Grant application outcomes for biomedical researchers who participated in the National Research Mentoring Network's Grant Writing Coaching Programs.

BACKGROUND: A diverse research workforce is essential for catalyzing biomedical advancements, but this workforce goal is hindered by persistent sex and racial/ethnic disparities among investigators receiving research grants from the National Institutes of Health (NIH). In response, the NIH-funded National Research Mentoring Network implemented a Grant Writing Coaching Program (GCP) to provide diverse cohorts of early-career investigators across the United States with intensive coaching throughout the proposal development process. We evaluated the GCP's national reach and short-term impact on participants' proposal submissions and funding outcomes. METHODS: The GCP was delivered as six similar but distinct models. All models began with an in-person group session, followed by a series of coaching sessions over 4 to 12 months. Participants were surveyed at 6-, 12- and 18-months after program completion to assess proposal outcomes (submissions, awards). Self-reported data were verified and supplemented by searches of public repositories of awarded grants when available. Submission and award rates were derived from counts of participants who submitted or were awarded at least one grant proposal in a category (NIH, other federal, non-federal). RESULTS: From June 2015 through March 2019, 545 investigators (67% female, 61% under-represented racial/ethnic minority, URM) from 187 different institutions participated in the GCP. Among them, 324 (59% of participants) submitted at least one grant application and 134 (41% of submitters) received funding. A total of 164 grants were awarded, the majority being from the NIH (93, 56%). Of the 74 R01 (or similar) NIH research proposals submitted by GCP participants, 16 have been funded thus far (56% to URM, 75% to women). This 22% award rate exceeded the 2016-2018 NIH success rates for new R01s. CONCLUSION: Inter- and intra-institutional grant writing coaching groups are a feasible and effective approach to supporting the grant acquisition efforts of early-career biomedical investigators, including women and those from URM groups.

The Impact of Grantsmanship Self-Efficacy on Early Stage Investigators of The National Research Mentoring Network Steps Toward Academic Research (NRMN STAR).

The NRMN STAR program was created to address the persistent underrepresentation in grant submissions and receipt of National Institutes of Health (NIH) awards by racial/ethnic minority groups. In our current study, we assessed program impact on trainees' self-efficacy related to grant writing. The program was conducted with two cohorts: one in June 2014 and one in June 2015. We used a 19-item grant writing self-efficacy scale drawn from the 88-item Clinical Research Assessment Inventory of three domains (conceptualizing, designing, and funding a study) to predict whether self-efficacy influences researchers' grant submissions. Trainees were assessed prior to and following program completion with subsequent assessments at 6 and 12 months beyond participation. The majority of trainees were Black (62%), female (62%), and had obtained a PhD (90%). More than half (52%) were assistant professors and 57% had none or <1 year of research experience beyond postdoctoral training. However, 24% of trainees reported no postdoctoral research training. NRMN STAR trainees' self-efficacy significantly improved on all three domains exhibiting a 2.0-point mean change score on two domains (conceptualizing and design) and 3.7 point mean change score on the domain, funding a study. Findings suggest that NRMN's STAR provides impactful, confidence-building training for diverse, early stage investigators with little-to-no skills, experiences, or low self-efficacy in writing research grants.

Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study.

OBJECTIVES: The purpose of this qualitative study was to examine relationships between psychological factors, particularly perceived control, and voice symptoms in adults seeking treatment for a voice problem. METHODS: Semistructured interviews of adult patients with a clinical diagnosis of muscle tension dysphonia were conducted and transcribed. Follow-up interviews were conducted as needed for further information or clarification. A multidisciplinary team analyzed interview content using inductive techniques. Common themes and subthemes were identified. A conceptual model was developed describing the association between voice symptoms, psychological factors, precipitants of ongoing voice symptoms, and perceived control. RESULTS: Thematic saturation was reached after 23 interviews. No participants reported a direct psychological cause for their voice problem, although half described significant life events preceding voice problem onset (eg, miscarriage and other health events, interpersonal conflicts, and family members' illnesses, injuries, and deaths). Participants described psychological influences on voice symptoms that led to rapid exacerbation of their voice symptoms. Participants described the helpfulness of speech therapy and sometimes also challenges of applying techniques in daily life. They also discussed personal coping strategies that included behavioral (eg, avoiding triggers and seeking social support) and psychological (eg, mind-body awareness and emotion regulation) components. Voice-related perceived control was associated with adaptive emotional and behavioral responses, which appeared to facilitate symptom improvement. CONCLUSIONS: In this qualitative pilot study, participant narratives suggested that psychological factors and emotions influence voice symptoms, facilitating development of a preliminary conceptual model of how adaptive and maladaptive responses develop and how they influence vocal function.

Early career biomedical grantsmanship self-efficacy: validation of an abbreviated self-assessment tool.

