Meetings covered tasks 1-4: steps 1) needs assessment, 2) identify target objectives, 3) select strategies for enhancement, and 4) prepare an implementation plan over 4-5 planning meetings in partnership with school food service, students, parents, and teachers, and administrators of each school. Transcripts were deductively coded using the Exploration, Preparation, Implementation and Sustainment (EPIS) and Getting to Equity (GTE) frameworks and inductively by the research team. Results:We engaged 19 participants across the 2 intervention schools (3 teachers, 2 food service, 2 parents, 2 administrators, 10 students). Data from the mapping meetings were primarily coded to Culture from the EPIS framework and Increase Healthy Options from the GTE framework. Code relations analysis between both frameworks highlighted factors such as school and district operations and social drivers of health among school communities impacting equitable USM implementation. Thematic coding yielded four primary themes: Infrastructure/Material Barriers, Communication, Stigma & Social Drivers, and Autonomy & Decision Making. These themes highlight the facilitators and barriers to implementation, mapping, and changing school meals on a systems level. Conclusion:Engaging school and district partners is an essential step for building lasting changes in the health of underrepresented communities. We successfully engaged a group of representatives to facilitate implementation mapping and implementation strategy development. This is one example of how community-partnered research can be leveraged to potentially facilitate change in school systems. Registration:ClinicalTrials.gov, NCT06579079, Registered on 07082024.

e13548 Background: Tobacco use is associated with 40% of all cancer diagnoses in the United States. Individuals with cancer who continue to smoke are at increased cancer-specific and all-cause mortality, treatment complications, and higher health care costs. As such, the American Society of Clinical Oncology emphasizes that the benefits of stopping cigarette use after a cancer diagnosis include longer and better quality of life, faster and more successful recovery, and lower risk of secondary cancers and infections. Different care models for tobacco cessation treatment programs exist. Here, we present a qualitative analysis from interviews from representatives of the Cancer Center Cessation Initiative (C3I) centers describing these care models. Methods: This analysis follows up on a cross-sectional study in 2023 that evaluated reach and effectiveness of tobacco treatments from 28 C3I centers. The centers were divided into four groups based on reach and effectiveness: Group A) High Reach/High Effectiveness, Group B) High Reach/Low Effectiveness, Group C) Low Reach/High Effectiveness, Group D) Low Reach/Low Effectiveness. Qualitative interviews were conducted with representatives from 16 of the 28 C3I centers to understand which tobacco cessation models were used and their associated outcomes. Interviews were recorded, transcribed, and deidentified. Strategies were organized into four Expert Recommendations for Implementing Change evidence-based implementation (ERIC) strategy categories: support clinicians, change infrastructure, engage consumers, and train stakeholders. Each transcript was coded by two unique coders. Inconsistencies among coders were calibrated. Strategies of Group A were further analyzed. Results: Tobacco care model strategies varied across the 4 groups. First, greater utilization of electronic health record (EHR) functions was associated with centers that had greater reach and effectiveness. Second, there was a tradeoff between reach and effectiveness, as related to engaging consumers through either automatic or tobacco treatment specialist (TTS) outreach. Automatic outreach had a greater reach and lower effectiveness, whereas TTS outreach had the opposite. Third, training stakeholders, including providers, and allowing data feedback was associated with centers that had increased reach. Conclusions: Results suggest that there is more than one path to success. High-performing programs may combine strategies from different ERIC categories, seeking synergy and ways to maximize impact for a population through broad reach and high effectiveness. EMR seems critical to achieving this. With the aim to increase smoking cessation treatments for cancer patients, these results can help guide cancer centers in their implementation of tobacco treatment programs in a strategy-supported, detailed manner while adapting to unique center needs.

IntroductionAdaptation is a key aspect of implementation science; interventions frequently need adaptation to better fit their delivery contexts and intended users and recipients. As digital health interventions are rapidly developed and expanded, it is important to understand how such interventions are modified. This paper details the process of engaging end-users in adapting the PREVENT digital health intervention for rural adults and systematically reporting adaptations using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). The secondary objective was to tailor FRAME for digital health interventions and to document potential implications for equity.MethodsPREVENT's adaptations were informed by two pilot feasibility trials and a planning grant which included advisory boards, direct clinic observations, and qualitative interviews with patients, caregivers, and healthcare team members. Adaptations were catalogued in an Excel tracker, including a brief description of the change. Pilot coding was conducted on a subset of adaptations to revise the FRAME codebook and generate consensus. We used a directed content analysis approach and conducted a secondary data analysis to apply the revised FRAME to all adaptations made to PREVENT (n = 20).ResultsAll but one adaptation was planned, most were reactive (versus proactive), and all adaptations preserved fidelity to PREVENT. Adaptations were made to content and features of the PREVENT tool and may have positive implications for equity that will be tested in future trials.ConclusionEngaging rural partners to adapt our digital health tool prior to implementation with rural adults was critical to meet the unique needs of rural, low-income adult patients, fit the rural clinical care settings, and increase the likelihood of generating the intended impact among this patient population. The digital health expansion of FRAME can be applied prospectively or retrospectively by researchers and practitioners to plan, understand, and characterize digital health adaptations. This can aid intervention design, scale up, and evaluation in the rapidly expanding area of digital health.

