Morning everyone, and welcome to the IUPUI Center for Translating Research into Practice Scholar of the Month Community Conversation. My name is Steve Vieweg. I'm the Associate Director of the Center, and it's my pleasure to welcome you here for this event. And to get started, I'll share my screen with you so that we have a few announcements to share ahead of time. And We're very thrilled to have doctor Devon Hensel with us today, who will be sharing some very interesting information with us. And as we get started, we do want to remind us about Zoom etiquette. We've all been on Zoom a lot recently. But we do have some suggestions to please keep your microphones on Mute. You're welcome to have your videos on. We hope you'll do that certainly when we get to the conversation part. And we do also hope that you will share questions with less in the chat or be so bold as to raise your hand mute during the conversation and actually have a conversation. We are recording today's presentation, and that will be available on our YouTube channel later. And you will receive a post event evaluation. We hope that you'll take a moment to answer a few questions about this event. We know you get lots of opportunities to do surveys, but please take advantage of our survey. Because we want to know. We want to know how we're doing. And I do want to share the background of the Center for Translating Research and to practice. It was the brain child of Professor Emeritus Sandra Petronio, who's a communications professor, and out of the genesis of her own translational work, when she and Charles Banz emeritus Chancellor of our campus, came to IPY. They recognize that a lot of the work that happens on our campus is what we would call translational. It's interdisciplinary work, it's generating knowledge or using knowledge to solve complex problems in our community. And so today is going to be an example of some of that translational work. And we're finding lots of ways to share that with people. So we hope that you know that you could get continuing education for attending these events. If you're interested in that, go check it out. And expand your learning. But keep learning about us. You can follow us on Twitter or on Facebook. That's one way we try to just shout out things that are going on, but if that's not enough, there's more. You can also subscribe to our YouTube channel where you can get some video clips of some of the translational work happening as well as recorded sessions like this one in case you miss it or maybe you want to have somebody come join it later, and you can also do Instagram. We keep finding ways that we can get the word out about translational work here. Now, today, we're going to hear from doctor Evan Hensel. Get back here. Why did that work. So you can go to our website. And if you go to the featured place, and for example, look up doctor Hensel. If you click on her profile, you'll be able to get better sense of the work that she's doing, but below that explanation, you'll see a whole bunch of her scholarly publications, which are linked to something called Scholar works. Here at I UPI, we have a program called Scholar Works, and the effort there is to available all those journal publications in a free accessible format. You can also click in the Scholar work section there, and you can see in another place in an I UPI website, all of her work that is freely available. Anybody who's interested in learning more about the journal publications, about her work or any of our folks, you're welcome to use that site. Now, coming up next month, we have a scholar of the month every month and we do one of these conversations. On Friday, April 22, we are welcoming our next person. Daniel Johns will be talking about interactions between social and environmental vulnerability. Please mark your calendar and join us for that check up. The website, you can see a bunch of things that are coming up over the rest of this year. Where we have lots of opportunities to have these conversations. But let's get started on today. We're very happy to have with us, doctor Devin Hensel, who's going to talk about community engaged research. Doctor Hensel is a faculty in the Department of Sociology in the School of Liberal Arts and faculty in Adolescent Medicine, which is in the Department of Pediatrics in the School of Medicine. And I'm going to unshare my slides now so that you, doctor Hensel, if I can get to that, why won't let? No. We'll stop sharing, and then you can do your work. We'll let you on, and let's give a warm Hosier welcome as we can on a Zoom to doctor Devon Hensel. Thank you for joining us. It is a pleasure to be here, doctor wig. Thank you for the invitation. I'm so excited to be here on this beautiful Spring, Indiana Day. Thank you for joining us, so we're your lunch hour. So today, I'm going to talk about two projects that I am engaged in currently that are still active projects, that are Really sought to use innovative research, recruitment, and data collection methods to overcome traditional barriers to participation in research in these communities. So I find it useful when I'm giving a talk to sort of situate my intellectual perspective in the world. So, as doctor Vizag hold hold two hats on campus. I'm a behavioral scientist in the school of medicine in the Department of Adolescent Medicine, but I'm also a sociologist by training, so I have a joint appointment in liberal arts teaching graduate students about research methods and statistics. I'm trained as a medical sociologist, which means my field examines