Acceptability and Feasibility of a Tai Chi/Qigong Intervention for Older People Living With HIV.

Tai chi/qigong (TCQ) is a low impact, meditative movement with breathwork that may benefit people with HIV (PWH) over 50 years old. This study is a feasibility clinical trial of a remote TCQ intervention for older PWH. Participants (n = 48) were recruited via clinic sites and social media and randomized to a TCQ, sham qigong, or wait-list control group. The 12-week intervention included fourteen 45-60-minute sessions. Acceptability (satisfaction, attitudes, practice, attendance) and feasibility (retention rate, adverse events, remote delivery) data were surveyed. Overall retention rate was 72.9%, but 81.2% for the TCQ group. Most TCQ participants attended at least 10 sessions (62.5%) and were practicing TCQ after 2 weeks (72.7%). Over 92% of TCQ participants reported satisfaction and positive attitudes and preferred remote versus in person delivery (63.6%). Two mild intervention related adverse events occurred. Findings suggest that a remote TCQ intervention is acceptable, feasible, and safe among older PWH.

RESUMEN: Tai chi/qigong (TCQ) es un movimiento meditativo de bajo impacto con ejercicios de respiración que puede beneficiar personas que viven con VIH (PVV) mayores de 50 años. Este estudio es un ensayo clínico de viabilidad que evalúa una intervención de TCQ administrada remotamente para personas mayores que viven con VIH. Participaron personas (n = 48) reclutadas en clínicas y redes sociales, asignadas aleatoriamente a un grupo de TCQ, qigong falso, o control en lista de espera. La intervención duró 12 semanas con catorce sesiones de 45 a 60 minutos. Se encuestaron datos sobre aceptabilidad (satisfacción, actitudes, práctica, asistencia) y viabilidad (retención, eventos adversos, entrega remota). La tasa de retención general fue del 72,9%, pero del 81,2% para el grupo de TCQ. La mayoría de los participantes de TCQ asistieron a al menos 10 sesiones (62,5%) y continuaron practicando después de 2 semanas (72,7%). La satisfacción y las actitudes positivas hacia la intervención fueron reportadas por más del 92% de los participantes de TCQ quienes prefirieron la participación remota contra clases en persona (63,6%). Dos eventos adversos leves relacionados con la intervención ocurrieron. Los resultados sugieren que una intervención de TCQ administrada de forma remota es aceptable, viable y seguro para personas mayores que viven con VIH.

Recruitment Challenges of a Colorectal Cancer Screening Dissemination Study.

BACKGROUND: Dissemination strategies to reach underserved and minority populations to promote screening for colorectal cancer (CRC) are key to reducing disparities. We conducted a study to examine a tailored messaging approach to navigate individuals from communities (i.e., lower income, less access to care, and underscreened) to clinics to receive CRC screening. We encountered several political, demographic, and secular trend issues that required reconsideration and redesign of implementation strategies. OBJECTIVES: Through study implementation from 2012 to 2017, changes in medical reimbursement and immigration policies-at the state level and later at the national level-affected healthcare delivery systems that had initially committed to supporting the study and our recruitment methods. Although our selected zip codes and sites had previously yielded high rates of CRC screening nonadherence, within a few years, these sites showed substantially higher screening adherence rates-yielding limited numbers of eligible participants. In addition, state immigration policy trends created mistrust and fear, leading to lower participation rates than anticipated. This report documents and provides valuable insights on how we and the community network developed creative strategies to overcome these challenges. METHODS: New relationships with community partners were extended to tap advisory board input to meet the challenges. Criteria for clinic participation widened from originally selected Federally Qualified Health Centers (FQHCs) to various nonprofit, hybrid, and privately insured reimbursement types. Recruitment site options were creatively redefined to reach community participants where they live, work, and receive services. RESULTS: Strategies that engage community members in identifying alternative healthcare delivery structures and that link recruitment efforts to community-based service organizations were found to be critical to recapturing community trust in the face of unfavorable political environments. Widening the type of clinic partners from FQHCs to stand-alone nonprofits and private clinics and identifying unusual types of recruitment sites provided alternative solutions for successful study implementation. DISCUSSION: In prevention-based studies that face unplanned system and political barriers to recruitment, embedding the study in the community may aid in reestablishing trust levels to improve engagement and recruitment of clinic partners and eligible participants.

The use of digital stories as a health promotion intervention: a scoping review.

