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Klein Buendel Opens a Second Location

Klein Buendel Opens a Second Location

Klein Buendel is pleased to announce the opening of its first satellite location in New Mexico. The new Albuquerque office will house Klein Buendel Senior Scientist Dr. Gill Woodall and a small staff, to conduct multiple health communication and behavior research projects with people in New Mexico and Texas.

The Vacteens project aims to raise the public health profile of human papillomavirus (HPV), increase the need for responsible health services, and examine the cost-effectiveness of risk-based screening to pave the way for the development of new strategies for the prevention of HPV-induced cancers. The objectives of the project are to develop and evaluate a mobile web app to encourage HPV vaccination in New Mexico, an ethnically-diverse state. Current ongoing randomized controlled efficacy trials with parents and their adolescent children in New Mexico clinics provide data to determine the impact of these mobile web apps on informed decision making and uptake for the HPV vaccine. This research was funded by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators include Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. David Buller from Klein Buendel.

B-SMART is a project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members. Using smartphone web app technology, B-SMART teaches coping skills, communication skills, and strategies to help deter Driving While Impaired (DWI). Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator) through the Small Business Innovation Research Program (SBIR). Collaborators include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico; Dr. Gary Cutter from Pythagorus, Inc. in Alabama; and Julia Berteletti from Klein Buendel.

WayToServe Espanol: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers is a redesign of WayToServe®, an evidence-based training to promote responsible alcohol beverage service (RBS). WayToServe Espanol was created after discovering current RBS training had not been tailored to address Spanish-speaking populations that represent disproportionately high rates of alcohol-related injury and death in the United States. This project promotes a culturally and linguistically adapted RBS training for Spanish-speaking servers, and changes to organizational and community norms because preventing alcohol-related injury and death is a national priority. This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. Gill Woodall, Principal Investigator) through the SBIR. Collaborators include Dr. Victoria Sanchez from the University of New Mexico Health Sciences Center; and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Development of Educational Modules to Enhance Care of Aged and Dying Inmates

Development of Educational Modules to Enhance Care of Aged and Dying Inmates

The United States has the highest rate of incarceration in the world and the demographics of the prison inmate population are shifting and aging. Many older adults are serving extended sentences and will age and die in place — making geriatric and end-of-life care an essential educational foci for prison staff. Consequently, resources are needed to adequately prepare prison staff to address this growing concern.

In a recent publication in Public Health Nursing, a research team led by Dr. Susan Loeb from Penn State University and including Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, reports on the development of educational modules to enhance the care of aged and dying inmates in prisons. The article describes the strategies used to “set-up” the Enhancing Care for the Aged and Dying in Prisons (ECAD-P) educational modules. “Set-up” is the first of four phases in the Institute for Healthcare Improvement (IHI) Framework for Going to Full Scale, which served as the conceptual framework for this study. Objectives achieved during the Set-up phase include: (a) establishing an approach for infusing the intervention into the target system; (b) identifying the product that needs scaling-up; and (c) determining what will be accomplished in the full-scale phase. Also, program buy-in within the given context and identification of the test sites, as well as support by early adopters, are essential.

The design approach for the educational modules included an environmental scan, a modified Delphi study, and a usability study.

An environmental scan provided a foundational understanding of the complex, contextual factors that impact correctional settings in the United States. Specifically, the environmental scan of diverse correctional settings helped to determine current educational approaches, education and learning preferences of personnel, and the technological capacity to deliver computer-based educational modules. Gaining knowledge was essential for the targeted development of modules that are tailored to address the health needs of the growing numbers of older inmates, many of whom will remain incarcerated through their end of life.

The Delphi process uses iterative group facilitation to forge reliable consensus on the opinion of experts through a series of structured questionnaires or rounds. The goal is to secure expert judgment based on experience. A Delphi survey was conducted early in the Set-Up phase to identify essential geriatric content for integration into the new prototype learning modules. The outcome was a reliable consensus on essential geriatric content for inclusion into the newly rebranded ECAD-P modules. An Expert Advisory Board reviewed the findings and validated the results.

