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Item 192. Health Equity Starts with Us: Recommendations from the Indiana Clinical and Translational Sciences Institute Racial Justice and Health Equity Task Force(Cambridge University Press, 2022) Sotto-Santiago, Sylk; Tucker Edmonds, Brownsyne; Wiehe, Sarah; Moe, SharonOBJECTIVES/GOALS: The Indiana CTSI Strategy Committee charged the Racial Justice and Health Equity Taskforce to identify priorities with short-term and long-term goals consistent with the I-CTSI mission. In addition, I-CTSI leadership asked for a general description of current state and the resources necessary to achieve the proposed goals. METHODS/STUDY POPULATION: The Taskforce applied an inclusive excellence model to the way we look at the I-CTSI structure, policies, and programs while performing an environmental scan within and across I-CTSI partner institutions. In order to reach equitable solutions and consensus, listening tours were held with partner stakeholders guided by the SOAR framework for strategic planning. This approach allowed us to assess current resources, needs, and gaps across the system, along with a baseline of measures currently monitored. Taskforce members openly discussed strengths and opportunities for enhancement of current programs and services. In addition, these conversations offered an opportunity to disrupt existing practices and through collective agency we identified priority areas that promote equity, diversity and inclusion. RESULTS/ANTICIPATED RESULTS: The Taskforce identified recurring themes in conversations with all partners, which led to the formation of three working groups that examined recruitment broadly: workforce, staffing, and research participation; professional development across all stakeholders from community members to I-CTSI staff; and data-centered metrics informing current state, decision-making, and accountability. Recommendations included these priorities, content, and implementation strategies. The Taskforce delivered a report to the I-CTSI leadership fostering the promotion of diversity, equity and inclusion along with a systematic collection of gender, race, and ethnicity data for individuals utilizing I-CTSI services and resources requiring additional metrics and tracking. DISCUSSION/SIGNIFICANCE: The pandemic shed light on the manner in which marginalized groups are rendered particularly vulnerable to death and disease by systemic and structural racism. The I-CTSI recognized that we cannot advance population health without attending to root causes of inequity and that includes our internal structure. We offer a potential model for other CTSAs.Item 4034 Can Connections IN Health become a research-based model to improve health outcomes through community health coalitions?(Cambridge University Press, 2020-07-29) Darbishire, Lily; Wiehe, Sarah; Savaiano, Dennis; Pediatrics, School of MedicineOBJECTIVES/GOALS: Connections IN Health’s goal is to coordinate, integrate, and enrich health coalition work through extended connections among community and academic stakeholders within and across coalitions and geographies within Indiana. We aim to evaluate stakeholder connections to assess coalition effectiveness and the quality of partnership networks. METHODS/STUDY POPULATION: We will collect data longitudinally to evaluate Connections IN Health using a unique triangulation of effectiveness surveys, social network analysis, and health data. Cross-sectional functioning and social network analysis surveys were distributed to coalition members before the transition to Connections IN Health engagement (baseline) and will be distributed again each year thereafter to identify changes in coalition perceived effectiveness and changes in the structure/nature of partnership networks after implementation of the partnership. We plan to utilize publicly available health data to measure proximal changes in health outcomes at the neighborhood level and use Pearson’s correlations to check for associations between perceived coalition effectiveness and health outcomes. RESULTS/ANTICIPATED RESULTS: We found low baseline scores in perceived effectiveness, especially in the areas of leadership, operational understanding, and satisfaction, from the coalition members. From our social network analysis, we found relatively low cohesion scores (measured as network density) among each of the coalition networks, and even lower scores for collaboration among coalition members. We expect to see positive increases in perceived coalition effectiveness, as well as an increase in the density and level of collaboration among coalition networks as Connections IN Health develops. Finally, we expect to see positive changes in proximal health outcomes associated with our measures of coalition effectiveness. