Assessing health behavior change and comparing remote, hybrid and in-person implementation of a school-based health promotion and coaching program for adolescents from low-income communities.

To assess the impact of a school-based health intervention on adolescents' health knowledge, psychosocial assets and health behaviors, including comparisons of implementation mode: remote, hybrid or in-person. The Stanford Youth Diabetes Coaches Program, an 8-week, school-based health promotion and coaching skills program, was offered to adolescents (ages 14-18 years) from four low-income US communities. Mode of program implementation was remote, hybrid or in-person. Participants completed online pre- and postsurveys. Analysis included paired t-tests, linear regression and qualitative coding. From Fall 2020 to Fall 2021, 262 adolescents enrolled and 179 finished the program and completed pre- and postsurveys. Of the 179, 80% were female, with a mean age of 15.9 years; 22% were Asian; 8% were Black or African American; 25% were White; and 40% were Hispanic. About 115 participants were remote, 25 were hybrid and 39 were in-person. Across all participants, significant improvements (P < 0.01) were reported in health knowledge, psychosocial assets (self-esteem, self-efficacy and problem-solving) and health behaviors (physical activity, nutrition and stress reduction). After adjusting for sex and age, these improvements were roughly equivalent across the three modes of delivery. Participation was associated with significant improvements in adolescent health behaviors. Furthermore, remote mode of instruction was just as effective as in-person and hybrid modes.

Engaging Underrepresented Youth: Remote Transition of the Health Career Collaborative Program.

INTRODUCTION: Pipeline programs can help increase diversity in health care by engaging underrepresented minority groups to pursue higher education and training in medical fields. Here we describe the implementation of Health Career Collaborative, a pipeline program designed to connect high school students with health care professionals, and the transition to remote delivery of the curriculum. METHODS: This study is a retrospective, descriptive observational study where the baseline characteristics of participating students were evaluated via preparticipation surveys. This study took place in a community with an area deprivation index of 6 at a high school in southern California in conjunction with an academic medical center and level I trauma center. Due to the coronavirus disease 2019 pandemic, the program transitioned to a virtual setting in the second half of the academic year. RESULTS: A total of 37 high school student participants enrolled in the 2019-2020 Health Career Collaborative program, with over 97% identifying as Hispanic, 89% female, and 92% between the ages of 15 and 17. Ninety-five percent of students indicated plans to graduate from high school and attend college, and 89% agreed with having a mentor to help plan for their future. While high school students had exposure to several health topics prior to the program, students reported a preference to learn about health topics from doctors compared to other sources. CONCLUSIONS: An online platform helped facilitate more interaction with health care professionals and could improve feasibility of implementing pipeline programs because physical space and transportation are not required.

Remote Implementation of a School-Based Health Promotion and Health Coaching Program in Low-Income Urban and Rural Sites: Program Impact during the COVID-19 Pandemic.

BACKGROUND: Adapting existing health programs for synchronous remote implementation has the potential to support vulnerable youth during the COVID 19 pandemic and beyond. METHODS: The Stanford Youth Diabetes Coaches Program (SYDCP), a school-based health promotion and coaching skills program, was adapted for remote implementation and offered to adolescents from low-income communities in the US: an urban site in San Jose, CA and rural sites in Lawrence County, MO, and Central Valley, CA. Participants completed online pre- and post- surveys. Analysis included paired T-tests, linear regression, and qualitative coding. RESULTS: Of 156 enrolled students, 100 completed pre- and post-surveys. Of those: 84% female; 40% Hispanic; 37% White; 28% Asian; 3% African American; 30% other race. With T-tests and regression models, the following measures showed statistically significant improvements after program participation: health knowledge, patient activation, health understanding and communication, consumption of fruits and vegetables, psychosocial assets of self-esteem, self-efficacy, problem-solving, and ability to reduce stress. Technology barriers were frequently reported at Lawrence County site. 96% participants reported making a lifestyle change after program participation. CONCLUSIONS: Remote implementation of health promotion programs for vulnerable youth in diverse settings has potential to support adoption of healthy behaviors, enhance patient activation levels, and improve psychosocial assets.

How do underserved adolescents want to learn about health? An exploration of health concerns, preferences, and resources utilized.