health as a socially organized and experienced phenomenon. So from the perspective of health equity, I really use this as a lens to understand how people's health experiences are linked to specific factors in their lives. So age, gender, and sexual identity, race and ethnicity, disability status, having a history of trauma, and how these particular factors create barriers to optimal well being in specific communities. And I want to call it my research bentor, my post doc here, doctor Dennis Fortenberry, I'm not entirely sure if he's on, but in the early stages of my career, he really challenged me to consider the fact that access to research participation could also be considered a health resource that many communities link to those same factors experience. And so that is, how do these same factors create barriers to participating in research. And more importantly, what implications does this exclusion have for their access to health and well being? And from my perspective, there are several reasons why inclusion and representation in community based research matter, from a basic perspective of research methodology and data, excluding communities creates an obvious selection bias, and this selection bias has important downstream implications for the quality of data that you get. Selection bias really reduces both the reliability and validity of the data that you collect, which, in turn, have implications for how well you consign educational programming and intervention design to be informed by those data. But more importantly, for me, in the focus of one I'm going to talk about today, exclusion and representation are an issue of social justice. The communities that are often most adversely impacted by different health experiences are often the ones whose voices are systematically erased from the literature that is seeking to help them. And these voices, as I'll try and argue to you today are an incredibly important piece of understanding how people navigate their day to day lives. And so I want to put forth the concept that's called the lived experience. This is an important tenant that organizes all of the work idea. This idea is a deliberate attempt by a researcher to walk a mile in another person's shoes, and specifically to understand how a person navigates a health experience within their own perspective. So as a researcher, this means I am always focused on getting as close to a health experience as possible as it is experienced by a specific community member or community members. There are specific data there are specific recruitment approaches and data collection paradigms, a few of which I'll talk about today that can be leveraged to help increase research or access to an experience as it's lived. So today, I'm going to talk about two very different community cohort studies in which I've tried to organize understanding the lived experience of these communities. One is a cohort of adults with spinofda, and the other is a cohort of adolescents attending a substance recovery High School. So in the next few slides, I'm going to highlight some basic background on both communities just so we have a working understanding sort of the different needs and different experiences. So the first study is an R 21 that I'm still currently working on that focuses on understanding the health experiences of adults with spinabfta. Spinabfa, for those of you that don't know is the most common congenital anomaly of the central nervous system. It impacts 3.4 in every 10,000 newborns annually. The important piece about this is that the condition often results in lifelong multi organ impairment. And increased survival in the last two decades means that individuals born with spinabfia are going to spend the bulk of their lives, navigating important spinabfd associated health conditions like urinary and fecal incontinence. And despite the potential long term lifelong impact, existing cross sectional work on the impact of incontinence in these individuals lives is quite scarce. Very little is known about how the experience of incontinence or how people's ability to manage and move through incontinence events impacts their emotional social and physical well being. So as part of an existing collaboration with colleagues in urology at Riley Children's Hospital. I was fortunate to attend a sexual health community summit for individuals with spinobfda in the spring of 2018. This summit brought together researchers, clinicians, spinobfda patients and caregivers. And it really gave me a chance to engage with the community members and ask, how often does your own care team, your clinical team ask about your incontinence experience? What kind of details do they ask? And more importantly, what do you want to be asked that you are not currently being asked. And there The uniformity of their answers astounded me. Patients wanted their doctors to know that their day to day experiences were different. That incontinence on Tuesday often wasn't linked to incontinence on Thursday or Saturday. They were different in frequency, in triggers, and impact. But despite these day to day variability details, they're typically only asked questions about their experiences retrospectively once at an annual visit. And the importance of retrospective reliance and retrospective information is that it introduces a lot of potential bias. And makes it difficult to understand those ebbs and flows from day to day. So, you know, things like do symptoms change from day to day? How does that change then impact downstream feelings about well being? And