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of our project will be distributed back to the coalition leaders and members in order to sustain and improve the coalitions. The visualization of the coalition member’s network can be used to demonstrate opportunities for enhanced partnerships and collaboration.Item 4405 Chronic Disease in Indiana – Using a Community Health Matrix to Determine Health Factors for Indiana Counties(Cambridge University Press, 2020-07-29) Wiehe, Sarah; Zych, Aaron; Hinshaw, Karen; Alley, Ann; Claxton, Gina; Savaiano, Dennis; Pediatrics, School of MedicineOBJECTIVES/GOALS: The goal of this project was to inform four chronic disease initiatives, working together on the team Connections IN Health, and counties in Indiana on certain areas of need to assist them in collaborative planning. The chronic diseases focused on include diabetes, cardiovascular disease, stroke, asthma, lung cancer and obesity. METHODS/STUDY POPULATION: Chronic disease health outcomes and social determinants of health indicators were identified in all 92 Indiana counties. Counties were compared by composite z scores in a matrix to determine the 23 counties with the poorest health statistics for diabetes, cardiovascular disease, stroke, asthma, lung cancer, obesity and life expectancy. Qualitative data were used to identify local health coalitions that have the capacity and desire to work with Connections IN Health to improve these health outcomes. With input from partners, the counties were narrowed to 10 that were identified as those with the most need in the specific areas of chronic disease that the initiatives focus on. The team will begin listening sessions with two of these counties to identify strategic partnerships, funding sources, and evidence-based programs to address community-identified health priorities. RESULTS/ANTICIPATED RESULTS: The 23 counties with the poorest health outcomes related to chronic disease and factors were Blackford, Clark, Clay, Fayette, Fulton, Grant, Greene, Howard, Jay, Jennings, Knox, Lake, LaPorte, Madison, Marion, Pike, Scott, Starke, Sullivan, Vanderburgh, Vermillion, Vigo, and Washington. There was significant overlap in low z score rankings for individual health and social determinants of health measures among these 23 counties. The following 10 counties were selected for focus in the next five years based on partner input: Blackford, Clay, Grant, Jennings, Lake, Madison, Marion, Starke, Vermillion, and Washington. The Connections IN Health team has initiated listening sessions in Grant and Vermillion Counties (with data for presentation at the ACTS meeting). DISCUSSION/SIGNIFICANCE OF IMPACT: This mixed methods approach using existing data and partner input on county capacity/readiness directed Connections IN Health to counties with the most need for coalition efforts. Engagement within each county will inform next steps (e.g., capacity building, partnership development, applications for funding, implementation of evidence-based programs) and specific health focus area(s).Item 4408 Using a human-centered design process to address challenges of engaging pregnant & parenting women with opioid use disorder(Cambridge University Press, 2020-07-29) Wiehe, Sarah; Lynch, Dustin; Moore, Courtney; Cockrum, Brandon; Hawryluk, Bridget; Claxton, Gina; Pediatrics, School of MedicineOBJECTIVES/GOALS: Using a human-centered approach, IDEO, a nationally-renown human-centered design team, and Research Jam, Indiana CTSI’s patient engagement core, integrated and tailored complimentary programs to address the challenges of engaging mothers with opioid misuse around the time of birth. METHODS/STUDY POPULATION: Gathered data through focus groups, site visits, and one-on-one interviews with key stakeholders: mothers in opioid use recovery, peer recovery coaches, and other people living with or directly affected by opioid use disorder (OUD). RESULTS/ANTICIPATED RESULTS: Themes emerged around stigma (e.g., constant judgment, majority of interactions focused on addiction, addiction comes from bad choices), the healthcare system (e.g., healthcare system bias and stigma, misalignment of services and timing of need, no support for support network), and relating to recovery (very variable but generally ambiguous and uncertain process and outcomes, importance of peer recovery coaches, importance of community resources). Identified themes were used to create insights that informed the underlying concepts of an engagement strategy including support and resources for recovery coaches, and education materials for mothers with OUD. One of human-centered design’s strengths is iteration, and the materials created for this have yet to be tested and refined thoroughly to be meaningful and lasting interventions. DISCUSSION/SIGNIFICANCE OF IMPACT: Considerable insights into the lived experience of those experiencing OUD and those who support these individuals yielded tangible ways to test improved engagement and recruitment of women with OUD at the time of birth.Item 4409 Indiana Clinical & Translational Science Monon Collaborative – Community Impact Hubs(Cambridge University Press, 2020-07-29) Wiehe, Sarah; Craig, David M.; Wilcox, Matthew; Hardwick, Emily; Lawrence, Carrie; Schicho, Fiona; Hudson, Brenda; Pediatrics, School of MedicineOBJECTIVES/GOALS: Conduct an