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Advisory Boards and Usability Testing of an E-Training Program for End-of-Life Care in Prisons

Advisory Boards and Usability Testing of an E-Training Program for End-of-Life Care in Prisons

The 14th Annual Academic and Health Policy Conference on Criminal Justice Health, hosted by the Academic Consortium on Criminal Justice Health, was held virtually on April 8-10, 2021. Susan J. Loeb, PhD, RN, FGSA, FAAN, from the Penn State College of Nursing gave two presentations on research conducted in collaboration with Klein Buendel Senior Scientist, Valerie Myers, PhD. The presentations were titled, “Planning, Maximizing, and Sustaining Advisory Boards to Inform and Facilitate Research in Prisons” and “Usability Testing of an E-Training Package to Enhance Geriatric and End-of-Life Care in Prisons.” 

Planning, Maximizing, and Sustaining Advisory Boards to Inform and Facilitate Research in Prisons 

Dr. Susan J. Loeb discussed working with Advisory Boards for research in prisons. Advisory Boards are comprised of targeted stakeholders who collaborate with researchers to promote cultural awareness, consideration of environmental facilitators and constraints, and the upholding of ethical responsibilities to keep the best interests of research participants at the forefront. 

Effective partnering with Advisory Boards can promote entrée and execution of corrections research and enhance the credibility, relevance, and translation of study findings. The team systematically considered stakeholders who were engaged on Advisory Boards across four previous NIH-funded studies to assess how to promote stability, infuse fresh perspectives, refine the focus of consultation, and extend the array of research settings during an era when in-person meetings were not feasible due to a pandemic. 

Adopting multiple advisory boards with unique foci and constituted by people possessing expertise in a focused area, allows for laser-focused videoconference meetings. While virtual meetings may not afford the same intensive opportunities for relationship building that on-site meetings do, the former does lessen travel-related budgetary, logistical, and time burdens. 

The research team concluded that teaming with and sustaining a diverse array of community stakeholders is a key strategy for generating science that is tailored to address the health needs and promote health equity for people living in prisons. 

Usability Testing of an E-Training Package to Enhance Geriatric and End-of-Life Care in Prisons 

Dr. Susan J. Loeb presented on usability testing and best practices of a full-scale media-rich interactive computer-based learning system for corrections staff in response to the growing population needing geriatric and end-of-life (EOL) care in prisons, which are not consistently adopted. The training is called, Enhancing Care of the Aged and Dying in Prisons (ECAD-P). 
 
The research team conducted face- to- face usability testing of the 6-module ECAD-P training with corrections staff in two rounds at two correctional facilities in different states. The System Usability Scale (SUS) was administered to assess usability and acceptability of ECAD-P. Full scale testing included 173 participants at seven state prisons who completed cognitive and posttest measures and the SUS. 
 
The mean SUS score was 75.10 in the face-to-face usability testing, which indicated a high level of acceptability and usability since a score of 68 is above average. For the large-scale testing, cognitive posttest scores were significantly higher than cognitive pretest scores. At posttest, affective measures were significantly higher than at pretest. The mean SUS score for the full-scale testing was 69.34. 

The corrections environment is not technology-rich; however, prison administration and staff are accustomed to and receptive of computer-based learning (a frequently used delivery platform for mandatory training sessions). Therefore, the research team concluded the ECAD-P product is acceptable, feasible, and usable in corrections.  

The research presented at ACCJH was funded by multiple SBIR/STTR grants to Klein Buendel from the National Institute on Aging (AG049570; AG057239; Dr. Susan J. Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the two presentations also included Dr. Erin Kitt-Lewis, Sherif Olanrewaju, and Katherine Fiochetta from Penn State University; and Jeannyfer Reither and Savanna Olivas from Klein Buendel. 

Working with Advisory Boards for Research in Prisons

Working with Advisory Boards for Research in Prisons

Susan Loeb, PhD, RN, FGSA, FAAN, from the Penn State College of Nursing presented research conducted in collaboration with Klein Buendel Senior Scientist, Valerie Myers, PhD, at the 33rd Annual (Virtual) Scientific Sessions of the Eastern Nursing Research Society on March 25 and 26, 2021. This year’s conference theme was Generating Nursing Science to Meet the Needs of a Diverse Society. Dr. Loeb’s poster was entitled, “Planning, Maximizing, and Sustaining Advisory Boards to Promote Equitable Care for Diverse Populations.”  