Context: This article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. Objective: The objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition. Design: A team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation. Setting: The research team conducted interviews remotely with health departments located in the West and Midwest. Participants: Participants included adults at least 18 years old and employed in 1 of 4 health departments. Main Outcome Measures: Emergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM. Results: Participants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community. Conclusions: QI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.

Background: Recent guidelines recommend maintenance and reliever therapy (MART) as the preferred inhaler regimen for patients with moderate to severe asthma. However, updated asthma action plans (AAPs), specifically tailored to MART, have not been developed for the US population. Objective: We sought to design a MART-specific AAP that is accessible, pictorial, and low-burden for clinicians to use during time-constrained clinical encounters. Methods: Together with health communication design experts, we used a multiphase, mixed-methods approach involving semistructured interviews with 7 adult patients with asthma and 6 clinicians at community health centers while exploring preferences for AAP content and design. Thematic analyses informed our design process, which used the 5E Design Thinking Framework. Our team ultimately developed 2 MART-specific AAPs and assessed their readability using a Flesch-Kincaid test. Results: Patients prioritized simple visuals, concise instructions, and clear guidance for managing worsening symptoms as key to a new MART-specific AAP. Clinicians emphasized the importance of time efficiency when completing AAPs. Using this feedback, we developed a 4” × 6” wallet-sized trifold AAP with a Flesch-Kincaid grade level of 3.7 specifically tailored for MART. Conclusions: Because guidelines endorse MART as the preferred asthma therapy, new and updated MART-specific AAPs are important to facilitate optimal asthma care. Our team codesigned 2 MART-specific AAPs based on patient and clinician feedback.

OBJECTIVES:Adolescents living with HIV (ALHIV) have low viral suppression levels, with 1 in 3 ALHIV experiencing virologic failure, calling for more efforts to reverse these trends. We developed and validated a model that predicts the risk of virologic failure (VF) among ALHIV. STUDY DESIGN:Cross-sectional study. METHODS:We used baseline data from 702 ALHIV enrolled in the Suubi + Adherence cluster-randomized clinical trial. Participants were aged 10-16 years, living with HIV and aware of their HIV status, and are living with a family. We developed a risk-prediction model for VF (viral load of ≥200 copies/mL) using sociodemographic, behavioral, psychological, economic, and treatment-related factors. LASSO logistic regression using 10-fold cross-validation with bootstrapping was used to select the predictors for the final model. Model performance was assessed by determining the discrimination using the area under the curve and calibration by drawing a calibration plot. RESULTS:Using a lambda value of 0.007, the final model had 24 predictors (and interaction terms). The predictors included the participants' age, sex, work status, stigma, depressive symptoms, adherence self-efficacy, HIV knowledge, duration with HIV, time spent on ART, communication with the caregiver, family cohesion, social support, orphanhood status, number of people in the household, HIV disclosure, years spent at the current residence, and household asset ownership. The model predicted VF with AUC of 73.8 (95 % CI: 68.3-78.0) and calibration slope of 0.985. CONCLUSIONS:We developed and validated a model to predict the risk of virologic failure among ALHIV in Uganda, demonstrating its potential utility in identifying individuals at elevated risk for VF. Future models could be refined by incorporating clinical characteristics such as CD4 count to further improve predictive accuracy.

Provision of government subsidized school meals at no charge to all students in income-eligible schools (Universal School Meals) is a critical policy approach to address food insecurity and risk for obesity in school-aged children. However, despite documented benefits, implementation challenges remain, which limit the uptake and associated impact of this provision. To ensure the longevity of this policy approach, equity-focused solutions that center the needs of those tasked with implementation and the most vulnerable Universal School Meals recipients are necessary. The aims of this study are to develop equity-focused implementation strategies and test them through a hybrid type III cluster-randomized trial to examine potential effectiveness on improving student uptake and implementation across the school system. Aim 1 will comprise the first tasks of Implementation Mapping to co-develop implementation strategies in partnership with school implementers and recipients to ensure contextual fit within their school system. Aim 2 will comprise the final step of implementation mapping with a hybrid type III implementation-effectiveness trial to examine primary implementation and effectiveness outcomes of the applied strategies. Reach and penetration will be the primary implementation outcomes in addition to acceptability, feasibility, cost, and sustainability. Health outcomes comprise family food security, student dietary behaviors, and body mass index. Baseline, 6-month, and 12-month assessments will be recorded. A convergent (Quantitative–Qualitative) mixed methods design will be employed for analysis; exploratory hierarchical multiple regression models will be run for each behavioral outcome using students as the unit of observation and schools as the unit of analysis. Survey and interview data for implementation outcomes will be analyzed deductively according to the Exploration, Preparation, Implementation, and Sustainment and Getting to Equity frameworks then inductively to generate overarching themes across the trial period. This implementation mapping process will yield equity-driven strategies, which can be successfully implemented in school settings to improve uptake of USM and reduce food insecurity and obesity-related disparities in high-risk youth. This study presents a rigorous and equity-driven implementation research agenda with the potential to advance school-based obesity prevention efforts by identifying, developing, and evaluating context-specific strategies that meet the needs of vulnerable student populations. ClinicalTrials.gov, NCT06579079, Registered on 11–5-2024.