the second project is focusing on adolescents who attend a recovery High School here in Indianapolis called Hope Academy. For those of you that are outside the substance abuse arena, nearly 1 million adolescents were diagnosed with the substance use disorder in 2018. Adolescents who use substances are at increased risk for high school dropout as they typically do not receive the treatment they need to both combat their disorder and balance the other stressors that are associated with this life stage. So recovery high schools offer a vitally needed opportunity to address these multiple needs that include ongoing treatment, life skill development, and educational completion. And like our friends in the spinoppta aport, very little is known about the day to day experiences of students, how they navigate things like cravings to use drugs, the stressors of daily life, and normal fluctuations in teenage mood. So, my collaborator on this project, doctor Victoria Garcia Wilburn, whose faculty in Department of Occupational Therapy, began a community and economic partnership with Hope Academy in Indianapolis in 2017, and we were fortunate to receive the 2021 Bans Award to fund the research that I'll be showing you today. Most parents and teachers, when we went to ask about possibilities of research, were interested in learning how to better support their students. And this included gaining a better understanding of what the day to day challenges were. Both the barriers and the opportunities related to managing substances. So from a measurement perspective, that meant asking students on a daily basis about their physical health and well being, as well as the frequency, timing, and severity of their substance use. So in the next few slides, I'm going to highlight some research study structure choices we made to better leverage our ability to address the inequities to participation in these communities. So for an overview for both studies, because they have very similar data collection approaches. My goal was to support in collaboration with my investigators to support communities in as integrated and as non invasive a way as possible. And After some discussion with both my research teams, it was clear that the best way to do this was to design and execute an entirely webbed based study process. This meant recruitment, enrollment, informed consent, data collection, and compensation would be done electronically, and that was deliberately to meet our participants exactly where they were, particularly during the COVID time frame. And such an approach is important to supporting both communities in different ways. For the Spina Bift to participants, mobility limitations can pose a challenge to getting to in person enrollment appointments. Often, clinical research with this group is done at doctors' appointments, where at the community summit, many of the community members told me, I am so slammed when I do go to a clinic that I don't have any time to participate in the research that I would love to participate in with you. And from an adolescent in recovery perspective, in person enrollment appointments could either intrude on the school day, interrupt other school activities like extracurriculars or therapy or academic support, and a basic deviation in routine could in fact serve as a trigger itself. And so what we ended up focusing on was really highlighting or pedestaling the idea of technology as central to an individual's communication. So using a cell phone or tablet. So in both communities, we know that there's a pretty high ubiquity of cell phone and tablet use. And this is important because the basic ways in which people engage those devices serves as training on research tasks. So things like entering information on a phone or text messaging or using social media or engaging with an app at different times in different locations, very closely mimics data entry for a study, and means that they have already trained themselves on the tasks that I would ask them to do as part of a study. And so these features really help us meet our participants where they are. They can control where and when they answer questions about sensitive and personal information, and this helps decrease substantially concerns that participants have about privacy and anonymity. And also, the electronic devices allow us much faster and more frequent communication with participants when they have questions that arise. And so a little bit about recruitment with an entirely web based studies infrastructure with both communities. We had to rely heavily on network driven communication to spread the word about the study. So for our Spinabfta community, we posted study notices on the social media pages and the web pages of international state and local Spinabta support and advocacy agencies. We also sent notices to clinic patients who had agreed to receive research related communication, and we allowed participants that were currently or had finished enrollment to refer other community members into the study. And for the Hope Academy study, the smaller starting population meant that we did an advertising opportunity at a school night, but allowed students to self enroll with, as I'll talk about in a moment, the consent of a parent. And I want to highlight for a moment just how we do enrollment and informed consent in a situation where we're using a population that has a disability as well as when we are doing something with minors. So we used a combination of a study manager mediated and self enrollment in both studies. So for our find bf study, we