Literature Collection

Ohio is one of the hardest-hit states in the United States when it comes to opioid overdose deaths. Confronted with over 4,000 opioid overdose deaths in 2017, the Ohio Department of Mental Health and Addiction Services launched the Community Collective Impact Model for Change (CCIM4C) initiative to encourage 12 Ohio counties to think more deeply about primary prevention. By moving upstream and taking a look at the causes of the opioid crisis, the counties involved in the CCIM4C initiative were able to expand the range of potential partners and potential solutions, moving from emergency response alone to broader efforts to support social connection, economic security, and other social determinants of health. Each county brought together a wide array of partners, including local employers, community colleges, health care organizations, faith leaders, youth-serving organizations, first responders, librarians, school board members, public health officials, parks and recreation staff, and people with lived experience. This article focuses on the efforts of three counties-Ashtabula, Lorain, and Lawrence-to take on the community conditions that increase the risk of unhealthy substance use and addiction. It describes what they learned as they went beyond a sole focus on preventing opioid overdoses and deaths-as critically important as that is-to transforming their communities to support health and well-being in the first place.

BACKGROUND: Self-measured blood pressure (SMBP) monitoring is an evidence-based practice effective for improving the diagnosis and control of hypertension. Healthcare settings face challenges integrating it into clinical care. PURPOSE: This study applied behavior change theory to design a clinic-based intervention to integrate SMBP within safety net primary care settings. METHODS: We conducted multi-phase, mixed methods research to adapt a clinic-level intervention across 25 safety net primary care clinics within three California public healthcare systems as part of the Championing Hypertension Remote Monitoring for Equity and Dissemination (CHARMED) Study. From February to August 2024, clinic champions participated in surveys and focus groups to assess: (i) current practices in hypertension management, (ii) implementation barriers, and (iii) strategies for optimizing the use of SMBP within clinics. Using the Behavior Change Wheel, we designed and tailored the intervention to improve clinical practices for SMBP. RESULTS: Over 50 clinicians/staff participated. Surveys revealed varying SMBP use due to knowledge gaps, lack of standardized processes, and insufficient financial and human resources. Focus groups highlighted the importance of increasing SMBP knowledge among patients and care teams (capability); promoting structured workflows/templates for documenting and acting on SMBP data (opportunity); and building care team buy-in for SMBP (motivation). These insights guided the final intervention activities. CONCLUSIONS: Using behavior change theory and stakeholder-engaged methods, we developed a multi-component clinic-focused intervention to promote tailored SMBP implementation within safety net primary care clinics. This evidence-based, adaptable approach may inform future efforts to implement SMBP at multiple levels of care. CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT06113458.; High blood pressure (also called hypertension) is a common health problem that can lead to serious conditions like heart disease and stroke. A proven way to help manage high blood pressure is for patients to regularly check their blood pressure at home. This is called self-measured blood pressure (SMBP) monitoring. However, safety net primary care clinics that often serve low-income communities and patients with public (e.g. Medicaid and County-run programs) or no health insurance face challenges in using SMBP as part of routine care. This study aimed to create a practical approach to help clinics better use SMBP. We worked with 25 safety net primary care clinics across California and gathered input from over 50 clinic staff and providers. Through surveys and group discussions, we learned about current practices, challenges, and what support clinics need. We found that clinics often lacked training, tools, and resources for using SMBP effectively. Using behavior change theory and feedback from clinic staff, we developed a multi-part program to support SMBP use. This includes training, workflow tools, and strategies to build team support. The final approach is flexible and designed to fit the needs of busy, resource-limited clinics. It may also be useful for others trying to improve blood pressure care in similar settings.; eng