The poster reported the exploration of effective ways to partner with Advisory Boards to promote successful entrée into prisons to (1) conduct and execute study aims; (2) enhance credibility, relevance, and translation of research; and (3) promote equitable health and health care for diverse populations. The specific study utilizing Advisory Boards was designed to engage carefully vetted men and women who are incarcerated to assist in caring for their older or sicker peers, and provide them with consistent high quality peer caregiving training. Trained peers contribute to a pressing health care need in our nation’s prisons.

In order to maximize Advisory Board effectiveness, the research team:

  • Reflected on past experiences and considered key stakeholders engaged on Advisory Boards across four previous NIH-funded studies in this area of research;
  • Deliberated on what worked well and challenges encountered;
  • Identified enthusiastic leaders and staff at prior research location with a focus on broadening the array of disciplines represented;
  • Bolstered representation of people who were previously incarcerated; and
  • Appraised budgetary capacity.

As a result, Advisory Board meetings were shortened and focused, representation by Departments of Corrections was expanded, relationship building and networking opportunities were achieved, virtual events reduced budgetary and logistical burdens associated, and cost savings allowed for more frequent Advisory Board engagement.

Building commitment of representative Advisory Boards facilitates access to hard-to-reach and often overlooked research populations. Advisory boards of invested and representative stakeholders are key to generating nursing science that addresses health needs and promotes health equity for people living in prison.

The research presented was funded by the following SBIR/STTR grants to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; AG049570; AG057239; AG057239; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on this poster also included Dr. Erin Kitt-Lewis, Sherif Olanrewaju, and Katherine Fiochetta from Penn State University; and Jeannyfer Reither and Savanna Olivas from Klein Buendel.

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Dr. David Buller, Klein Buendel Director of Research, presented a poster on workplace sun safety policies at the virtual 13th Annual Conference on the Science of Dissemination and Implementation in Health December 15-17, 2020.  

The U.S. Surgeon General and Community Guide recommend implementation of interventions to protect outdoor workers from solar ultraviolet radiation (UV) exposure to prevent skin cancer. For the research presented in this poster, written policies at state Departments of Transportation (DOTs) were examined and analyses tested the hypothesis that presence and strength of sun safety policy would be associated with greater implementation of workplace sun safety actions. 

Written policies from 21 U.S. state DOTs were coded for 15 sun safety components including engineering controls (physical work environment), administrative controls (workplace procedures), and personal protection practices (workers’ sun safety). Managers supervising outdoor workers in 138 regional DOT districts reported on workplace sun safety training and actions (monitoring UV Index to adjust work schedules, employees wearing UV-protective clothing, hats, eyewear, and sunscreen, sun safety messages to employees, employer provides sun protection resources and temporary/permanent shade, employer requests contractor staff comply with policy, employer encourages employees to regularly check skin, and employer conducts a risk assessment). 

Twenty state DOTs had a policy with at least one sun protection component (e.g., sunscreen, clothing, hat, shade provision, adjusting schedules), but almost none included training of employees, managers or supervisors. Many policies were also not explicitly intended for sun safety, except for sunscreen. Though not written, some reported unwritten standard operating, administrative, or training procedures on sun protection. Sun safety training and actions were predicted by a written sun safety policy and unwritten procedure, managers’ behaviors, job responsibilities, and characteristics. 

Policies are essential for implementation and maintenance of employee sun safety. While many state DOTs have policies, they could be improved by explicitly referencing sun safety. Also, training should be added to policy to create collective commitment among managers to support policy implementation and improve employees’ sun safety skills on the job. 

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller, Principal Investigator). Additional poster coauthors included Dr. Barbara Walkosz, Mary Buller, Rachel Eye, Andrew Grayson, Alishia Kinsey, Xia Liu, and Savanna Olivas from Klein Buendel. 

Listen to the poster presentation.