For the usability assessment, the research team collaborated to design and program three media-rich, interactive computer-based prototype modules designed for the corrections context. The prototype, containing three modules, was built using Axure development software. The prototype was self-contained on a laptop computer. Each module had learning objectives, content delivered through multiple interactive features (for example: drag and drop, hover, click and reveal, video) and a final comprehension check quiz. Usability and acceptability testing were assessed following an established protocol examine navigability, detect problems, observe time spent solving problems, identify problem severity, and develop recovery strategies. After usability testing, the participants completed the System Usability Scale, a validated tool for assessing the usability and acceptability of technology-based products. Testing was conducted with 16 participants at two state correctional institutions in one mid-Atlantic state.

A full description of the methods, results, conclusions, and limitations of this study, as well as the implications for public health nursing, can be found in Public Health Nursing. This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb, Principal Investigator). Other collaborators/coauthors include Dr. Janice Penrod, Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Brenda Baney from Penn State University; and Sophia Strickfaden from Johnson & Wales University. KB’s Creative Team produced the ECAD-P prototype modules.

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018. This research is being conducted with Dr. Valerie Myers at Klein Buendel (KB), a co-author on the presentation.

The increasing numbers and complex needs of aged and dying inmates intensifies the burden of care and costs incurred by prisons. In an initial study (NR011874), best practices in the community were adapted in the Toolkit for Enhancing End-of-Life Care (EOL) in Prisons to train prison staff in EOL care. The print-based Toolkit was well received; however, not well suited for dissemination and lacked geriatric content. The Toolkit was transformed and expanded into Enhancing Care of the Aged and Dying in Prisons (ECAD-P) computer-based learning (CBL) modules in a second study (AG049570). ECAD-P development revealed the need to develop e-training for inmates to assist staff as caregivers for aged and dying inmates.

The purpose of the third study, which was presented at the D&I Conference, is to transform best practices in inmate peer caregiving into a comprehensive training program  that consists of media-rich and interactive computer-based learning modules for providing geriatric and EOL care to peers (i.e., prisoner to prisoner). Focus groups with inmate caregivers, prison staff, and training staff were conducted to determine a menu of CBL modules. An Advisory Board of experts in EOL care, geriatrics, ethics, and corrections health informed the selection of modules for development. Usability testing will soon be conducted in one men’s and one women’s prison with inmates who are experienced in providing mental health peer support, but have not been caregivers for their aged and dying peers. Focus group data will be analyzed using thematic analysis. Usability data will be analyzed using descriptive statistics and content analysis. Data are currently being collected. Analysis will be complete in October and the presentation completed by November.

The Prisoner to Prisoner (P2P) project allows the creation of innovative technology while being mindful of security and safety concerns regarding prisoners. Expanded testing of the P2P product will optimize the scalable unit for broader dissemination, establish the effectiveness of the training, provide critical insights relevant to dissemination of the commercial product, and position the research team to study broad dissemination and implementation outcomes.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis and Dr. Rachel Wion from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from KB. The technology is being developed by the KB Creative Team.

Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners

Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners

Klein Buendel (KB) collaborator, Susan Loeb, PhD, RN, described the development and testing of computer-based training for corrections staff on caring for aged and dying prisoners in a poster she presented at the National Commission on Correctional Health Care (NCCHC). The conference was held in Las Vegas, NV from October 20-24, 2018.

The Enhancing Care of the Aged and Dying in Prisons (ECAD-P) training program is a collaboration between KB and Penn State University. The research team, which includes KB Senior Scientist, Dr. Valerie Myers and KB’s Creative Team, built upon electronic file training materials that had been developed at Penn State University, and transformed them into interactive computer-based training that is relevant to a broad spectrum of correctional staff.

Approaches employed in an earlier phase of this research included: (a) engagement with an Expert Advisory Board, including representatives from corrections, geriatrics, and hospice; (b) a Community Advisory Board constituted by corrections officials and returning citizens; (c) an environmental scan conducted with corrections training officers and information technology staff; (d) a modified Delphi survey with geriatric and corrections nurses; and (e) initial in-person usability testing of an early version of three training modules. In a second phase, usability testing of six modules was conducted in a large jail in the Northeast and a State Correctional Institution in the Midwest.

Analytic approaches employed throughout this research included content analysis, geriatric content identification, and acceptability, feasibility, and usability evaluation using qualitative observation approaches and the System Usability Scale. The Phase I study established proof of concept, produced three prototypical modules, a drafted a detailed specifications document for full program development in Phase II. Phase II included refinement of Phase I learning modules and development of three additional modules. Phase II assessments showed that the program is acceptable, feasible, and usable in corrections.