set up an intake appointment with our study manager all over Zoom or the phone, who screened our potential participants for any eligibility, and more importantly, any foreseen barriers that specific person might have had to participating in the study. And we'd had some extensive training done with this particular study manager so that she was capable of proactively walking through the most commonly anticipated barriers in helping people decide whether or not they could, in fact, participate. And once this was finished, if an individual passed screening, we sent them an enrollment link where they completed informed consent by themselves. At Hope Academy, since we had already done a presentation to students and parents at their back to school night, all students were sent another link in their e mail or to their phone that had the study description that contained a link to informed consent, which then both the adolescent and their parent signed for participation. And both studies involve three arms of data collection. So once informed consent was finished, people did a baseline questionnaire, which collected basic data about demographics, past attitudes, and past behaviors. They also completed a daily diary arm, which was 30 days of daily surveys, and they also completed an exit questionnaire, which had questions related to study participation and repeated some basic 30 day information for ability to verify and do some correlations and reliability. Bjects. And more importantly, how this works to allow participants to do this in a way that is seamless as you set up the different data collection arms to be triggered when the prior arm is completed. So that meant when informed consent was submitted, they were sent the baseline questionnaire. When that was submitted, the first diary was triggered, the second diary, and so on. And as part of informed consent, they were able to select a data arm delivery method either via e mail or via SMS. And I'd say about 80% of both studies chose the SMS delivery. And again, I think that speaks to the centrality of technology in people's lives. And so at any point in time, we were always checking to make sure that people were on track with their particularly their diary completion, and we would check in if we had more than two days go by where a student or a spina eft participant had not submitted something. And that constant check in also served as an important retention method because people felt connected and supported as I moved through the study. A question that usually comes up when I present the data structure of studies is, well, how did you keep the data safe and secure? And the answer is actually quite easily. I U has an excellent technology infrastructure that provides a safe and secure platform for a study like this on which to be stored. So all three data arms were collected through a data collection platform called Qualtrax. We hose Qualtrax over Redcap simply because it's a little easier to use diaries with. And it again has an added layer of data security. So one layer of security lies in the completion and transmission. So when a participant fills out their survey or whatever data collection arm and hit send, the data are vacated from that device, and so nothing resides on a participant's device, which is one layer of security. When the data are transmitted before they are sent, and it only takes about less than the time it takes you to blink for the data to go behind the IU firewall. While the data are being transmitted, they are encoded. So a question that says, yes, no, on the participant screen is coded as a zero or one, and that happens for all questions. So in the very unlikely event that something is intercepted in the very quick time it takes to be dropped behind the IU firewall, it would show up as nonsensical numbers and letters rather than data to which a person could be attached. And the second layer is simply insecure protected password storage, both behind the firewall, and we certainly make all of our data devoid of personal details prior to analysis. And compensation is always an important piece of study, successful study navigation. And I was trained with people who really believed in honoring people's experiences with fair and adequate compensation, and I continued to put that fourth into the research universe as I conduct my own studies. And so that means in both studies, each arm had a specific amount attached to it, so both the baseline and exit surveys were $15. Each diary was $0.50, so a maximum of $15 for the 30 days. We also included a 90% completion bonus for diaries. So that is if people completed 90% or more of the expected number of diaries, they were given a $10 bonus, and then each participant got a $30, amount of money to cover the cell phone coverage costs. So in bill studies, about a month of work could be equivalent to $85. I'm going to talk just for a moment about the daily diaries, because I want to highlight how important this particular methodology can be to meeting people where they are and really getting at the lived experience and voices of your participation. So a logical question is, why would we even need to use daily measurements, either of incontinence or substance use. And the question is because both of these phenomenon are variable. And as a social scientist, I know that that means whether something occurs or not and how it happens is going to be tied to the background context in which it occurs. An important piece of including participant voices on their experience is capturing this variability, including