BACKGROUND: It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants' permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. METHODS: We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. RESULTS: Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). CONCLUSIONS: Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.

Feasibility of a Digital Storytelling Intervention for Hematopoietic Cell Transplant Patients.

Patients undergoing hematopoietic cell transplantation (HCT) are at risk for psychological and social impairment given the rigors and multiple sequelae of treatment. The purpose of this pilot study was to test the feasibility of a digital storytelling (DS) intervention for HCT patients, and to examine limited efficacy of the intervention relative to control arm on psychological distress and perceived social support. Adult HCT patients (n = 40, M age = 59.2 years) were enrolled immediately post-HCT and randomly assigned to either DS intervention or information control (IC). DS participants viewed four 3-min personal, emotionally rich digital stories, and IC condition participants viewed four videos containing information about post-HCT care. Feasibility regarding recruitment, enrollment efforts, and change scores from pre- to post-intervention (Δs) on depression, anxiety, and perceived social support were tracked. Fifty-four (51.4%) of 105 eligible patients consented. Forty (74%) patients completed the intervention. All but one completed the post-intervention assessments demonstrating that HCT patients can be recruited and retained for this intervention. On average, perceived social support increased for the DS group (Δ = 0.06) but decreased for the IC group (Δ = - 0.05). Anxiety and depression improved over time in both conditions. Viewing digital stories with content evoking emotional contexts similar to one's own health challenges may improve perceptions of social support among HCT patients. How DS can improve perceived social support for both short-term and longer-term sustained effects in a longitudinal study is an area ripe for additional investigation.

Pilot study of tai chi and qigong on body composition, sleep, and emotional eating in midlife/older women.

Weight gain and related adverse changes in body composition are prevalent among midlife and older women and contribute to chronic disease (e.g., type 2 diabetes, hypertension, depression). Tai Chi (TC) and Qigong (QG), forms of Meditative Movement, demonstrate improved physical/psychological symptoms and body composition. Using a standardized TC/QG protocol, we explored pre/post intervention differences in percent body fat and factors related to body composition in midlife/older women. In the context of a single-group pilot study, females ages 45-75 (N = 51) enrolled in an 8-week TC/QG intervention. Primary outcome measures of body composition, sleep quality, emotional eating and select secondary outcome psycho-emotional factors (perceived stress, mood state, mindfulness, self-compassion, body awareness) were collected. Change in percent body fat did not reach statistical significance (p = .30, M =  0.35, 95% CI [- 0.32, 1.0]). Sleep quality improved significantly, p = .04, M = - 0.88, 95% CI [-1.71, - 0.04]. Emotional eating changed in the expected direction, but not significantly, p = .08, M =  -0.16, 95% CI [-0.34, 0.02]. Significant differences were found in body awareness, p = .01, M =  0.36, 95% CI [0.08, 0.63] and perceived stress, p = .05, M =  -2.36, 95% CI [-4.76, 0.04]. Preliminary results are promising as results showed improvements in factors related to healthy body composition. Refined research is needed to understand if/how TC/QG may improve body composition among midlife and older women.

Recruitment and retention of underrepresented and vulnerable populations to research.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Heart-focused breathing and perceptions of burden in Alzheimer's caregivers: An online randomized controlled pilot study.

Informal caregivers of patients with Alzheimer's disease (AD) often experience high stress and reduced wellbeing and quality of life. HeartMath's Heart Lock-In® technique has been shown to reduce stress. In a randomized controlled pilot study among ten informal AD caregivers, we examined a two-week ten-minute daily, internet delivered heart-focused breathing protocol (n = 5) compared to waitlist control (n = 5). Participants completed pre- and post- self-assessments of perceived caregiver burden, stress, quality of life, anxiety, self-compassion and heart rate variability (HRV). Quality of life improved significantly in the control group compared to intervention, while self-compassion and HRV trended towards the expected direction. Caregiver burden and anxiety worsened in the intervention vs. waitlist control, suggesting the perception of added stress related to the required new daily task. While heart-focused breathing may hold promise for improving aspects of the caregiving experience, exploring online delivery methods and schedules that do not add extra burden is needed.

Effects of a Community-to-Clinic Navigation Intervention on Colorectal Cancer Screening Among Underserved People.