A hallmark of success for early career biomedical researchers is the acquisition of research funding. There are marked disparities among principal investigators who submit grants and the likelihood of receiving national funding. The National Research Mentoring Network was funded by the National Institutes of Health to diversify the biomedical research workforce and included grantsmanship training for early career researchers. Self-efficacy in developing research grant applications is significantly improved over time with training and experience. We created a 19-item self-efficacy assessment inventory. Our aims were to confirm the internal consistency of a three-factor solution for grantsmanship confidence and to test the likelihood that self-efficacy influences grant proposal submission timing. We gathered data from 190 diverse biomedical trainees who completed NRMN grantsmanship training between August 2015 and June 2017. Findings revealed high internal consistency for items in each of three factors. There was a statistically significant association between self-efficacy mean scores and grant submission timing predicting that, for every one-point increase in the mean score, the odds of submitting a grant 6 months post-training increased by 69%. An abbreviated inventory of grantsmanship skills self-efficacy is a promising tool for monitoring changes over time in early career researchers and for promoting tailored grantsmanship interventions.

Process Evaluation for Improving K12 Program Effectiveness: Case Study of a National Institutes of Health Building Interdisciplinary Research Careers in Women's Health Research Career Development Program.

INTRODUCTION: Process evaluation is an important tool in quality improvement efforts. This article illustrates how a systematic and continuous evaluation process can be used to improve the quality of faculty career development programs by using the University of Minnesota's Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 program as an exemplar. METHODS: Data from a rigorous process evaluation incorporating quantitative and qualitative measurements were analyzed and reviewed by the BIRCWH program leadership on a regular basis. RESULTS: Examples are provided of how this evaluation model and processes were used to improve many aspects of the program, thereby improving scholar, mentor, and advisory committee members' satisfaction and scholar outcomes. CONCLUSIONS: A rigorous evaluation plan can increase the effectiveness and impact of a research career development plan.

Integrating Community Health Workers Into Medical Homes.

PURPOSE: Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. METHODS: We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics. RESULTS: Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient. CONCLUSIONS: We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce.

Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories.

BACKGROUND: Women veterans in the United States, particularly those with posttraumatic stress disorder (PTSD) or a history of military sexual assault, have unique health care needs, but their minority status in the US Veterans Health Administration (VHA) has led to documented healthcare disparities when compared to men. This study's objective was to obtain a richer understanding of the challenges and successes encountered by women veterans with self-reported service-related trauma histories (particularly those with a history of military sexual assault and/or posttraumatic stress symptomology) receiving VHA care. METHODS: Thirty-seven female Vietnam and post-Vietnam (1975-1998) era veterans were randomly selected from a cohort of PTSD disability benefit applicants to complete semi-structured interviews in 2011-2012. Grounded-theory informed procedures were used to identify interview themes; differences between veterans with and without a history of military sexual assault were examined through constant comparison. RESULTS: At the time of the interviews, many women believed that VHA was falling short of meeting women veterans' needs (e.g., lack of women-only mental health programming). Also common, but particularly among those with a military sexual assault history, was the perception that VHA's environment was unwelcoming; being "surrounded by men" yielded emotions ranging from discomfort and mistrust to severe anxiety. A few veterans reported recent positive changes and offered additional suggestions for improvement. CONCLUSIONS: Findings suggest that while at the time of the interviews gains had been made in the delivery of gender-sensitive outpatient medical care, women veterans with a history of military sexual assault and/or posttraumatic stress symptomology perceived that they were not receiving the same quality of care as male veterans.

"You have to go through it and have your children": reproductive experiences among women with vulvodynia.

BACKGROUND: Vulvodynia is a potentially debilitating chronic pain condition affecting the vulva (external genitalia) in women, with typical age of onset during the early-to mid-reproductive years. Yet, virtually nothing is known about the thoughts, feelings and experience of vulvodynia patients regarding conception, pregnancy and delivery; including the effect that a hallmark symptom, dyspareunia (painful sex), can have on a couple's physical and emotional ability to conceive. We sought to describe these experiences and beliefs among women with vulvodynia who were pregnant or who recently had delivered a child. METHODS: The study used in-depth, qualitative exploratory interview methods to gain a deeper understanding of these experiences for 18 women with vulvar pain who were recruited from an existing, nationally-sampled prospective pregnancy cohort study. RESULTS: Four major themes were reported by our participants. Women described their reaction to pain as volatile at first, and, over time, more self-controlled, regardless of medical treatment; once the volatility became more stable and overall severity lessened, many women began planning for pregnancy. Techniques described by women to cope with pain around pregnancy included pain minimization, planning pregnancy-safe treatment and timing intercourse around ovulation. Regardless of the degree to which interaction with health care providers before pregnancy were positive, most participants developed mistrustful attitudes toward future dealings with health care systems and providers. Nearly all women described anxiety regarding how pregnancy may change pain symptoms, yet described being hopeful. CONCLUSIONS: Women described strategies regarding reproduction such as finding a personally acceptable level of pain before planning pregnancy, and a resilience that allowed them to achieve their reproductive goals despite pain and perceived lack of assistance from healthcare providers. Therefore, future research should assess the benefits of increased psychosocial support from partners and professionals who may assist in improving resilience.