Objective: This article focuses on supports and challenges to health equity that small local health departments (LHDs) experienced while working toward national reaccreditation or Pathways Recognition with the Public Health Accreditation Board’s Standards & Measures Version 2022 (PHAB S&M v2022). Design: The study team conducted 22 qualitative interview sessions with members of health department leadership teams. Setting: In the spring of 2024, participants from 4 small LHDs in the western and midwestern regions of the United States participated in individual remote interview sessions. Participants: Participants were members of leadership teams in LHDs with population jurisdictions less than 50 000. Main Outcome Measure(s): Common challenges relating to the health equity measures in the PHAB S&M v2022 included external influences on equity language; lack of small population data; and racially and ethnically homogeneous populations and staff. The main support was the national equity standards provided justification for pursuing equity work. Results: Strategies to overcome challenges associated with the equity measures included staff training, seeking alternative equity language, and examining socioeconomic inequities in addition to race and ethnicity. Internal workforce understanding of health equity was improved through department-wide training initiatives. When working under restrictive language requirements for state agencies, grants, and other funding sources, staff suggested using alternative phrases and keywords such as level playing field and equal access. When addressing racially and ethnically homogenous populations, staff pursued equity in terms of income and focused on those living with pre-existing conditions (ie, diabetes). Conclusions: Ensuring that LHDs can work toward health equity is crucial for reducing health inequities. While the equity focus of PHAB S&M v2022 proved challenging, for this selection of LHDs, participants affirmed that PHAB accreditation allowed them to solidify their equity work to better serve their communities.

IntroductionRural areas of the United States have lower levels of physical activity (PA) as compared to their urban and suburban counterparts, leading to higher levels of chronic diseases. The objective of the study was to increase PA in rural communities via a multilevel intervention.MethodsWe implemented a cluster randomized controlled trial of a community-based multilevel PA intervention between 2019 and 2022 in 14 rural communities. The intervention consisted of (1) text messaging (i.e., individual level), (2) encouragement of walking groups (i.e., interpersonal level), and (3) community-based marketing (i.e., community level).ResultsParticipants meeting the 2018 PA guidelines for aerobic PA increased among the intervention group, with no differences in recreational, occupational, transportation, or total PA.DiscussionIn this multilevel study the intervention is associated with meeting PA guidelines. The complexities of the impact of COVID-19 make it hard to disentangle the effects of the intervention on PA and other outcomes. Though the main tenets of the multilevel intervention had to be altered due to the pandemic, there was value in text messaging in rural areas to promote PA. Future studies should consider incorporating text messages into rural areas as a component of a PA promotion campaign.Clinical trial registrationClinicaltrials.gov, identifier NCT03683173.

Context: This paper describes experiences and views of leadership teams from 4 small local health departments (LHDs) seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. The Pathways program launched in 2022 provides additional supports for improvement of public health practice. Objective: Given the need to accelerate accreditation among small health departments, the purpose of this study is to share small health departments’ strategies for overcoming accreditation challenges and actionable advice for use by other health departments. Design: In this descriptive qualitative study, the study team conducted 22 individual interviews with 4 small LHDs from January to March 2024. Setting: Participating small health departments were located in the Midwestern and Western United States with staff sizes ranging from 3 to 47. Participants: Interview participants included small health department leadership teams, a local board of health member, and a contracted external accreditation consultant. Main Outcome Measures: We used a semi-structured interview guide to elicit participant experiences and views on accreditation processes, benefits, facilitators, strategies for overcoming challenges, and advice for other small health departments. Results: Participants suggested that accreditation benefits far outweighed the challenges. Perceived benefits included improved organizational procedures, equitable delivery of needed effective programs and services, and enhanced public perception. Key strategies to overcome staff capacity challenges were establishing a team approach and orienting and mentoring new staff in the “why” and “how” of accreditation. Advice included learning what is involved, taking the time to lay a foundation beforehand, and not waiting for a perfect time as accreditation is about improvement, not perfection. Conclusions: Small health departments can achieve and maintain PHAB accreditation by strategically implementing strategies to overcome staff capacity and other challenges. The Pathways Recognition program is a supportive option for small health departments wanting to improve public health practice.