Understanding health concerns and preferences of underserved adolescents has potential to shape health interventions. The objective of this study is to better understand these adolescents' current and preferred health resources, prior to the COVID-19 pandemic. High school students from underrepresented communities in six US cities completed a pre-pipeline program survey in which they reported level of personal concern, as well as current and preferred sources of information about 1) depression/anxiety, 2) nutrition, 3) sexual health, 4) trauma/violence, and 5) alcohol/drugs. 259 participants completed the survey (avg. age 15.7, 79% female, 58.3% Hispanic, and 36.0% Black). At least a moderate level of concern and some degree of prior knowledge (>3 on 5-point Likert scale) were reported across all health topics. Participants reported the lowest level of knowledge on the topic of trauma/violence. Students reported family (24%) and teachers (21%) as the most utilized current sources of information. Students reported doctors as the preferred source of information across all health topics. The difference between students' current source of information and preferred source of information was significant across four topics: depression/anxiety, sexual health, trauma, and alcohol/drugs (p <0.01). These results underscore the important role of physicians as educators and suggest a need for improved education on trauma/violence. These results also establish a pre-COVID-19 baseline for adolescent health concerns, current, and preference health resources. This baseline understanding may shift because of pandemic changes.

If You Can See It, You Can Be It: Perceptions of Diversity in Surgery Among Under-Represented Minority High School Students.

PURPOSE: Increasing racial and ethnic diversity in the surgical workforce is essential to improving outcomes for marginalized communities. To address the persistent shortage of under-represented minority (URM) surgeons, this study assessed the impact of providing early exposure to the field of surgery on URM high school students' perceptions of pursuing surgical careers. METHODS: The Association of Women Surgeons organized a pilot 3-hour "Day in the Life" virtual event geared toward URM high school students involving suturing/knot-tying, case conferences, and mentoring activities. RESULTS: Pre- and post-event survey results from 65 participants showed that students became more familiar with surgery (p < 0.001) and perceived the field as more diverse (p = 0.017). Over 70% felt capable of becoming surgeons themselves and over 80% were interested in learning more and gaining mentorship. CONCLUSIONS: Our programming provides a model for future initiatives aimed at strengthening the pipeline of URM surgeons.

Effect of Stanford Youth Diabetes Coaches' Program on Youth and Adults in Diverse Communities.

The Stanford Youth Diabetes Coaches' Program (SYDCP) trains high school students to become diabetes coaches for friends and adult family members. The objective of this study was to assess effects of SYDCP participation on youth and adults from a rural and urban underserved high school community. We used a mixed-methods approach. Patient-Reported Outcomes Measurement Information System (PROMIS) measures for Pediatric Sense of Meaning and Purpose were measured in high school students. PROMIS Adult Global Health and Self-Efficacy was measured in coached adults. Paired t tests compared pre- and postintervention and 6-month follow-up scores. Thematic analysis was used to analyze focus group discussion of adults. Twenty-five students participated, 15 students coached adults with diabetes or prediabetes. Students' sense of meaning and purpose significantly improved postintervention compared to preintervention. Diet and physical activity behaviors improved. Adolescent-adult relationships mediated participation benefits. Our study showed SYDCP improved adolescents' sense of meaning and purpose. In addition, youth and adult relatedness led to improved health behaviors. These findings have important implications, as a sense of purpose and youth-adult connectedness are associated with health behaviors and psychological well-being. Further larger studies of health education programs that engage related youth-adult dyads and assess long-term behaviors and health outcomes are needed.

Increasing patient activation scores of vulnerable youth by partnering medical residency programs with public high schools.

OBJECTIVE: To assess whether participation in Stanford Youth Coaches Programs (SYCP) increases patient activation scores and patient activation levels for vulnerable youth from low income communities. METHODS: From 2016 to 18, seven high schools and four residency programs in California, Alabama, Kansas and Missouri participated in SYCPs. Enrolled youth participants completed online pre and post-participation surveys including the Patient Activation Measure (PAM®10). We used paired T-tests, chi square tests, and linear multivariate models to compare pre-and post-scores and levels. RESULTS: 143 participants completed pre- and post-participation surveys. The PAM®10 mean pre-test score was 64.5 and post-test was 69.37, with mean difference 4.89 (p=.002). Participants showed significant improvement in patient activation levels after participation. 60 % participants in lowest activation Level 1; 63 % in Level 2; and 32 % in Level 3 moved to a higher level of activation after participation; 46 % who started in Level 4 moved down to Level 3 after participation. CONCLUSION AND PRACTICE IMPLICATIONS: Participation in SYCPs has potential to significantly increase patient activation for vulnerable youth which could lead to lifelong improvements in health outcomes and decrease in healthcare costs.