Measuring central airway obstruction. What do bronchoscopists do?

RATIONALE: All bronchoscopists will encounter, at some point, central airway obstruction (CAO) and will face the problem of documenting its severity. Axial imaging is suggested as the gold standard for assessing CAO, but anecdotal evidence indicates that many bronchoscopists use visual estimation. The prevalence and reliability of this method have not been extensively studied. OBJECTIVES: This study aimed to determine bronchoscopists' opinions about assessing CAO and to assess the variability of visual estimation. METHODS: All 438 members of the American Association of Bronchology and Interventional Pulmonology were invited to participate in an online questionnaire. In addition to reporting opinions and practice in measuring CAO, participants estimated degree of obstruction for 10 bronchoscopic photos of abnormal central airway lesions using a sliding scale from 0 to 100%. MEASUREMENTS AND MAIN RESULTS: Responses were obtained from 118 individuals with varied interventional bronchoscopy experience. Most participants reported using visual estimation of CAO (91%) and largely by numeric estimates (87%). A total of 55 participants volunteered additional methods they employed, and their comments reflected discontent with the dependability of those. When shown the same 10 bronchoscopic photos, estimates varied considerably, with very large ranges of responses for all images. Most (86%) agreed that measurement of airway narrowing should be standardized. CONCLUSIONS: Although limited by sample size and static photos of abnormal airways, this study supports the tenet that most bronchoscopists use a subjective and variable method of estimating CAO, which is anecdotally pervasive in the absence of a clinically practical alternative.

Do neighborhood attributes moderate the relationship between alcohol establishment density and crime?

Although numerous studies have found a positive association between the density of alcohol establishments and various types of crime, few have examined how neighborhood attributes (e.g., schools, parks) could moderate this association. We used data from Minneapolis, MN with neighborhood as the unit of analysis (n = 83). We examined eight types of crime (assault, rape, robbery, vandalism, nuisance crime, public alcohol consumption, driving while intoxicated, underage alcohol possession/consumption) and measured density as the total number of establishments per roadway mile. Neighborhood attributes assessed as potential moderators included non-alcohol businesses, schools, parks, religious institutions, neighborhood activism, neighborhood quality, and number of condemned houses. Using Bayesian techniques, we created a model for each crime outcome (accounting for spatial auto-correlation and controlling for relevant demographics) with an interaction term (moderator × density) to test each potential moderating effect. Few interaction terms were statistically significant. The presence of at least one college was the only neighborhood attribute that consistently moderated the density-crime association, with the presence of a college attenuating the association between the density and three types of crime (assaults, nuisance crime, and public consumption). However, caution should be used when interpreting the moderating effect of college presence because of the small number of colleges in our sample. The lack of moderating effects of neighborhood attributes, except for presence of a college, suggests that the addition of alcohol establishments to any neighborhood, regardless of its other attributes, could result in an increase in a wide range of crime.

"I connect with the ringleader:" health professionals' perspectives on promoting the sexual health of adolescent males.

In-depth interviews with nine professionals in adolescent health were used to identify perceived barriers, facilitators, and innovative strategies to reach, engage, and serve adolescent males for sexual and reproductive health care. Barriers included stigma, embarrassment, and lack of social norms around sexually transmitted infection (STI) testing for men. Facilitators included crisis situations and partner support. Clinic-based approaches to reach and engage young men included developing authentic staff-youth engagement and ensuring that access to services is easy and appealing. To be innovative, providers should become part of the real-world context of adolescent males. Technology (e.g., text messaging) and social media can be utilized to target and eliminate barriers to health care among young men.

The association between density of alcohol establishments and violent crime within urban neighborhoods.