The NCCHC poster concluded that correctional settings across the United States face growing demands to better address the health care and management needs of aged, chronically ill, and dying inmates. The ECAD-P computer-based training holds promise to contribute to better preparation of correctional staff to effectively care for these populations.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators/coauthors in addition to Dr. Loeb and Dr. Myers include Dr. Erin Kitt-Lewis from the Penn State University College of Nursing.

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Alcohol use and misuse is a leading cause of preventable death in the United States. Alcohol servers may help prevent alcohol-impaired car accidents and other harms by discouraging overconsumption by patrons. Responsible beverage service (RBS) training is designed to improve serving behavior, especially by avoiding selling too many drinks to a patron, refusing sales to intoxicated patrons, and properly checking identification to prevent sales to minors. Positive evaluations of RBS programs have been reported, yet online technologies hold promise for improving training quality, fidelity, cost, and uptake.

In a recent publication in the Journal of Studies on Alcohol and Drugsresearchers led by Klein Buendel (KB) Senior Scientist, Dr. W. Gill Woodall, reported the results of a randomized trial of the media-rich, interactive web-based WayToServe® (WTS) RBS training. The study hypothesized that servers who completed the WTS training would refuse alcohol service to apparently-intoxicated patrons at significantly higher rates compared with servers who completed the usual and customary (UC) live training.

In the study, alcohol-serving establishments (such as bars) in New Mexico were randomly assigned to receive WTS training (n=154) or the UC live training (n=155). Establishments were assessed before training, immediately after training, at six months after training, and at one year after training with a pseudo-intoxicated patron protocol (in which buyers were trained to enacting documented behavioral signs of intoxication) to assess premise alcohol service during early to mid-evening hours. The primary outcome variable for the assessment was the proportion of apparently-intoxicated buyers who were refused alcohol service.

Results indicated significantly higher refusal rates for WTS than for UC premises at the immediate (WTS=68% vs. UC=49%) and the one-year post-training assessment points (WTS=68% vs. UC=58%), but not at the six-month post-training assessment (WTS=69% vs. UC=64%). Results also indicated that younger pseudo-patrons were consistently refused more often than older pseudo-patrons. The study concluded that RBS training can be delivered online, broadening the scale of distribution and making it a potentially more cost-effective way to reach alcohol servers with effective and beneficial RBS training.

A full description of the methods, results, and limitations of this study, as well as commentaries by Buvik & Rossow (2018) and Miller (2018), and an author response, can be found in the Journal of Studies on Alcohol and Drugs.

The research was funded by the National Institute on Alcohol Abuse and Alcoholism (AA014982; W. Gill Woodall, Principal Investigator) at the National Institutes of Health. Collaborators/coauthors includeDr. Randall Starling from the University of New Mexico, Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in California, Dr. David Buller from KB, and Dr. Paula Stranghetta from Paula Stanghetta & Associates, Inc. in Ontario, Canada. KB’s Creative Team produced the WayToServe® web-based training. WayToServe® has been licensed to Wedge Communications LLC for commercial sale and distribution.

Results of Train To Tend Presented at APHA

Results of Train To Tend Presented at APHA

To date, ten U.S. states and the District of Columbia (DC) have legalized the use and/or sale of recreational marijuana. Training in responsible sales practices in the alcohol market has reduced sales to minors and, in some cases, intoxicated patrons. Responsible sales practices training could have similar benefits in the recreational marijuana market.

Dr. David Buller, Director of Research at Klein Buendel (KB) presented the results of the implementation and effectiveness trial of Train To Tend at the Annual Meeting and Expo of the American Public Health Association (APHA) in San Diego, California, November 10-14, 2018. APHA’s annual conference is the largest annual gathering of public health professionals with over 12,000 attendees.

Train To Tend is a unique responsible marijuana vending (RMV) training program developed by KB scientists and staff. The online RMV training was developed through input from state regulators, local law enforcement personnel, Colorado Marijuana Enforcement Division’s curriculum standards, interviews with recreational marijuana store personnel (n=15), and usability testing of a prototype training with store personnel (n=19). The RMV training contained five modules: State laws and regulations, ID checking, health effects of cannabis, customer service practices including recognizing intoxicated patrons, and rules of the trade including inventory tracking.