when it does and doesn't occur, what the volume and frequency of the phenomenon is, the contextual factors that make these things more or less likely, and how these things change over time, right? And that links back a little bit to what I said a few slides ago about the spinabfea participant saying, My doctor does not ask me how these things change over time, and I'm trying to tell them that they do. So, for example, we could ask questions in the context of either study, like, how many days in a month do someone with spinabpta experience urinary incontinence or fecal incontinence? What makes these events more or less bothersome for someone? Or how often for an adolescent in a recovery a high school, did hybrid learning experiences during COVID exacerbate their cravings? Was there something about in person school versus hybrid learning that made recovery more difficult? And so increasing this fidelity to the ways in which our participants are experiencing their health events increases the strength of programming efforts. We call this ecological validity. So it's a greater a tighter tie to measuring things in the ways that participants experience them. And again, the more reliable data we collect, the stronger our programming efforts are going to be from those data, we can better tailor our experiences to individual needs. And again, it really does reinforce the idea of honoring the lived experience of those who are providing data. So in an ideal world, if I want to know what is happening in the moment that someone is incontinent or in the moment when someone's experiencing a craving to drug use, I would measure it right then and there and as frequently as possible, to cast a wide net and get as many experience as I can. Obviously, I can't walk into someone's home, and I can't walk into a high school all the time and ask a student, Are you having a craving now? So the best alternative is to get as close in time as possible and ask about the context of those events, which is what the daily diaries are designed to do. And finally, I want to share some very high level findings that I find particularly meaningful, but that have also addressed direct concerns as expressed by the community members themselves. And so you can get just a very brief snapshot of all of our participants in these two groups. One thing I do want to highlight is in the spin of Fa study, you can see the my goal was an N of 50. Once word got out in the community that someone was asking the questions that had been unaddressed for so long. Even in the midst of COVID, we nearly doubled our planned enrollment. And I very reticently had to cut off enrollment because we were out of money to pay people. So it's a really nice nice validation when your work resonates with the community members. And we had six of 40 enrolled students at Hope Academy, which is, you know, we didn't know kind of what we were going to get. So those six were very important. And here are some characteristics here that are similar across both studies. I want to highlight just how well things can go when you ask the community members what they need and how they want to be asked questions. So, for our completion rate, when I talk about feasibility, I'm addressing how well did the study go. So number one, how many people completed the diaries that we needed them to complete. So as a whole, 91 spin efit our participants completed and submitted 98.3% of the diaries that we expected. Our adolescents and recovery submitted the 81.7% of diaries that we expected, and neither one of these groups had completion that varied by background characteristics from our baseline survey. And secondly, if I'm designing something to be as non intrusive as possible, I want to know how long it takes people to complete those diaries. And so you can see that both populations had a completion time that was around 2 minutes, and completion also did not differ by study characteristics. And so some key findings, commensurate with the conversations I had with community members, those who were actually impacted by spinabfta, and the questions that I was asking. And again, they were telling me these things change from day to day, but no one has asked me how that happens. And so as a nice nod to those testimonies, we found that frequency amount and the adverse mood impact for both urinary and fecal incontinence in the spinabfta population varied significantly from day to day. And again, from a lay translation, that simply means that we were validating that incontinence on Tuesday can look very differently than incontinence on Thursday. Interestingly, we did find that independent management of incontinence substantially lessened the impact on mood meaning. The more that one could be scaffolded to take care of things like cleaning up hygiene by themselves, the less it would make their mood negative following that incontinence event, right? And so when we talk about ways that we tailor use data to tailor solutions for people. As a clinician reading these data, I can't take away the experience of incontinence, but I can help someone build the skills to manage it by themselves, right? That's a very clear intervention point. And thirdly, daily activities are things that people mentioned they missed because they were experiencing incontinence. But interestingly, I measured, what did you miss today because you were incontinent, or what did you not do because you were worried about being incontinent? And we found that more daily activities were avoided, and these were daily activities such as going