Health Career Academy: Addition of a Surgical Case-Based Learning Curriculum Captures the Interest of High School Students.

OBJECTIVE: The Health Career Academy (HCA) is a national program which provides a structure to introduce underserved high school students to healthcare careers. Utilizing the HCA framework, we adapted the curriculum to emphasize surgical cases and invited physicians to enrich the learning experience. DESIGN, SETTING, AND PARTICIPANTS: Medical students adapted a surgical case-based learning (CBL) curriculum at a local high school serving students from a primarily ethnic minority and low-income community (61% Black, 20% Hispanic; 58% free or reduced lunch). Each grade level received a minimum of ten, 90-minute CBL sessions. Expert faculty lecturers supplemented lessons. Medical student volunteers and 10th and 11th grade students completed postsemester surveys. RESULTS: Over four semesters, HCA held 44 sessions, with 81 students graduating from the program. A total of 66% of sessions featured at least one faculty volunteer. A total of 36 students in 10th and 11th grade and 15 medical student volunteers completed postparticipation surveys. A total of 46.2% of 11th grade students previously participated in the 10th grade curriculum. On a scale of 1 to 4, students rated HCA highly in its overview of career options (mean 3.61, [SD 0.5]) and instilling understanding of patient care (3.78 [0.42]). Students enjoyed learning about career paths (3.61 [0.50]) and health topics (3.83 [0.39]). Of 10th and 11th grade students, 100% considered a healthcare career, with 34.8% of 10th and 61.5% of 11th grade students expressing interest in pursuing a surgical specialty. After volunteering, medical students felt like better educators (4.47 [0.64]) and were more likely to pursue teaching roles (4.2 [0.86]). CONCLUSIONS: The Duke HCA chapter implemented the HCA program featuring CBL sessions emphasizing surgical cases. This program engaged minority students and potentially contributed to student interest in surgical careers. It helped to prepare medical students for future teaching roles. An interactive, surgery-focused program may increase the number of minority youth interested in pursuing health careers.

Addressing Health Disparities with School-Based Outreach: the Health Career Academy Program.

Pipeline programs address health disparities by promoting academic achievement and entry of low-income ethnic and racial minority youth into healthcare fields. The Health Career Academy (HCA) is a 3-year pipeline program for high school students from low-income, ethnic, and racial minority communities. Health professional students serve as program mentors. The HCA has been implemented in nine US sites, with partnerships between 17 health professional schools and 17 high schools. A total of 386 10th grade students and 95 11th grade students enrolled as participants in the 2015-2016 HCA program. In post-participation surveys, 10th grade students reported that the HCA helped them learn about different healthcare career options, plan for how to reach career goals, and understand how healthcare workers care for patients. Eleventh grade participants noted the program made them aware of the importance of public health and taught them about medical conditions, self-care, and safety. Eighty-six percent of 10th graders and 71% of 11th graders reported that they are considering healthcare careers. Students' favorite aspects of the HCA included the following: time with mentors, learning about science and health, team collaboration and hands-on experiences, field trips, and team presentations. Teachers noted the following as most important in the program: interaction with mentors and healthcare professionals, learning broadly applicable skills, stimulation of interest in health-related careers, presentation skills, and creating optimism about furthering education. The HCA is well received by participants and can be replicated successfully at multiple sites nationally. By providing mentorship, increasing exposure to health professionals and health careers, offering high-level science and health curriculum, and fostering collaboration and presentation skills, the HCA has potential to increase interest in health professions among racial and ethnic minority youth from low-income communities.

Supporting At-Risk Youth and Their Families to Manage and Prevent Diabetes: Developing a National Partnership of Medical Residency Programs and High Schools.