Family Determinants of Sun-Safe Behaviors in Hispanic Children

Family Determinants of Sun-Safe Behaviors in Hispanic Children

Melanoma is common, particularly among Non-Hispanic Whites (NHW). However, Hispanics are diagnosed at more advanced stages compared to NHW prompting the need for more research into Hispanic sun protection practices.  

Sarah Davila, Klein Buendel collaborator and student from Claremont Graduate University, recently presented findings on family determinants of child sun protection from the Sun Safe Schools project at the virtual 2020 American Public Health Association conference. Family determinants of child sun protection have seldom been tested among Hispanics. The team hypothesized that parent sun protection behavior, perceived risk for skin cancer, skin-phenotype, and purchase of sun protection products, along with child skin-phenotype and interaction of child skin-phenotype with child ethnicity would associate with child sun protection behavior and child sunburn. To test this, parents of elementary school-aged children completed self-report surveys and a multilevel analysis was conducted with Hispanic and NHW parents nested within schools and nested within districts.  

Parent sun protection behavior, number of sun-safe items purchased, and child skin-phenotype were all positively associated with child sun protection behavior, while parent perceived risk was negatively associated. The interaction of child skin-phenotype with child ethnicity was significant, indicating no difference at Type 1 skin-phenotype, but greater protective behavior for Hispanics relative to NHW for subsequent skin-phenotypes. Parent perceived risk and child skin-phenotype were also positively associated with child sunburn. Overall, the results suggest a need for parent modeling and environmental controls to increase sun protection behavior in Hispanic children.  

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds and Dr. David Buller, Multiple Principal Investigators). Other authors included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from Claremont Graduate University; and Julia Berteletti, Mary Buller, and Lucia Liu from Klein Buendel. 

Bilingual Web App to Improve HPV Vaccine Uptake

Bilingual Web App to Improve HPV Vaccine Uptake

Dr. W. Gill Woodall, Klein Buendel Senior Scientist, presented findings from the Vacteens/Vacuna Adolescente Project at the virtual 33rd International Papillomavirus Conference & Basic Science, Clinical and Public Health Workshops (IPVC), July 20-24, 2020.

The uptake of HPV vaccine in the United States remains substantially below the Healthy People 2020 goal of 80% series completion, particularly for young adolescents, when immunogenic response to the vaccine is strongest. Physician and clinic-based interventions have shown some limited positive effect on vaccine uptake. However, parental barriers to HPV vaccination may be addressed by digital interventions, such as smartphone applications, that are tailored to their concerns. Potential parental barriers include confusion, uncertainty, and misinformation about HPV vaccine schedule, safety, and effectiveness.

A research project was conducted to test whether digital information delivered to parents in a community setting may be an effective way to help reach HPV vaccine uptake goals in the United States. Diffusion of Innovations Theory principles were used to guide the development of the Vacteens/Vacuna Adolescente mobile app in English and Spanish. The app was designed  to encourage HPV vaccination in New Mexico, an ethnically-diverse state with insufficient vaccine uptake. Parents and adolescents were recruited from pediatric clinics in New Mexico to a randomized trial evaluating the mobile web app, which focused on daughters (ages 11-14). Parents were randomized to receive either the Vacteens/VacunaAdolescente mobile web app or the usual and customary online HPV vaccination pamphlet from the U.S. Centers for Disease Control and Prevention. Adolescent vaccine records were collected for daughters at a 9-month assessment point. Vaccine uptake results from the trial found that parents who received the Vacteens/VacunaAdolescente web app were significantly more likely to have their daughters vaccinated.

This research was funded by grants from PCORI and the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s collaborators include Dr. Alberta Kong and Dr. Lance Chilton from the University of New Mexico, Dr. Greg Zimet from Indiana University, and Jeannyfer Reither, Dr. David Buller, and Dr. Valerie Myers from Klein Buendel.

HPV VACCINATION RATES IN A TRIAL TESTING A SOCIAL MEDIA CAMPAIGN WITH MOTHERS OF TEENAGE DAUGHTERS

HPV VACCINATION RATES IN A TRIAL TESTING A SOCIAL MEDIA CAMPAIGN WITH MOTHERS OF TEENAGE DAUGHTERS

Dr. David Buller, Director of Research from Klein Buendel, presented findings from the Health Chat Project at the virtual 33rd International Papillomavirus Conference & Basic Science, Clinical and Public Health Workshops (IPVC), July 20-24, 2020.