shopping, exercising, even having sex. People avoided more things because they were worried about incontinence happening, even though it didn't actually occur, then activities they avoided because of actual incontinence. And I think this is a very important point. Helping people then the intervention point becomes helping people walk back their anxiety about potential incontinence. And that's a different intervention point than dealing with things when incontinence actually happens. And a few key highlights from our adolescence and recovery data set. Similar to our friends in the Spina befita study, cravings to use drugs varied from day to day. So again, that means how I felt about drugs on Monday is going to be different than how I felt on Tuesday. Craving was higher and more frequent on days with hybrid learning than on days that were in person. So, again, that speaks in my mind to the structure that's important and helping adolescents who are recovering to finish their high school. And the impact of cravings on emotional well being also varied from day to day. So having a craving isn't necessarily a direct correlation with negative mood. Things like intensity, duration, and the number of times that have happened are a tighter correlation with mood. And finally, I want to share some questions we asked both communities about what it was like to participate in the study. And so we asked these same questions to both groups, and you can see the percent who agreed or strongly agreed with both. They very highly enjoyed participating, felt the payment was fair, felt it was easy to use their tablets or phones to take the surveys, did not feel the surveys were too long. Both groups said unequivocally, I gave truthful information. They were quite comfortable answering questions and would participate in a study like this again. And these are the types of data points that I use directly to inform what I'm doing to let me know if I am on the right track. And just a few concluding thoughts. So I hope I've shown you today little pieces of how matching design and execution of a research study can really increase your ability to reach the needs of a specific community. And again, the data that we get are so important because in addition to honoring the voices of the lived experience of community members, you also increase the data reliability and validity that can be used to serve that community afterwards. And ultimately, this is why we engage in community based research as a means of improving the lives of those from whom we collect data. So thank you so much for your attention, and I will be happy to take your questions. Thank you, doctor Henson. And you can unshare your screen so that we could invite our community audience to go ahead and turn on your camera so we can see who you are, where you are, and we'll invite some conversation as you're coming to the community here with your videos. You might raise a hand. We already have one up. I do want to share that I work in developmental medicine in the School of Medicine, and have been in conversations like this for a long time with people who have neurodevelopmental disabilities, as well as physical disabilities. But they are saying to us now is nothing about us, without us. So your presentation today is a really nice way to help us understand better about why we would do this, but also how we would do it. Doctor Megadi, you have your hand raised, so please unmute and ask your question. Let's have some conversation. Thank you. Devon, loved your presentation. Love love that final questionnaire. I'm going to reach out to you about that. That's a great idea. Have a question. We use Red Cap. And when I say we, I say other people because I can't figure redcap out. Every time I sign up, they kick me out eventually because I don't use it. Do you know differences between redcap and Qualtrix, which you prefer? You said some really important things about qualtrix that made it interesting to me. Yeah. So that's a really good question. So I think, you know, it's sort of like choosing between a golden delicious apple and a Granny Smith apple? Both of them have you know, both of them inherently are really good pieces of fruit. I have many colleagues in Adolescent Medicine who are squarely redcap users and find its functionality quite well. Qualtrax through my research, prior to both of these studies, has a much better interface for integrating the daily diary piece, and that technology was a needed one, and that's ultimately why I ended up using Qualtrax. Just from a personal perspective, I find the interface, like the physical interface of Qualtrax just a little bit easier and quicker for me to use if I'm doing just a quick survey that's not related to either one of these studies. But, you know, both of them, if you have lung juvenile studies, Redcap can work equally as well as Qual Trex. Okay. Thank you. There is a question in the chat. I don't know if you saw that that's asking about if there was for the substance use disorder responds to provider. A context for why the hybrid learning was maybe more triggering for the. This is a very important question, right? And we had hypothesized that this might be the case, and so we actually held off on data collection an extra two weeks so that we could capture this piece of the data. I think there's a lot of reasons why that could be. We haven't drilled down into the minutia of the data to really sort of understand that full context. But, you know, from a routine perspective, being at home could provide a very different set of structure