BACKGROUND: The Stanford Youth Diabetes Coaches Program (SYDCP) is a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. This study evaluates the impact of the SYDCP when disseminated to remote sites. Additionally, this study aims to assess perceived benefit of enhanced curriculum. METHODS: From 2012-2015, 10 high schools and one summer camp in the US and Canada and five residency programs were selected to participate. Physicians and other health providers implemented the SYDCP with racial/ethnic-minority students from low-income communities. Student coaches completed pre- and posttest surveys which included knowledge, health behavior, and psychosocial asset questions (i.e., worth and resilience), as well as open-ended feedback questions. T-test pre-post comparisons were used to determine differences in knowledge and psychosocial assets, and open and axial coding methods were used to analyze qualitative data. RESULTS: A total of 216 participating high school students completed both pre-and posttests, and 96 nonparticipating students also completed pre- and posttests. Student coaches improved from pre- to posttest significantly on knowledge (p<0.005 in 2012-13, 2014 camp, and 2014-15); worth (p<0.1 in 2014-15); problem solving (p<0.005 in 2014 camp and p<0.1 in 2014-15); and self-efficacy (p<0.05 in 2014 camp). Eighty-two percent of student coaches reported that they considered making a behavior change to improve their own health as a result of program participation. Qualitative feedback themes included acknowledgment of usefulness and relevance of the program, appreciation for physician instructors, knowledge gain, pride in helping family members, improved relationships and connectedness with family members, and lifestyle improvements. CONCLUSION: Overall, when disseminated, this program can increase health knowledge and some psychosocial assets of at-risk youth and holds promise to empower these youth with health literacy and encourage them to adopt healthy behaviors.

Service-Based Learning for Residents: A Success for Communities and Medical Education.

BACKGROUND AND OBJECTIVES: Community-based service-learning opportunities could support residents' acquisition of Accreditation Council for Graduate Medical Education (ACGME) competencies, but this concept has not been tested, and such programs are difficult to find. The objective of this work was to assess the value and the ACGME competency relevance of a service-learning program for residents that could be easily replicated nationally. METHODS: Forty-one family medicine residents from three training programs participated in the Stanford Youth Diabetes Coaches Program at six high schools in California and Georgia serving minority students of low socioeconomic status. Residents completed online surveys to provide qualitative feedback and assess the program's impact on their acquisition of residency program competencies and self-management support proficiencies, including prior use and planned use of action plans-a key self-management support strategy. RESULTS: Ninety-five percent of residents indicated that the program was a valuable experience that contributed to acquisition of residency program competencies, including interpersonal and communication skills and communication with teens. Compared with baseline, significantly more residents reported intention to use action plans with patients following participation. Themes from qualitative feedback included: valuing the overall experience, increasing opportunities to practice teaching, enhancing their ability to communicate with adolescents, contributing to the health of the community, recognizing the potential of action plans, and increasing intent to use action plans. CONCLUSIONS: This pilot demonstrated that a brief service-learning program can enhance standard residency curriculum by encouraging acquisition of ACGME competencies and promoting utilization of self-management support in clinical practice.

Training at-risk youth to become diabetes self-management coaches for family members: partnering family medicine residents with underserved schools.

PURPOSE: The purpose of this study is to evaluate the impact of a school-based health program in which family medicine residents trained healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. METHODS: A mixed methods study included 97 adolescents from 3 San Francisco Bay Area high schools serving primarily ethnic minority youth of low socioeconomic status. Physicians came to schools once a week for 8 weeks and trained 49 adolescents to become coaches. Student coaches and 48 nonparticipant students completed pre- and posttest intervention questionnaires, and 15 student coaches and 9 family members with diabetes gave in-depth interviews after participation. Linear regression was used to determine differences in knowledge and psychosocial assets on pre- and posttests between student coaches and nonparticipant students, and NVIVO was used to analyze interview transcripts. RESULTS: After controlling for initial score, sex, grade, and ethnicity, student coaches improved from pre- to posttest significantly compared to nonparticipants on knowledge, belonging, and worth scales. Student coaches reported high satisfaction with the program. Articulated program benefits included improvement in diet, increased physical activity, and improved relationship between student coach and family member. CONCLUSIONS: Overall, this program can increase diabetes knowledge and psychosocial assets of at-risk youth, and it holds promise to promote positive health behaviors among at-risk youth and their families.