Parental decisions on HPV vaccine uptake in the United States are influenced by information and misinformation about the vaccine in social media. Mothers’ reports on vaccination of their adolescent daughters were examined in an evaluation of a social media adolescent health campaign.

For this intervention, 881 mothers from 34 states were recruited into a randomized controlled trial evaluating a social media adolescent health campaign. Eligibility criteria included having a daughter aged 14-17, in state without a complete ban on indoor tanning by minors, using a Facebook account one or more times a week, completing the baseline survey, and joining the Facebook group. The campaign included didactic and narrative posts some of which promoted HPV vaccination, such as the need for vaccine, percent of adolescents vaccinated, and how HPV vaccines are decreasing infection rates. It was delivered through two Facebook private groups differing on inclusion of indoor tanning or prescription drug mis-use posts .

At baseline, nearly two-thirds of mothers reported that their daughters had been vaccinated for HPV. HPV vaccine uptake increased during the 12-month social media campaign. At the 12-month posttest, nearly 8% more mothers reported that daughters had been vaccinated for HPV. The increase appeared to be largest in completion of the multi-dose series. Uptake increased among older and more educated mothers and those with a family history of skin cancer. Mothers’ reports of HPV vaccine uptake were corroborated by daughters. Effective strategies are needed in social media to promote HPV vaccines and counter misinformation about and resistance to them.

This research is funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Collaborators include Jessica Oleski from the University of Connecticut, Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, Dr. Kim Henry from Colorado State University, and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Effects of an Online Responsible Vendor Training for Recreational Marijuana Stores

Effects of an Online Responsible Vendor Training for Recreational Marijuana Stores

The Train To Tend® responsible marijuana vendor (RMV) training research team recently published results from online RMV training on responsible sales for recreational marijuana store personnel as an abstract for the Annals of Behavioral Medicine. The Train To Tend research team is led by Dr. David Buller from Klein Buendel who would have presented the findings at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

Recreational marijuana regulations have been designed, in part, to ensure that cannabis products are sold only to adults over the age of 21 who provide state-approved identification (ID). The Train to Tend online RMV training was developed with input from state regulators and recreational marijuana store personnel to train store staff. The training consists of five modules with interactive learning elements that cover state laws, ID checking, health effects of marijuana, driving under the influence, refusal of sales to intoxicated customers, and store processes, such as product labeling and tracking.

A sample of 175 recreational marijuana stores in Colorado and Washington were selected for a randomized controlled trial with sales to pseudo-underage customers. Of the 175 stores, 75 were assigned to the control condition (usual and customary training) and the remaining 100 were given the online RMV training. At baseline, sales of marijuana to pseudo-underage buyers were refused at 93% of 349 visits to stores across the two states. After adjusting for store characteristics, there was no difference in change in refusal rates between treatment groups from baseline, to a 3-month posttest, or a 9-month posttest. For the intervention stores, training uptake was not related to refusal rate and nearly all recreational cannabis stores refused sales to young patrons who failed to produce appropriate ID.

This research was funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Co-authors include Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation; Dr. Gary Cutter from the University of Alabama, Birmingham; and Dr. Gill Woodall, Andrew Grayson, Mary Buller, Sierra Svendsen, and Lucia Liu from Klein Buendel.

Health Misinformation in Participant Comments in a Facebook-Delivered Cancer Risk Reduction Intervention

Health Misinformation in Participant Comments in a Facebook-Delivered Cancer Risk Reduction Intervention

Little is known about how how participants in a health intervention share health misinformation via social media platforms. The Health Chat research team published insights from their Facebook-delivered cancer risk reduction intervention and randomized trial with mothers and teen daughters as an abstract for the Society of Behavioral Medicine (SBM). The lead author, Kelsey Arroyo, from the University of Connecticut, would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

For this study, the researchers examined 175 comments made to 42 randomly-selected Facebook posts on different health topics such as substance use, indoor tanning, vaccines, mental health by study participants. The Facebook groups were moderated by health professionals. The participant comments were coded as sharing an opinion, a personal experience, an intention, or information. Comments were analyzed for whether misinformation was conveyed. According to the authors, “misinformation was defined as a fact, belief, opinion, or action that is not supported by scientific evidence.”