than being at school potentially is number one. But number two, I just think, you know, when we're asking, you know, I have a teenager myself, and she's not in recovery, right? And I've watched sort of the stresses of COVID and the ebbs and flows that has had on her, and I would imagine you can amplify the impact of those stressors for adolescents that are in a recovery high school. And so an important piece of the analysis to understand the why we'll started beat the to look at. Well, if hybrid learning on Tuesday was a super intense trigger to use drugs, what happened, what was going on with your triggers on Monday? If we lag a day, can we see an impact? And then if we lag Tuesday because the intervention point might be for a future pandemic, supporting kiddos who are in recovery might include an extra set of, you know, check ins with their advisor, or their mentor just to help bring down some of that stress that could be linked to the craving. Thanks. I see doctors Spans and Petronio have a hand raise, so mute, can please ask your question. Thank you very much, Devin. Sandra and I looked at each other at some of the data. And one of the questions that we posed is this issue that it's a small difference, but it's a substantial difference in that the younger adolescents found the interface harder to use. And I know you've only got six and all of that, but that just stands out given the dramatic difference in every age. Uh. Yes. So Yeah. And I absolutely appreciate that. And some of the questions then that we go back and ask, we have a question that said, Is there anything else about the study and your experience that we need to know, and those data still are yet. This data are literally fresh off the press as of about two days ago. So, but also, remember that, you know, the impact of one observation out of a sample of six is about what you saw. So there was one person who neither agreed or disagreed with that particular item that it was easy to do. And that able could be related to, you know, sometimes as best as we try, the SMS that's delivered to their cell phone doesn't reach it because they're out of an area of Wi Fi or they're, you know, moving between places and the cell phone reception switch towers. There's a handful of reasons, but these are very important, right? Because when not if, but when we repeat the study with other recovery high schools around the nation, and that's our goal is to do that next is to understand how things like geographic location might impact the timeliness of someone to get to the SMS link, but then also their efficacy in hitting send and have those data land where they are. Good. One of the other things is just stunning in your data and you touched on it, which is the positive response of the spinabfd. I mean, that's the kind of thing that they train you in Stats class to go and check the data to make sure that the being scored right. It's so positive. Yeah, and, you know, the other thing that I did not have time to present was the virtual load of unsolicited thank yous that we got from participants. And, you know, I can paraphrase, but they all say something to the effect of, thank you for doing this research. I would have done this for free, but no one's asking me about these things. In fact, the feasibility paper to come from those data are going to lead with. No one's ever asked me about this. In these types of things. And so we were very unprepared for how many people wanted to participate in this, and we've actually started another list for the next study to come out because people also said, please include me in the next one. Again, you don't have to pay me. I just want the data to inform something that will help the community. Great. That's our great response to knowing you're on the right path. Exactly. Thank you. So there are two questions in the chat that are somewhat related. So I'm going to share those with you and the audience about one, acknowledging the value, the idea of checking in with participants about, being involved, but then wondering about the barriers that might have been shared and what you did to work around those. And then Teresa Bennett's question about what were the watchots from this? What did you learn along the way from mistakes that might have been made that would be beneficial for others to know about? Absolutely. Thank you. Great questions and I love these sort of method oriented questions because such a group think opportunity like this really offers so many great opportunities. So I'll address doctor Chen's question first. The barriers. So we had participants range in age 18-73 in R. We expected that based on the SMS portion of it, that some of our older participants, for example, might have trouble figuring out how to get access their text messages, number one, if they'd never used it before, but number two, how to click the link, go through the survey, and so one of the things we did was do a practice session with some of them where we sent to practice SMS and had our a study manager, walk people through like, what the interface was going to look like for the first couple of questions. So they got used to, and they and at least I'm like, Oh, this is just how I text message with my grandchild or my sister. But an example of an unanticipated barrier was we found that one specific cell phone carrier, T Mobile, had a block to the phone number from which the SMS was delivered. And I took a couple of weeks to triage what that was, and it ended up being something as simple as having to toggle a setting in T mobile users