There is a high prevalence of stimulant use among HIV-infected individuals, which is associated with suboptimal antiretroviral therapy (ART) adherence, HIV treatment interruptions, detectable HIV viral load, and transmission of HIV via increased sexual risk behavior. Contingency management (CM) is an initially effective treatment for stimulant use. However, the effects of CM are not sustained after the active intervention has ended. One potential contributor to the intractability of existing treatments may be a lack of attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. As a potential approach to address the CM rebound effect - informed by our formative qualitative research with the participant population - we conducted an open pilot trial of an intervention combining CM-BA for HIV-infected individuals with stimulant use disorder. Participants completed weekly BA therapy sessions (10-16 sessions) and thrice-weekly toxicology screenings (12 weeks); contingencies were rewarded for negative toxicology tests to support reengagement into positive life activities. Major assessments were conducted at baseline, 3-, and 6-months. Toxicology screening was repeated prior to the 6-month assessment. Eleven participants with stimulant use disorder enrolled; 7 initiated treatment and completed the full intervention. The mean age was 46 (SD = 5.03) and 14% identified as a racial/ethnic minority. Of the completers, the mean change score in self-reported stimulant use within the past 30 days (within-person change; reduction in self-reported stimulant use) was 4.14 days at 3 months and 5.0 days at 6 months [Cohen's d = 0.89]. The mean change score in weekly toxicology screens (reduction in positive toxicology screens) was .71 at 3 months and 1 at 6 months [Cohen's d = 1.05]. Exit interviews indicated that the integrated intervention was well received and acceptable. This study provides preliminary evidence that a combined CM-BA intervention for this population was feasible (100% retention at 6-months), acceptable (100% of intervention sessions attended; participants rated the intervention 'acceptable' or 'very acceptable'), and may be an option to augment the potency and sustained impact of CM for this population. Future pilot testing using a randomized controlled design is warranted.

INTRODUCTION: Falls are common among older people, and medications, in particular central nervous system-active medications, increase fall risk. The Centers for Disease Control and Prevention funded a pragmatic trial to test a deprescribing intervention (STOP-FALLS) for its effect on falls, while simultaneously collecting implementation process data. This article describes prospective modifications to the STOP-FALLS intervention and offers a summary of the strategies deployed per reporting recommendations from implementation science. METHODS: In a preimplementation phase for this pragmatic trial, the multidisciplinary research team collaborated with delivery system leaders to modify the intervention for this new context, held focus groups with end users representative of the new population to optimize patient educational brochures, and pilot-tested the intervention in a single clinic. This study took place in the Kaiser Permanente Washington integrated health care delivery system, primary care settings. Preimplementation activities were systematically tracked using 2 established implementation frameworks for: 1) intervention adaptation and 2) strategy deployment. RESULTS: Twenty-seven adaptations were made to STOP-FALLS, and 13 discrete implementation strategies were deployed across the 3 preimplementation phases of the study. CONCLUSION: Adaptation tracking revealed several changes to the intervention context and content that reflected different guidelines for this trial (eg, include opioid medications) and idiosyncrasies of Kaiser Permanente Washington delivery system operations, in addition to refinements to optimize the intervention according to patient and primary care practitioner preferences. Implementation strategies were not specific to the focus of the trial and may reflect best practices for health system-embedded pragmatic effectiveness trials moving forward.

PURPOSE AND APPROACH: Women in recovery describe stigma, negative treatment, and limited support as barriers to achieving their health and parenting goals. Mobile health technologies carefully tailored to support the unique needs of recovery communities can provide less burdensome alternatives to in-person services for women transitioning out of substance use treatment. An iterative design process integrated women's interests into the structure, content, and interaction flow of a mobile health (mHealth) app. SETTING AND PARTICIPANTS: Participants included women in recovery from opioid, alcohol, and polysubstance use disorders in a comprehensive housing program in urban Arizona. METHODS: Five focus groups with 3-7 participants each (n = 27 total) informed creation of the mHealth app. Informed by theoretical models of usability and person-centered design, development involved an iterative series of focus groups in which we asked women to comment on interest in using each feature. This provided a qualitative priority framework for feature development. We then modified the app and repeated the process to gauge consensus and continually refine our prototype. RESULTS: Women were interested in access to resources, such as housing, counseling, and parenting advice in settings known to treat women in recovery with respect. They also asked for positive messages, chatting with peers, and access to expert answers. They were less interested in points-based learning modules and "scored" activities, leading us to develop a "daily challenges" concept that builds good habits, but does not feel like "classwork". Women's recommendations shaped an mHealth app tailored to maximize utility, access, and safety for this at-risk population. CONCLUSION: Integration of user-centered design with applied ethnographic techniques guided the development of a custom-tailored mHealth app responsive to lived experiences and needs of women in recovery. Future research should evaluate the potential for user-centered apps to increase self-efficacy, perceived social support, and to reduce risk of relapse.