BACKGROUND: Colorectal cancer screening remains suboptimal among poor and underserved people. PURPOSE: We tested the effectiveness of a community-to-clinic navigator intervention to guide multicultural, underinsured individuals into primary care clinics to complete colorectal cancer screening. METHODS: This two-phase behavioral intervention study was conducted in Phoenix, Arizona (2012-2018). Community sites were randomized to group education or group education plus tailored navigation to increase attendance at primary care clinics (Phase I). Individuals who completed a clinic appointment received the tailored navigation in person or via phone (Phase II). RESULTS: In Phase I (N = 345), 37.9% of the intervention group scheduled a clinic appointment versus 19.4% of the comparison group. In Phase II, 26.5% of the original intervention group were screened versus only 10.4% of the original comparison group. Those in the intervention group were 3.84 times more likely to be screened than were those in the comparison group (odds ratio = 3.84; 95% confidence interval = 1.81-6.92). CONCLUSIONS: Translation of an efficacious tailored navigation intervention for colorectal cancer screening to a community-to-clinic context is associated with significantly increased rates of colorectal cancer screening. Navigation assistance to address barriers to screening may serve as the most important component of any educational program to increase individual adherence to colorectal cancer screening.

Feasibility and Acceptability of a 3-Day Group-Based Digital Storytelling Workshop among Caregivers of Allogeneic Hematopoietic Cell Transplantation Patients: A Mixed-Methods Approach.

Family caregivers are essential partners for patients undergoing hematopoietic cell transplantation (HCT). The caregiving role is emotionally, physically, and financially demanding. Intervention efforts to provide relief for caregiver stress during HCT are highly warranted. Storytelling interventions are accruing evidence for efficacy in therapeutic contexts. The purpose of this study was to conduct a 3-full consecutive day digital storytelling (DST) workshop to build knowledge on caregivers' lived experiences during HCT, to pilot test DST with a small group of HCT caregivers, and to demonstrate feasibility and acceptability using qualitative and quantitative measures. Six adult caregivers of allogeneic HCT recipients (mean age, 60.2 years) attended a 3-day DST program (66% female, 83% white). All successfully created their personal audiovisual digital story (2 to 3 minutes long) and completed a survey. All participants rated the DST workshop as highly acceptable and therapeutic (mean score 5, on a scale of 1 to 5). Group discussions and interviews with participants further demonstrated high satisfaction and acceptability of the workshop format, setting, process, and structure. The survey results showed decreases in anxiety and depression from before to after the DST workshop with all participants showing change in the expected direction. This study demonstrates the feasibility and acceptability of a 3-day DST workshop as a distress-relieving tool for HCT caregivers. Future research is needed to test the efficacy of DST relative to a control condition.

Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research.

BACKGROUND: Myeloproliferative neoplasm (MPN) patients suffer from significant symptoms, inflammation and reduced quality of life. Yoga improves these outcomes in other cancers, but this hasn't been demonstrated in MPNs. The purpose of this study was to: (1) explore the limited efficacy (does the program show promise of success) of a 12-week online yoga intervention among MPN patients on symptom burden and quality of life and (2) determine feasibility (practicality: to what extent a measure can be carried out) of remotely collecting inflammatory biomarkers. METHODS: Patients were recruited nationally and randomized to online yoga (60 min/week of yoga) or wait-list control (asked to maintain normal activity). Weekly yoga minutes were collected with Clicky (online web analytics tool) and self-report. Those in online yoga completed a blood draw at baseline and week 12 to assess inflammation (interleukin-6, tumor necrosis factor-alpha [TNF-α]). All participants completed questionnaires assessing depression, anxiety, fatigue, pain, sleep disturbance, sexual function, total symptom burden, global health, and quality of life at baseline, week seven, 12, and 16. Change from baseline at each time point was computed by group and effect sizes were calculated. Pre-post intervention change in inflammation for the yoga group was compared by t-test. RESULTS: Sixty-two MPN patients enrolled and 48 completed the intervention (online yoga = 27; control group = 21). Yoga participation averaged 40.8 min/week via Clicky and 56.1 min/week via self-report. Small/moderate effect sizes were generated from the yoga intervention for sleep disturbance (d = - 0.26 to - 0.61), pain intensity (d = - 0.34 to - 0.51), anxiety (d = - 0.27 to - 0.37), and depression (d = - 0.53 to - 0.78). A total of 92.6 and 70.4% of online yoga participants completed the blood draw at baseline and week 12, respectively, and there was a decrease in TNF-α from baseline to week 12 (- 1.3 ± 1.5 pg/ml). CONCLUSIONS: Online yoga demonstrated small effects on sleep, pain, and anxiety as well as a moderate effect on depression. Remote blood draw procedures are feasible and the effect size of the intervention on TNF-α was large. Future fully powered randomized controlled trials are needed to test for efficacy. TRIAL REGISTRATION: This trial was retrospectively registered with clinicaltrials.gov (ID: NCT03503838 ) on 4/19/2018.