phones. But that took a lot of tenacity from the study participants to say, Yeah, I, hang with you, we're trying to figure it out. They could have easily dropped out. But, you know, that's where it takes, you know, study staff who are really well trained can engage people and gain their trust. And so I think that links nicely to the question about, what are the mistakes you made along the way. If I could do particularly this finobfio study over again, I would have tested it for longer, I think, with our participant group. Many of them said in their feedback at the end of the study, COVID impacted so much of how I organize my daily life. So I didn't do an inside exercise video because I was still worried about being incontinent, but that level of anxiety would have been higher if I'd gone to the exercise studio. Itself. And I you know, we also didn't ask questions that were open ended for every question, which was something that was requested from the participants themselves on the next go around, you know, and you always have to balance things about what's feasible versus how are you going to use those data and what you can collect that minimizes conversations and things like that. You know, there are other aspects of health and well being that people said, you know, my health is my health itself is relatively consistent. That was a question we asked, How is your health today? Poor, fair, good Excellent? And they said, what you should be asking me is not how my health is, but how my physical health is, my mental health is, and how my emotional health is. And so that is certainly something that will be differentiating as we move forward. So I think there's another question. Well, there is another question that we will pull up, and I think it's remarkable because what I hear you saying is that you worked with the participants to help create what it would look like. And then some of the feedback you got was for them to say, you could have asked me more and it wasn't enough. Yes. We might not have had that response without having had that first experience of inventive So kudos to you for doing. Thank you. Yes. And then, did any of the participants share that they learned something new about their situation as a result of participating in the daily diartdy? Interestingly, yes, and I didn't ever anticipate that this might occur. We had a number of participants asked to get their data, their daily diary data to share with their doctor after they were finished. As a method of demonstrating to their doctor exactly when they were incontinent, how it bothered them, you know, as they really got what we were trying to do. I mean, everyone really appreciated the endeavor, but some of them really understood the value of the daily, markers of these things. And so we sent a number of people, like, Here's a little report. One of them called them her bathroom report card, and I said, absolutely. Let's use this in a very way, which opened up this amazing sort of line of one potential. This could be a very informative clinical tool, right? Moving forward and thinking about diagnostics and tailored solutions and things in a way that I hadn't necessarily considered. So Wow. I think that's pretty remarkable about, just the approach here and what it could lead to, not only for methodology, but for clinical application, which is what you were interested in in the beginning. That's pretty amazing. Is there any other questions before we would wrap up our time together, as we might look in the chat, or if anybody raises a hand. We do want to thank you so much for sharing this in such a way that was so accessible to us to understand all that went into this and the value and the benefits of considering the lived experience of the participants. You had it from two very different perspectives, I think, too, and what that could mean for us around having community engaged research, that in fact does address the concerns and issues that people have and how to make things better. We couldn't ask for a better example of this. Do you have any final comments you want to share, doctor Hensel before we would wrap up for the day? You know, just as a plug to collaboration, I'm really passionate about using electronic resources to leverage opportunities in research. So I'm happy to have a conversation with anyone about how any of these methodologies could be used in the context of your own research. I hope people take you up on that opportunity. And I do want to as we conclude our time together, we'd like to try to end these times a little bit before. You've taken your time over lunch. You probably have 1:00 meeting, and so we want to thank you. And we do have a reminder next month on April 22, we've invited Daniel Johnson to come talk about interactions between social and environmental vulnerability. And we want to thank you for joining us today. Remind you that you're going to get a survey. In the e mail, along with some information about how to access the copy of this, et cetera. But please take a moment to give us the feedback and go back to the website, follow us on social media, whatever you can do to stay in touch. And we will stay on here for a few minutes. If there's anybody that wants to do the traditional after we're done of the program, have a little sidebar with doctor Hensel. We'll be here for a few minutes, but we understand if you need to leave. And we just want to thank you again for joining us, and let's give a big round of applause to doctor Hensel for her work and for taking the time today to share it with us. Thank you so much.