At the intersection of trust and mistrust: A qualitative analysis of motivators and barriers to research participation at a safety-net hospital.

INTRODUCTION: The underrepresentation of Black, Indigenous, and People of Color (BIPOC) individuals in healthcare research limits generalizability and contributes to healthcare inequities. Existing barriers and attitudes toward research participation must be addressed to increase the representation of safety net and other underserved populations. METHODS: We conducted semi-structured qualitative interviews with patients at an urban safety net hospital, focusing on facilitators, barriers, motivators, and preferences for research participation. We conducted direct content analysis guided by an implementation framework and used rapid analysis methods to generate final themes. RESULTS: We completed 38 interviews and identified six major themes related to preferences for engagement in research participation: (1) wide variation in research recruitment preferences; (2) logistical complexity negatively impacts willingness to participate; (3) risk contributes to hesitation toward research participation; (4) personal/community benefit, interest in study topic, and compensation serve as motivators for research participation; (5) continued participation despite reported shortcomings of informed consent process; and (6) mistrust could be overcome by relationship or credibility of information sources. CONCLUSION: Despite barriers to participation in research studies among safety-net populations, there are also facilitators that can be implemented to increase knowledge and comprehension, ease of participation, and willingness to join research studies. Study teams should vary recruitment and participation methods to ensure equal access to research opportunities. PATIENT/PUBLIC CONTRIBUTION: Our analysis methods and study progress were presented to individuals within the Boston Medical Center healthcare system. Through this process community engagement specialists, clinical experts, research directors, and others with significant experience working with safety-net populations supported data interpretation and provided recommendations for action following the dissemination of data.

"Community members have more impact on their neighbors than celebrities": leveraging community partnerships to build COVID-19 vaccine confidence.

BACKGROUND: Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS: We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS: Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION: This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.

Youth engagement to achieve health equity: Are healthcare organizations and leaders prepared?

Youth engagement in institutional decision-making is necessary to ensure policy and practice is responsive and relevant to youth and community needs. In particular, it is critical to engage the voices and experiences of youth of Color who have historically been marginalized by healthcare organizations. The present study used multiple methods to examine youth and adult perspectives on the facilitators and barriers to implementing a citywide youth advisory board of youths of Color for a safety net hospital. Data were analyzed using thematic analysis. The findings illustrate the need to employ an antiracist framework to ensure organizational and adult readiness to engage youth of Color in an advisory board. Organizational readiness included assessing organizational culture, clear expectation setting, and creating safe spaces for youth. Adult readiness included adult facilitators who are trained in antiracist and equity-focused practice and the youth-adult partnership model, and a recognition of the bidirectional benefits of youth engagement in decision-making. The implications and recommendations of this study are timely given the historical mistrust between healthcare organizations and communities of Color, as well as the racial health inequities that have been further exposed during the COVID-19 pandemic.

Resident Outcomes and Perspectives Over 2 Years of a New Scholarship Curriculum.

BACKGROUND AND OBJECTIVES: Scholarship is recognized as a challenge in many family medicine residency programs. Among evaluations of scholarship curricula, few describe resident experiences of such interventions. To bridge this gap in knowledge, we measured resident confidence, satisfaction, and participation before and after implementing a new scholarship curriculum. METHODS: The redesigned curriculum included a structured project timeline, resident research in progress meetings, faculty mentorship, scholarly skills workshops, and mentored journal clubs. We conducted a curriculum evaluation via surveys of residents prior to implementation and after years 1 and 2, measuring satisfaction with the scholarly environment and opportunities, and confidence and participation in specific scholarly activities using Likert scales from 1 (least confidence) to 5. RESULTS: Compared to baseline (n=28), after 2 years (n=27) of the curriculum, residents reported increased mean confidence in critical appraisal of scientific articles (2.6±1.1 to 3.3±0.7, P=.007), carrying out a scholarly project (2.5±0.8 to 3.4±1.0, P=.005), and writing an abstract (3.0±0.8 to 3.8±0.7, P=.002). As compared to the first year, more residents in the second year participated in quality improvement projects (7.1% vs 29.6%, P=.031) and wrote conference abstracts (10.7% vs 37.0%, P=.022). Over the same period, those very satisfied with the scholarly environment increased from 0 (0%) to 8 (29.6%, P=.017). The June 2020 survey identified increased interest in scholarship because of the antiracism movement (51.9%) and COVID-19 pandemic (40.7%). CONCLUSIONS: Implementation of a redesigned scholarship curriculum was associated with increases in family medicine resident scholarship confidence and satisfaction.