Restor(y)ing Health: A Conceptual Model of the Effects of Digital Storytelling.

We currently see an interdisciplinary shift toward a "participatory turn" in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.

Body Composition Outcomes of Tai Chi and Qigong Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: Meditative movement (MM) practices are increasingly being studied, including examination of the potential for these modalities to contribute to weight management. METHODS: A search was conducted for randomized controlled trials testing one or both of two forms of MM, Tai Chi and Qigong, reporting effects on changes in body composition. Data from these studies were extracted and tabled, and a meta-analysis of studies with inactive control conditions was conducted. Risk of bias was assessed, and seven RCTs had a low risk of bias. Sources of bias include publication bias and selection of English only. RESULTS: Publications meeting inclusion criteria yielded 24 studies (N = 1621 participants). Significant improvements in body composition, primarily body mass index, were noted for 41.7% of studies. A synthesis table describes the distribution of design factors, including type of comparison condition (inactive vs. active) and baseline body composition status (whether or not overweight/obese). A meta-analysis was conducted on 12 studies with inactive controls (using a random effects model) finding a small-to-medium treatment effect (SMD = - 0.388, CI = [- 0.732, - 0.044], t = 2.48, p < 0.03) for TC or QG interventions with a high level of heterogeneity. CONCLUSIONS: Tai Chi and Qigong show demonstrable effects on body composition, when compared to inactive control conditions. Systematic evaluation and valid conclusions regarding the impact of Tai Chi and Qigong on body composition outcomes will require more targeted study designs and control of comparison conditions.

Nurse Leadership Style, Nurse Satisfaction, and Patient Satisfaction: A Systematic Review.

The purpose of this systematic review was to synthesize current evidence on nursing leadership styles, nurse satisfaction, and patient satisfaction. Results suggest that relational leadership traits contribute to greater nurse satisfaction whereas task-oriented styles may decrease nurse satisfaction. Minimal information for the connection between nursing leadership and patient satisfaction was found.

Narrative Influences on "Desire to Act in My Community" in Digital Storytelling Workshops for Latina Teens.

Digital storytelling workshops are increasingly being used to capture lived experiences and develop/disseminate health promotion messages for vulnerable and marginalized populations. Thirty female Latina teens of varied sexual/parity status produced digital stories of significant life experiences in a group context and then viewed and evaluated them using the Narrative Quality Assessment Tool. This tool was used to examine participants' experience of emotional engagement and identification with each story as well as a single-item indicator of desire to "do something in my community" related to the story. Emotional engagement was moderately strong; identification scores were neutral relative to the stories. Emotional engagement was strongly, significantly related to "desire to act in my community," while identification was not related. Emotional engagement should be considered an important factor to incorporate in the production of digital stories for purposes of developing interest in social action beyond the digital storytelling workshop.

Health and well-being benefits of spending time in forests: systematic review.

BACKGROUND: Numerous studies have reported that spending time in nature is associated with the improvement of various health outcomes and well-being. This review evaluated the physical and psychological benefits of a specific type of exposure to nature, forest therapy. METHOD: A literature search was carried out using MEDLINE, PubMed, ScienceDirect, EMBASE, and ProQuest databases and manual searches from inception up to December 2016. Key words: "Forest" or "Shinrin -Yoku" or "Forest bath" AND "Health" or "Wellbeing". The methodological quality of each randomized controlled trials (RCTs) was assessed according to the Cochrane risk of bias (ROB) tool. RESULTS: Six RCTs met the inclusion criteria. Participants' ages ranged from 20 to 79 years. Sample size ranged from 18 to 99. Populations studied varied from young healthy university students to elderly people with chronic disease. Studies reported the positive impact of forest therapy on hypertension (n = 2), cardiac and pulmonary function (n = 1), immune function (n = 2), inflammation (n = 3), oxidative stress (n = 1), stress (n = 1), stress hormone (n = 1), anxiety (n = 1), depression (n = 2), and emotional response (n = 3). The quality of all studies included in this review had a high ROB. CONCLUSION: Forest therapy may play an important role in health promotion and disease prevention. However, the lack of high-quality studies limits the strength of results, rendering the evidence insufficient to establish clinical practice guidelines for its use. More robust RCTs are warranted.

