Psychometric Properties of the Altarum Consumer Engagement (ACE) Measure of Activation in Patients with Prediabetes.

BackgroundPatient activation is associated with better outcomes in chronic conditions.ObjectiveWe evaluated the psychometric properties of the 12-item Altarum Consumer Engagement™ Measure (ACE-12) in patients with prediabetes.ParticipantsACE-12 was administered to patients in the Prediabetes Informed Decisions and Education Study.Main measuresWe conducted an exploratory factor analysis followed by confirmatory factor analytic models. We evaluated item response categories using item characteristic curves. Construct validity was assessed by examining correlations of the ACE-12 scales with education, depressive symptoms, self-rated health, hemoglobin A1c, body mass index, and weight loss.Key resultsParticipants (n = 515) had a median age of 58; 56% were female; 17% Hispanic; 54% were non-White. The scree plot and Tucker and Lewis reliability coefficient (0.95) suggested three factors similar to the original scales. One item loaded on the navigation rather than the informed choice scale. Ordinal alpha coefficients for the original scales were commitment (0.75); informed choice (0.71); and navigation (0.54). ICCs indicated that one or more of the response categories for 5 of the 12 items were never most likely to be selected. Patients with lower education were less activated on the commitment (r = - 0.124, p = 0.004), choice (r = - 0.085, p = 0.009), and overall score (r = - 0.042, p = 0.011). Patients with depressive symptoms had lower commitment (r = - 0.313, p ≤ 0.001) and overall scores (r = - 0.172, p = 0.012). Patients with poorer health scored lower on the Commitment (r = - 0.308, p ≤ 0.001), Navigation (r = - 0.137, p ≤ 0.001), and overall score (r = - 0.279, p ≤ 0.001).ConclusionThe analyses provide some support for the psychometric properties of the ACE-12 in prediabetic patients. Future research evaluating this tool among patients with other chronic conditions are needed to determine whether Q1 (I spend a lot of time learning about health) should remain in the informed choice or be included in the navigation scale. Additional items may be needed to yield acceptable reliability for the navigation scale

MivacunaLA (MyshotLA): A Community-Partnered Mobile Phone Intervention to Improve COVID-19 Vaccination Behaviors among Low-Income, Spanish-Speaking, and Immigrant Latino Parents or Caregivers

We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12-17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2-11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities

Using Digital Technology to Build COVID-19 Vaccine Confidence: A Qualitative Study among Latinx Parents of Children Aged 5–11 in Under-Resourced Communities across Los Angeles County

Background: Latinx school-aged children are more than twice as likely to be infected with and die from COVID-19 as non-Latinx White children in Los Angeles. Although COVID-19 vaccination has the potential to mitigate health disparities exacerbated by the pandemic, vaccination uptake among Latinx children remains limited. MiVacunaLA (MVLA) is a mobile-phone-delivered digital intervention that improved vaccination rates in 12- to 17-year-old Latinx children and parental intention to vaccinate 2- to 11-year-old children. Since piloting MVLA, the COVID-19 vaccine became available to children aged 5–11. We sought to understand parental experiences with the MVLA intervention and their attitudes and beliefs about vaccinating their young children to improve vaccination confidence in the Latinx community. Methods: We conducted six virtual focus groups with 47 parents/caregivers of children aged 5–11 who participated in the MVLA intervention. We used standard qualitative content analysis methods and rigid and accelerated data reduction to identify and analyze major themes discussed in the sessions. Results: Each salient theme from our focus groups was mapped to one of the 5Cs constructs. The themes included the parents’ need for more contemplation about vaccinating their children than about vaccinating themselves; the parents’ need for trusted sources of vaccine information; the parents’ motivations to vaccinate their children against COVID-19; parental concern about short- and long-term effects of the vaccine in children; digital technology and videos as useful engagement tools; and age and health stratification as an approach to parental vaccination decision-making. Conclusions: The results of this study clarify the key factors that influence the decision of Latinx parents and caregivers to vaccinate their children against COVID-19. Our findings can inform efforts to increase COVID-19 vaccination rates among children in underserved Latinx communities, especially regarding the use of digital technologies for promoting vaccine confidence

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

BackgroundSignificant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach.MethodsWe conducted three in-depth virtual focus groups with 17 NA adults living in an urban community (Los Angeles County) between December 2020 and January 2021. Participants were recruited through NA community-based organizations and community stakeholders. Reflexive thematic analysis was conducted using Atlas.ti.FindingsParticipants in this study identified two overarching themes with implications for health vaccination campaigns. First, participants described a need for tailored information and outreach, including NA vaccine outreach that addresses misconceptions about vaccine development to calm fears of experimentation and support communication of vaccine evidence specific to NA people. Second, participants suggested strategies to improve public health resources in the urban NA community, such as the need for unified, proactive communication across trusted NA entities, navigation support to improve vaccine accessibility, and adequately resourcing health partnerships with and among trusted NA community agencies for improved reach.ConclusionIn this qualitative study, we found that urban NA participants reported several factors that affected their vaccine decision-making, including a lack of tailored information for their communities. Our findings also underscore the need to work with tribes, tribal leadership, and urban NA serving organizations to coordinate vaccine communication and distribution to urban communities where the majority of NAs now reside. Further, these findings have implications for COVID-19 vaccine outreach among urban NA communities and demonstrate the need for clear and tailored engagement about the COVID-19 vaccine

Exploring Perspectives on Establishing COVID-19 Vaccine Confidence in Black Communities.

