Understanding organizational perspectives from clinical research stakeholders involved in recruitment for biopharmaceutical-sponsored clinical trials in the United States: Recommendations for organizational initiatives to improve access and inclusivity in clinical research.

Background: Equitable representation of racially and ethnically diverse subpopulations in clinical trials continues to be a problem, and trial participants do not always reflect the demographics of the population that the investigational product will be used to treat. The imperativeness of equitable representation of clinically relevant populations in clinical trials has implications for improving health outcomes, increasing knowledge about the safety and efficacy of new treatments across a wider population, and broadening access to innovative treatment options offered in clinical trials. Methods: The purpose of this study was to understand organizational elements that are involved in the active implementation of racially and ethnically diverse inclusive recruitment practices for biopharmaceutical-funded trials in the United States. Semi-structured, in-depth interviews were used in this qualitative study. The interview guide was designed to explore the perceptions, practices and experiences of 15 clinical research site professionals related to recruiting diverse trial participants. Data analysis utilized an inductive coding process. Results: Five themes were identified pertaining to the actual implementation of inclusive recruitment practices that provided explanations for organizational components: 1) provision of culturally appropriate, general disease and clinical trial education 2) organizational structure tailored for diverse recruitment 3) strong sense of mission related to improving healthcare through clinical research 4) culture of inclusion 5) inclusive recruitment practices evolving based on learning. Conclusion: The findings from this study offer insight into improving access to clinical trials by focusing on organizational change initiatives.

Understanding the Perspectives of Latino Adults Who Smoke on Physical Activity: A Qualitative Study.

Smoking and sedentary lifestyle frequently co-occur among Latinos. Evidence suggests that moderate to vigorous physical activity (MVPA) may enhance smoking cessation rates. However, this synergistic phenomenon has not been studied among Latinos, the largest minority group in the United States. This qualitative study consisted of semi-structured interviews in English or Spanish with Latino adults who smoke (n = 20) to understand their perspectives on physical activity. Participants were recruited using community-based recruitment strategies. The Health Belief Model was used as a framework for qualitative theoretical analysis. Multiple perceived benefits (e.g., mood management, strategy to quit smoking), susceptibility (e.g., risk of cardiovascular diseases, physical impairment), and barriers (e.g., lack of social support, low financial resources) of being physically active were identified. Moreover, multiple cues to action to do physical activity (e.g., being a role model, spending time with family and friends) were identified. These factors provide concrete operational strategies to address smoking cessation and physical activity among Latinos. Further research is needed on how best to integrate these perspectives into smoking cessation interventions.

Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics.

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions.

Mind Mapping to Enhance Critical Thinking Skills in Physician Assistant Education: A Randomized Controlled Study.

Physician assistant (PA) students need to assimilate and integrate voluminous information quickly and effectively to promote critical thinking skills required to deliver competent care. Mind mapping (MM) is an innovative strategy used to facilitate students' recognition and recall of essential information and to ensure depth in their understanding via making connections between pieces of information. The establishment of relationships between concepts expressed in mind maps enhances critical thinking skills. The purpose of this study was to determine the overall critical thinking skills of PA students using MM as a learning strategy and to determine if there was a significant difference in critical thinking skills between students who used MM versus standard note-taking in their learning environment. In this randomized control study, a convenience sample of 74 PA students was assigned to a standard note-taking group (SNTG) or mind-mapping group (MMG). After completing the Health Science Reasoning Test (pre-HSRT), MMG members were instructed on how to construct mind maps and then asked to create weekly mind maps for 9 weeks, while the SNTG followed their method of study without mind maps for 9 weeks. Differences in the mean pre- and post-overall HSRT scores between groups and within groups were analyzed using independent and dependent t-tests, respectively. There was no significant difference between pre- and post-overall critical thinking scores as measured by HSRT after 9 weeks of intervention in both groups. However, there was a significant difference in the mean overall post-HSRT scores between groups (p=0.026). Hence, mind mapping is a viable active learning strategy to promote critical thinking in PA students.

Association of health professional leadership behaviors on health promotion practice beliefs.

BACKGROUND: Leadership is a process by which an individual influences a group or individual to achieve a common goal, in this case health promotion for individuals with disabilities. OBJECTIVES: (1) To examine the association between the transformational leadership behaviors of the Association of University Centers on Disabilities (AUCD) network professionals and their practice beliefs about health promotion activities, specifically cardiovascular fitness and healthy weight, for people with disabilities. (2) To determine if discipline and/or years of practice moderate the association between transformational leadership behaviors and practice beliefs regarding health promotion. HYPOTHESIS: There is a positive association between transformational leadership behaviors and health professionals practice beliefs regarding health promotion activities for persons with disabilities. METHODS: A quantitative cross-sectional web-based survey design was used to determine the association between leadership behaviors and practices beliefs regarding health promotion for people with disabilities. The Multifactor Leadership Questionnaire and an adapted version of the Role of Health Promotion in Physical Therapy Survey were used to measure leadership and practice beliefs, respectively. Multiple regression analysis was applied to determine the association of leadership behaviors with health promotion practice beliefs variables. RESULTS: Transformational leadership behaviors of the AUCD network professionals were positively associated with health promotion practice beliefs about cardiovascular fitness for people with disabilities. Years post licensure and discipline did not moderate the association between transformational leadership and practice beliefs regarding health promotion. CONCLUSION: Transformational leadership may facilitate health professionals' health promotion practices for people with disabilities. Further research and training in leadership is needed.

Exercise motivation of college students in online, face-to-face, and blended basic studies physical activity and wellness course delivery formats.