Randomized controlled trial of Qigong/Tai Chi Easy on cancer-related fatigue in breast cancer survivors.

BACKGROUND: Many breast cancer survivors experience fatigue, mood, and sleep disturbances. PURPOSE: This study aims to compare a meditative movement practice, Qigong/Tai Chi Easy (QG/TCE) with sham Qigong (SQG), testing effects of meditation/breath aspects of QG/TCE on breast cancer survivors' persistent fatigue and other symptoms. METHODS: This double-blind, randomized controlled trial tested 12 weeks of QG/TCE versus SQG on fatigue, depression, and sleep among 87 postmenopausal, fatigued breast cancer survivors, stages 0-III, age 40-75. RESULTS: Fatigue decreased significantly in the QG/TCE group compared to control at post-intervention (p = 0.005) and 3 months follow-up (p = 0.024), but not depression and sleep quality. Improvement occurred over time for both interventions in depression and sleep quality (all p < 0.05). CONCLUSIONS: QG/TCE showed significant improvement over time compared to SQG for fatigue, but not depression or sleep. Both QG/TCE and SQG showed improvement for two prevalent symptoms among breast cancer survivors, depression and sleep dysfunction.

Feasibility of implementing a meditative movement intervention with bariatric patients.

UNLABELLED: Successful interventions are needed to help improve obesity rates in the United States. Roughly two-thirds of adults in the United States are overweight, and almost one-third are obese. In 1991, the National Institutes of Health released a consensus statement endorsing bariatric surgery as the only means for sustainable weight loss for severely obese patients. However, approximately one-third of bariatric patients will experience significant post surgical weight gain. PURPOSE OF STUDY: This study is designed to determine if meditative movement (MM) would be a feasible physical activity (PA) modality to initiate weight loss in bariatric surgery patients who have re-gained weight. METHODS USED: A feasibility study was recently completed in 39 bariatric patients at Scottsdale Bariatric Center (SBC) during regularly scheduled bariatric support groups at SBC. A short demonstration of MM was presented after which a short focus group was conducted to gauge interest level, acceptability and the potential demand for MM programs in this population. Attitudes and intentions surrounding MM were also collected. FINDINGS: Approximately 75% of participants indicated they would consider practicing MM as part of their post surgical PA routine. CONCLUSIONS: MM may be a feasible PA modality in bariatric patients to improve bariatric surgery weight outcomes.

GCC women: causes and processes of midlife weight gain.

Perimenopausal obesity is a particular problem in Gulf Cooperation Council (GCC) countries. This study examined the culturally specific views of perimenopausal GCC women, and the causes and processes of midlife weight gain using a qualitative descriptive design with semistructured interviewing and content analysis. Constructs derived from the health belief model and Kleiman's explanatory model were used to identify and sort themes into conceptual categories. The findings of this study suggest that weight-management program plans targeting perimenopausal GCC women should take into consideration the multiple levels of factors and cultural influences on their behavior.

Protocol for a community-based digital storytelling pilot intervention to reduce Hispanic parents' vaccine hesitancy to immunize their children against COVID-19.

COVID-19 vaccines, currently available to children over six months old, are a powerful method of reducing the risk of COVID-19-related hospitalizations and death. However, vaccination rates among Hispanic children remain suboptimal, primarily due to parental vaccine hesitancy. Health communication researchers have suggested using culturally aligned storytelling to reduce vaccine hesitancy; however, few studies have evaluated this approach for Hispanic parents of unvaccinated children. Working with community health workers, we will engage Hispanic parents who were previously hesitant to vaccinate their child(ren) against COVID-19 but currently support vaccination. We will ask them to share their stories of conversion in COVID-19 vaccine perspectives to help other parents overcome their mistrust of COVID-19 vaccines. We will then assess the feasibility and acceptability of a web-based pilot digital storytelling intervention based on these conversion stories vs. an information-only control among 80 parents and/or legal guardians of children who are not up-to-date with COVID-19 vaccines. We will also examine pre- to post-intervention changes in vaccine perceptions, hesitancy, intentions, and uptake of children's COVID-19 vaccination at two months post-intervention. If our pilot study demonstrates feasibility and acceptability while reducing COVID-19 vaccine hesitancy and increasing vaccine uptake, we will conduct a full-scale randomized controlled trial to examine the effectiveness of the DST intervention to reduce vaccine hesitancy.