ObjectiveTo explore factors influencing COVID-19 vaccine decision-making among Black adults at high-risk for COVID-19 infection. Despite effective treatment and vaccination availability, Black Americans continue to be disproportionately impacted by COVID-19.Design setting and participantsUsing community-engaged qualitative methods, we conducted virtual, semi-structured focus groups with Black residents in Los Angeles County before widespread vaccine rollout. Recruitment occurred through local community partners.Main outcome measuresThemes and subthemes on factors for vaccine confidence and accessibility.MethodsAs part of a larger study exploring COVID-19 vaccine decision-making factors among multiethnic groups, two-hour virtual focus groups were conducted between December 15, 2020 and January 27, 2021. Transcripts were analyzed using reflexive thematic analysis.ResultsThree focus groups were conducted with 17 Black participants, who were primarily female (n=15), residents of high-poverty zip codes (n=11) and employed full-time (n=6). Black-specific considerations for vaccine confidence and accessibility include: 1) reduced confidence in COVID-19 vaccines due to historical government inaction and racism (existing health inequities and disparities are rooted in racism; historical unethical research practices); 2) misunderstanding of Black communities' vaccine concerns ("vaccine hesitancy" as an inaccurate label to describe vaccine skepticism; ignorance to root causes of vaccine skepticism); and 3) recognizing and building on resources (community agency to address COVID-19 vaccine needs adequately).ConclusionsVaccination campaigns should improve understanding of underlying vaccination concerns to improve vaccine outreach effectiveness and should partner with, provide resources to, and invest in local, trusted Black community entities to improve COVID-19 vaccination disparities

Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial.

IMPORTANCE: Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences. OBJECTIVE: To test the effectiveness of a prediabetes SDM intervention. DESIGN: Cluster randomized controlled trial. SETTING: Twenty primary care clinics within a large regional health system. PARTICIPANTS: Overweight/obese adults with prediabetes (BMI ≥ 24 kg/m2 and HbA1c 5.7-6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics. INTERVENTION: Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention: DPP, DPP ± metformin, metformin only, or usual care. MAIN OUTCOMES AND MEASURES: Primary endpoint was uptake of DPP (≥ 9 sessions), metformin, or both strategies at 4 months. Secondary endpoint was weight change (lbs.) at 12 months. RESULTS: Uptake of DPP and/or metformin was higher among SDM participants (n = 351) than controls receiving usual care (n = 1028; 38% vs. 2%, p < .001). At 12-month follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (- 5.3 vs. - 0.2, p < .001). LIMITATIONS: Absence of DPP supplier participation data for matched patients in usual care clinics. CONCLUSIONS AND RELEVANCE: A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4 months and weight loss at 12 months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk. TRIAL REGISTRATION: This study was registered at clinicaltrails.gov (NCT02384109))

Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives

BackgroundMany Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up.ObjectiveTo explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups.ParticipantsSample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24).ApproachWe conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL-, enrolled in DPP and lost <3% weight; DPP-/WL-, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose.Key resultsCompared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes).ConclusionsWe found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes

“The System Doesn’t Let Us in”—A Call for Inclusive COVID-19 Vaccine Outreach Rooted in Los Angeles Latinos’ Experience of Pandemic Hardships and Inequities

Objective. Latino adults in Los Angeles have experienced disproportionate cases, deaths, and socioeconomic impacts from the COVID-19 pandemic. This qualitative study aimed to explore community perspectives on readiness for COVID-19 vaccination and to identify culturally tailored vaccine outreach strategies. Methods. We conducted virtual focus groups with Los Angeles County Latino/a residents via Zoom between December 2020 to January 2021, as the first COVID-19 vaccines were receiving Emergency Use Authorization (EUA). Focus groups were facilitated in Spanish and English by bilingual members of the research team. Discussions were analyzed via Atlas.ti software using reflexive thematic analysis. Results. Three focus groups (n = 15; four to six people each; two Spanish focus groups; one English) were conducted. Thematic findings centered on Latino COVID-19 vaccine equity: (1) Disproportionate infection risk due to essential worker status and socioeconomic burdens, misinformation, and familial or cultural tensions (2) Concerns for inequitable vaccine access due to immigration fears and limited healthcare access, and (3) A need for community-centered COVID-19 vaccine outreach and access. Conclusions. Our study on early Latino adult reactions to vaccine roll-out suggests the need for outreach strategies centering on validating community hardships, combating dis-/misinformation through trusted sources, and addressing socio-economic needs impacted by the pandemic