BACKGROUND: Numerous studies have found that areas with higher alcohol establishment density are more likely to have higher violent crime rates, but many of these studies did not assess the differential effects of type of establishments or the effects on multiple categories of crime. In this study, we assess whether alcohol establishment density is associated with 4 categories of violent crime and whether the strength of the associations varies by type of violent crime and by on-premise establishments (e.g., bars, restaurants) versus off-premise establishments (e.g., liquor and convenience stores). METHODS: Data come from the city of Minneapolis, Minnesota in 2009 and were aggregated and analyzed at the neighborhood level. Across the 83 neighborhoods in Minneapolis, we examined 4 categories of violent crime: assault, rape, robbery, and total violent crime. We used a Bayesian hierarchical inference approach to model the data, accounting for spatial auto-correlation and controlling for relevant neighborhood demographics. Models were estimated for total alcohol establishment density as well as separately for on-premise establishments and off-premise establishments. RESULTS: Positive, statistically significant associations were observed for total alcohol establishment density and each of the violent crime outcomes. We estimate that a 3.9 to 4.3% increase across crime categories would result from a 20% increase in neighborhood establishment density. The associations between on-premise density and each of the individual violent crime outcomes were also all positive and significant and similar in strength as for total establishment density. The relationships between off-premise density and the crime outcomes were all positive but not significant for rape or total violent crime, and the strength of the associations was weaker than those for total and on-premise density. CONCLUSIONS: Results of this study, combined with earlier findings, provide more evidence that community leaders should be cautious about increasing the density of alcohol establishments within their neighborhoods.

Is the density of alcohol establishments related to nonviolent crime?

OBJECTIVE: We examined the associations between the density of alcohol establishments and five types of nonviolent crime across urban neighborhoods. METHOD: Data from the city of Minneapolis, MN, in 2009 were aggregated and analyzed at the neighborhood level. We examined the association between alcohol establishment density and five categories of nonviolent crime: vandalism, nuisance crime, public alcohol consumption, driving while intoxicated, and underage alcohol possession/consumption. A Bayesian approach was used for model estimation accounting for spatial auto-correlation and controlling for relevant neighborhood demographics. Models were estimated for total alcohol establishment density and then separately for off-premise establishments (e.g., liquor and convenience stores) and on-premise establishments (e.g., bars and restaurants). RESULTS: We found positive associations between density and each crime category. The association was strongest for public consumption and weakest for vandalism. We estimated that a 3.3%-10.9% increase across crime categories would result from a 20% increase in neighborhood establishment density. Similar results were seen for on- and off-premise establishments, although the strength of the associations was lower for off-premise density. CONCLUSIONS: Our results indicate that communities should consider the potential increase in nonviolent crime associated with an increase in the number of alcohol establishments within neighborhoods.

Do young adults participate in surveys that 'go green'? Response rates to a web and mailed survey of weight-related health behaviors.

There is a paucity of research regarding the contextual factors that influence health behaviors to inform the development of programs and services for youth during the transition from adolescence to young adulthood. Researchers are thus in need of efficient strategies for surveying diverse populations of young adults. This study among a population-based sample of young adults aimed to 1) examine response to a mixed-mode survey design (web and mailed surveys) and 2) identify demographic correlates of response mode. Young adults who participated in previous study waves were invited to participate in the third wave of a 10-year longitudinal study (Project EAT-III: 2008-2009) examining factors associated with weight-related behaviors. Participants were mailed invitation letters providing the web address and a unique password for completing the survey. Nonresponders were mailed three reminder invitations; the third mailing included the paper form, and all other mailings included a postage-paid card for requesting the paper form. Most completed surveys (82.1% of n=2,287) were returned by respondents within the first four months of fielding prior to the mailing which included the paper form. Nearly all of these early responders (92.6% of n=1,878) and 86.5% of the full respondent sample (n=1,979 of 2,287) completed the web form. Response to the web versus mailed paper form of the survey was associated with age >25 years, higher socioeconomic status, current employment, student status, and having no children. The combination of web and mailed survey modes is an effective strategy for conducting data collection in demographically diverse, young adult populations.

Online resources for persons recently diagnosed with HIV/AIDS: an analysis of HIV-related webpages.

The Internet is a major source of HIV-related information and resources for persons recently diagnosed with HIV/AIDS (PRDHA). This study examined the types of HIV-related websites that appear as a result of HIV-related keyword searches and the extent to which website information targets PRDHA. The first page of HIV-related webpages from 18 keyword searches was coded. Among 137 webpages meeting inclusion criteria, 63% represented HIV-informational websites, 31% targeted HIV-positive individuals, and over half contained or provided access to HIV prevention, treatment, and transmission information. Thirty-three percent of webpages contained or provided access to PRDHA-targeted information, with a greater percentage of those webpages having mobile, non-English, and "Ask the Expert" features compared with non-PRDHA targeted webpages. Implications for PRDHA include the following: (1) they should explore HIV-related websites to gain insight into the credibility of the information contained on those sites; (2) PRDHA must be aware that HIV-related websites have the potential to elicit dated, emotionally distressing, or irrelevant information; and (3) to obtain information that relates to their demographic and situational profile, they may wish to use specific key terms (e.g., "HIV women") rather than attempting to navigate webpages that arise from general search terms (e.g., "HIV"). Recommendations for future development of online resources for PRDHA include providing HIV-relevant information in a stepwise fashion, providing demographically targeted HIV information, and greater utilization of mobile technology.