Analysis showed that more than three-quarters of comments shared a personal experience. Overall, less than one-fifth of the comments conveyed misinformation, and more than half of the misinformation was conveyed in comments that shared a personal experience.

This research is funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Collaborators and co-authors on the SBM abstract include Kelsey Arroyo, Jared Goetz, and Dr. Molly Waring from the University of Connecticut; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kim Henry from Colorado State University; Dr. Jerod Stapleton formerly from the Rutgers Cancer Institute of New Jersey; and Julia Berteletti and Dr. Barbara Walkosz from Klein Buendel.

Lessons Learned: Accessing Sites for Correctional Research

Lessons Learned: Accessing Sites for Correctional Research

Dr. Erin Kitt-Lewis from Penn State University presented insights into accessing correctional facilities for research at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, was a co-author on the presentation.

Despite the imperative to engage in research in corrections, researchers face many challenges due to the restrictive nature of this setting. Dr. Kitt-Lewis shared many of the lessons learned by this collaborative research team as they worked to secure diverse prison and jail settings to research, develop, and test the Enhancing Care for the Aged and Dying in Prison program.

Lessons learned included the discovery of contextually-specific constraints such as the closing or consolidating of services or facilities, managing staffing constraints, relocating staff, ascertaining and adhering to policies and administrative directives, and working within the guidelines of the review board of the correctional system.

Establishing and maintaining relationships with key stakeholders in corrections were also important aspects of this research. In her presentation, Dr. Kitt-Lewis discussed developing networking opportunities such as connecting via social media like LinkedIn, attending corrections conferences, and discussing potential research opportunities to help build relationships with key stakeholders and decision-makers. Additional perceptions from the field included identifying potential barriers or constraints to accessing correctional sites, and sustaining relationships post-research via ongoing communication such as sharing periodic updates, final reports, and publications with partners.

The correctional system has often been called a “closed” system due to the difficulty faced by researchers in attempting to access and conduct research. However, establishing well-defined strategies to conduct research in the system appears to create efficiency and promote much needed health-related research in the correction setting. Research outcomes that are contextually-specific can support and foster equitable care for people who are incarcerated.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented, in addition to Dr. Erin Kitt-Lewis, include Dr. Susan Loeb and Kaléi Kowalchik from Penn State University; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Dr. Susan Loeb from The Pennsylvania State University College of Nursing is presenting on the creation of a computer-based learning (CBL) program for corrections staff at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, is a co-author on the presentation.

Experts in corrections have identified the care of older individuals who are incarcerated as a high priority area for research and policy. Therefore, there is a need to provide evidence-based training tailored to frontline corrections personnel who are charged with the care and oversight of aged and dying incarcerated individuals. In response, the research team developed, implemented, and tested a CBL program that aligned with contextual environment constraints and the infrastructure-specific needs of corrections.

The virtual presentation will describe how the adoption mechanisms and support systems were integrated from set up to full-scale usability testing of the CBL program, Enhancing Care for the Aged and Dying in Prison (ECAD-P) for corrections staff. Specifically, factors that affect adoption and support systems were identified, examined and implemented at each phase of the development and implementation process of ECAD-P. In the Set-Up phase, the format of a paper-pencil toolkit was not sustainable for long-term, broad dissemination of the program, so support systems were evaluated to determine the capabilities of CBL. Throughout the development, Expert and Community Advisory Boards critically examined the content and programming measures of the product to ensure the product complied with usual practices and institutional constraints.

During testing, small scale usability-testing was conducted to determine human capacity, infrastructure capabilities, reporting systems, and program design and function. In going to full-scale, large-scale usability testing provided valuable insights on implementation considerations, such as leadership, communication, policy, and culture of institution. Consideration of adoption mechanisms and support systems ultimately allowed for researchers to refine ECAD-P for future, effective, large-scale dissemination.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented include Dr. Erin Kitt-Lewis and Kaléi Kowalchik from The Pennsylvania State University College of Nursing; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.