In a randomized controlled trial enrolling state-licensed retail recreational marijuana stores (n=225) in Colorado, Oregon, and Washington State, 125 stores were randomly assigned to receive the RMV training. Trainees completed pre- and post-training surveys evaluating usability and effects of the training. A total of 459 cannabis store employees completed the online training in 55 stores in the three states between June 2017 and February 2018. The training improved trainees’ ability to check IDs, their confidence to use the state’s inventory tracking system, and their ability to recognize intoxicated customers. Most trainees found the training to be user-friendly (78.4%), were satisfied with it (68.8%), and would recommend it to another employee (91.1%).

Overall, online RMV training was acceptable to retail recreational marijuana personnel and appeared to improve responsible sales practices. Training in responsible sales practices has been a successful policy intervention in the alcohol market that should be considered for the recreational marijuana market.

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). APHA presentation collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall, Andrew Grayson, Mary Buller, and Sierra Svendsen from KB. Research details and more results of this study have been reported in an e-publication in the Journal of Public Health Management and Practice.

Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores

Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores

Since 2012, nine U.S. States and the District of Columbia (DC) have legalized recreational marijuana, and several other states are looking to follow suit in coming years. At the outset of the legalization of recreational marijuana, the U.S. Department of Justice (DOJ) informed these states that they must put robust constraints into place that prevent youth access to marijuana. To accomplish this DOJ objective, Dr. David Buller and Dr. Gill Woodall from Klein Buendel (KB), and their co-authors created Train To Tend, an online responsible marijuana vendor (RMV) training program that aims to provide retail marijuana staff with the knowledge and skills they need in order to sell marijuana responsibly, and keep their communities safe. In a recent e-publication in the Journal of Public Health Management and Practice, the authors report the results of the implementation and evaluation of Train To Tend and what these results could mean for future research and policy.

Train To Tend was created with input from state regulators and local law enforcement personnel, curriculum standards published by the Colorado Marijuana Enforcement Division, interviews with recreational marijuana store personnel (n=15), and usability testing of a prototype training with store personnel (n=19) in Colorado and Washington State. Of all the input from these various stakeholders, retail marijuana store personnel reported that comprehensive training in responsible sales practices was uncommon in the industry. Coupled with the DOJ objective of preventing youth access to marijuana, this finding demonstrated a need for RMV.

Once all stakeholder input was reviewed, Train To Tend was created, and the training ultimately contained five modules: state laws and regulations, ID checking, health effects of marijuana, customer service practices including recognizing intoxicated patrons, and rules of the trade.

In a randomized controlled trial, the training was tested using a random sample of state-licensed recreational marijuana stores (n=225) in Colorado, Oregon, and Washington State. One hundred twenty-five stores were randomly selected to receive Train To Tend, while the remaining 100 stores received the usual and customary training in their state. In total, 420 store employees completed Train To Tend in 2017 and 2018. Pre- and post-training surveys were administered to Train To Tend trainees to gauge their perceptions of self-efficacy toward RMV practices, as well as their ratings of usability for Train To Tend.

Results revealed that the training improved trainees’ ability to check IDs, use their state’s inventory tracking system, and spot intoxicated customers. Also, most trainees felt very confident using the training, rated the training as user-friendly, and thought that the information and skills learned in the training would help keep their communities safe.

Overall, trainees’ improvement in confidence to engage in responsible sales practices, as well as the high levels of usability for Train To Tend they reported, suggests that programs like Train To Tend are feasible and potentially effective at training staff in recreational marijuana markets. In addition, this randomized-controlled trial provides a solid foundation upon which future research into RMV trainings can be built. This type of research is imperative to ensure the safety of customers that live in early-adopting recreational marijuana markets like Colorado, Oregon, and Washington State. By conducting research like this when recreational marijuana legalization is in its early stages, many unforeseen problems can be mitigated before they grow too large, and ultimately the public can be kept safer.

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). Coauthors include Dr. Gill Woodall, Mr. Andy Grayson, and Ms. Mary Buller from KB, and Dr. Robert Saltz from the Pacific Institute for Research and Evaluation.