The COVID-19 pandemic has impacted all sectors of society, with effects that have been acutely experienced at the local, national, regional, and global levels. This study examined the heterogeneous impacts of and vulnerability to COVID-19 for promoting urban sustainability and resilience. We performed a scoping review on the basis of the relevant literature from the Web of Science and PubMed, and a national survey conducted among a total of 5,376 participants in early 2020. The survey adopted a repeated cross-sectional design to study changes in residents’ risk perception of COVID-19 across the three stages (21–23 January, 27–28 February, and 24–27 March), using a snowball sampling method to recruit 2,144, 2,021, and 1,211 participants, respectively. This study revealed that the spatial, social, economic, and health impacts of COVID-19 have not been distributed evenly among populations, with specific individuals and communities more vulnerable than others. Among the determinants of these inequalities are socioeconomic status, housing arrangements, and working requirements, which influence the extent to which people can safely adhere to stay-at-home and social distancing policies and how they perceive risks. Additionally, racial/ethnic minorities face differing risks, in part because of socioeconomic factors but also because some groups experience higher shares of comorbidities. Moreover, overall, these risk factors are the healthcare systems meant to shield individuals and communities from pandemic impacts, which, however, have become increasingly taxed due to the sudden influx of patients and the resultant shortages of resources – including crucial personal protective equipment to minimize interpersonal transmission. Understanding the heterogeneous impacts of and vulnerability to COVID-19 could inform the design of environmentally sustainable and socially resilient cities, making them better equipped to encounter future epidemics. This study would help us identify more effective and equitable solutions to the ongoing challenges of the pandemic, promoting sustainability and resilience at multiple societal levels.

This paper explores how small local health departments (LHDs) motivated staff members, communicated progress toward Public Health Accreditation Board accreditation or Pathways Recognition, and celebrated interim and final accreditation accomplishments. Qualitative key informant interviews were conducted with 22 employees and affiliates of 4 LHDs with jurisdiction populations <50 000. LHDs motivated staff through ownership, creative strategies to monitor and record progress, and meaningful no- or low-cost incentives. Participants communicated accreditation progress internally and externally through in-person and electronic communication. Individuals described small rituals and large, community-wide celebrations to express collective investment in and ownership of the accreditation process. Strategies to motivate staff were top-down and bottom-up, and accreditation status updates were communicated through multiple channels. Participants viewed celebrations as valuable aspects of the accreditation process. Reaccreditation participants deemed Public Health Accreditation Board accreditation worthy of celebration and an accomplishment to share with the community.

BACKGROUND:As implementation science evolves, it is essential to expand training capacity to build intellectual capital continually. The demand for training in implementation science far outstrips the current supply. This paper presents the methods and findings from the Institute for Implementation Science Scholars (IS-2) national training program (2020-2024). METHODS:The IS-2 was a US-based, two-year training program that provided mentored training for early- and mid-career researchers interested in applying implementation science principles to reduce the burden of chronic disease disparities. Scholars attended two annual, 2.5-day intensive training sessions, received ongoing remote and in-person mentoring, and were supported by other activities (e.g., pilot funding, networking events, mock grant reviews). A quasi-experimental (pre/post) design evaluated IS-2 on skill building, mentoring, and networking. We used descriptive and inferential statistics to characterize the sample and analyzed primary outcomes and networks. RESULTS:A majority of the 59 scholars were female (86%), white (61%), and assistant professors (61%). Forty-three implementation science competencies were assessed; all skill categories increased from baseline to 10 months and from 10 to 22 months post-enrollment. The relative change was largest for advanced competencies. Scholars rated their assigned mentors as highly competent across all mentoring competencies. A vibrant mentoring network was established, with the highest number of network ties in 2023, facilitating manuscript publication and joint research. Under-represented scholars (n = 21) had similar skill gains relative to scholars not-under represented, yet were less likely to hold network ties in 2024. After accounting for other predictors, sharing a mentoring relationship within the previous two years was a strong positive predictor of forming collaboration ties between network members in 2024 (odds ratio = 9.66; 95% confidence interval = 6.34-14.74). IS-2 showed multiple impacts of practice and societal relevance (e.g., improving intervention reach, building cost data in patient decision aids). CONCLUSIONS:The approaches used in IS-2 effectively helped mentees gain skills in implementation science, experience mentorship for career development, and establish collaborative networks. The results demonstrate how the field can develop and utilize a mentoring program to reach diverse scholars, incorporate equity into curricula, and conduct high-quality mentoring to address critical implementation science topics.