OBJECTIVE: The purpose of this study was to assess exercise motivation among college students self-selected into 4 online (OL) and face-to-face (F2F) basic studies' physical activity and wellness course delivery formats. PARTICIPANTS/METHODS: Out of 1,037 enrolled students during the Spring 2009 semester, 602 responded online to demographic questions and to the Behavioural Regulation in Exercise Questionnaire, which assessed exercise motivation on 5 subscales. RESULTS: There were no significant differences (p > .05) in exercise motivation for students across course delivery formats, but there was a significant difference in age and employment status between the completely OL and F2F course formats. CONCLUSIONS: Health and physical educators can utilize these findings to better understand that physical activity and wellness students are not necessarily trying to avoid physical activity when selecting the OL course format, but are more likely trying to balance work and school responsibilities and need greater flexibility in time and location.

Recycling Mentors: an intergenerational, service-learning program to promote recycling and environmental awareness.

The purpose of Recycling Mentors was to implement an intergenerational, service-learning program focused on promoting recycling and environmental awareness among students enrolled in Community Health (HEA 301) and Current Issues in Gerontology (GRN 440/540) and adults older than 60 years. Recycling Mentors was conducted in New Hanover County (NHC), North Carolina, where a moderate climate and coastal location attracts many tourists, retirees, and college students. A community like NHC is a good place to implement service-learning that educates both students and older adults about the benefits of recycling to individual health and the environment. During the Fall 2009 semester, undergraduate and graduate students completed institutional review board training and then conducted the program with older adults. The education component of Recycling Mentors included a pre/post survey, brochure, and scheduled visits. Overall, Recycling Mentors was positive service-learning experience with students identifying salient outcomes such as learning about recycling and the environment and working with older adults. In addition, teaching the education component of Recycling Mentors was good practice for students who will be the future health professionals. While service-learning and environmentally themed projects are common, a program that combines the 2 like Recycling Mentors is unique and has the potential to motivate individual change while positively impacting the local community and the environment.

Construct validity and reliability of college students' responses to the reasons for smoking scale.

When utilizing self-assessments to determine motives for health behaviors, it is essential that the resulting data demonstrate sound psychometric properties. The purpose of this research was to assess the reliability and construct validity of college students' responses to the Reasons for Smoking Scale (RFS). Confirmatory factor analyses and internal consistency reliability coefficients were completed. The data of 110 college students who smoke fell short of providing a good fit, chi2(130) = 343.856, root mean square error of approximation (RMSEA) = 0.123, comparative fit index (CFI) = 0.793, Tucker-Lewis index (TLI) = 0.756. Reliability coefficients ranged from .615 to .912. Three subscales improved reliability by removing an item. Although the fit indices showed improvement with these modifications, good model fit was still not achieved, chi2(50) = 148.059, RMSEA = 0.134, CFI = 0.872, TLI = 0.831. Although other populations' responses to the RFS have demonstrated validity and reliability, this college population's did not. Health educators should use caution when interpreting the results of college students' responses to the RFS because they may be incomplete and/or inaccurate.

An online learning module focused on smoking education and prevention for college students: implications for college health instructors and allied health professionals.

The purpose of this research was to pilot-test the effectiveness of an online learning module focused on smoking for an undergraduate general education fitness and wellness course. Students enrolled in a required fitness and wellness course were given the opportunity to participate. Participants (n = 510) completed a brief demographic questionnaire and a 10-question pretest about the effects of smoking before viewing a 15-minute presentation about the effects of smoking and completing the same 10 questions as a post-test. Repeated measures ANOVAs were conducted to evaluate knowledge gains. An overall time effect was observed (pretest score 4.9 +/- 1.3, post-test score 7.2 +/- 2.1). Significantly greater knowledge gains were found in nonsmokers (2.1 +/- 2.2) than in smokers (1.1 +/- 2.2). Females (2.3 +/- 2.3) had significantly greater knowledge gains than males (1.5 +/- 2.2). Evidence supporting the effectiveness of the online learning module included significant knowledge gains for both smokers and nonsmokers, and the participants who smoked agreed the online learning module encouraged them to quit. In this research, students were also grouped by major (health-related majors vs non-health-related). There were 118 health-related majors in the sample, with 110 of those students completing the entire learning module. In this research, a learning module for college students was developed, but practical applications are provided not only for college health instructors but also for allied health professionals.

How "healthful" are aerobics classes? Exploring the health and wellness messages in aerobics classes for women.

The purpose of this study was to explore the health messages communicated by aerobics instructors in aerobics classes for women. A theoretical framework influenced by adult learning theory and feminist pedagogy was used in this qualitative study. Over a 3-month period, the practices of five aerobics instructors working at one nonprofit fitness center and one wellness facility were explored. The methods of data collection were one interview with each aerobics instructor and 14 site visits to conduct participant observations and to retrieve of documents. Despite the nonprofit and wellness-based environment of the exercise facilities in this research, there was still an overemphasis on the physical aspect of aerobics classes. Therefore, the potential wellness-related benefits of aerobics classes for women, especially in environments that identified themselves as promoting wellness, were not fully realized.

Struggling with recovery: participant perspectives on battling an eating disorder.

Recovery from an eating disorder encompasses a complex matrix of mental, physical, and social factors. Although methodological differences affect rates of reported recovery (from 24 to 76%), many women are not experiencing full recoveries from eating disorders. This trend is apparent in persons who discontinue severely destructive behaviors but continue to exhibit psychiatric problems and impairment in social and occupational roles. The purpose of this grounded theory study was to provide an explanatory schema about recovery. Data collection included 17 interviews, a focus group, and participant observation. Findings included repeating wavelike patterns of disease and recovery that seldom returned to a state of normal eating but, instead, remained at a level of atypical eating.