environmental scan of Marion County (Indianapolis) neighborhoods using electronic medical record data, state health data, and social and economic data. Develop strong network of community collaborators. Conduct a thorough assessment for each targeted neighborhood by listening and understanding the pressing health issues in the community and working together to design and deliver solutions. METHODS/STUDY POPULATION: Identify measures in the 3 domains of vulnerability, health and assets for the targeted neighborhoods and conduct bivariate descriptive statistics and multivariable regression analyses to investigate association between measures of vulnerability and health outcomes. Initiate relationships with leaders and residents in targeted neighborhoods. Locate organizations working in targeted neighborhoods through online mapping software and word-of-mouth at neighborhood events, and created a spreadsheet with contact information. Conduct multidisciplinary assessment (i.e. key informant interviews, focus groups, town hall meetings) of the targeted neighborhood. Iteratively synthesize assessments to develop areas of interest and relevance to the community. Develop a road map for solutions identified by the community. RESULTS/ANTICIPATED RESULTS: The results from the environmental scan conducted will be displayed in a report and visual “map” of health outcomes and health determinants, including assets and barriers for the targeted neighborhoods. The research team will use results from the environmental scan coupled with listening activities including attendance at community events, key informant interviews and focus groups to develop relationships and strong collaborations with the targeted neighborhood stakeholders. The relationship building between the research team and community will provide increased trust and engagement that will further enhance the effectiveness of the assessments completed with the targeted neighborhood. The assessments will help to empower communities to develop sustainable solutions and drive future work that will lead to future grant applications and larger-scale implementation in other community impact hub neighborhoods. DISCUSSION/SIGNIFICANCE OF IMPACT: Through the community impact hub work, we will develop collaborative efforts with targeted neighborhoods with the greatest health inequities in the Marion County area. In partnership with these neighborhoods, we will build a foundation – a network of community collaborators and a focused plan – upon which we will improve the health outcomes of residents while learning best practices on how to do so.Item 58896 Feasibility of a Parent Navigator Program for Parents of Justice-Involved Youth(Cambridge University Press, 2021-03-30) Dir, Allyson L.; Wiehe, Sarah; Aalsma, Matthew C.; Psychiatry, School of MedicineABSTRACT IMPACT: Development and implementation of a parent navigator program to help parents of justice-involved youth could assist parents in navigating the justice system, improve engagement with court and probation, and ultimately improve outcomes for youth involved in the juvenile justice system OBJECTIVES/GOALS: The goals of the study are to (1) develop a parent-peer navigator program utilizing community-based participatory design; and (2) implement and assess the feasibility of a parent peer navigator program in an urban juvenile justice system. METHODS/STUDY POPULATION: The EPIS framework will guide development and implementation of the navigator program as well as measurement of the implementation process, including measurements of feasibility and acceptability. In the Exploration phase, qualitative interviews with juvenile justice staff, parents of justice-involved youth, and members of the local family advisory board will inform program needs. In the preparation stage, I will work closely with the family advisory board to develop the actual parent navigator program protocol, including a training plan for navigators and their specific roles. I will conduct an open trial in the implementation phase, measuring program feasibility and acceptability among parents, navigators, juvenile justice staff, parents, and youth utilizing mixed methods. RESULTS/ANTICIPATED RESULTS: Results will inform feasibility of implementing the program as well as acceptability of the program based on mixed methods data from parents of justice-involved youth, juvenile justice staff, family advisory board members, and other community stakeholders. Results will potentially inform conduct of a larger scale pilot hybrid implementation-effectiveness study. DISCUSSION/SIGNIFICANCE OF FINDINGS: Development and implementation of a parent navigator program to help parents of justice-involved youth could assist parents in navigating the justice system, improve engagement with court and probation, and ultimately improve outcomes for youth involved in the juvenile justice system.Item A human-centered designed outreach strategy for a youth contraception navigator program(Elsevier, 2022) Wilkinson, Tracey A.; Hawryluk, Bridget; Moore, Courtney; Peipert, Jeffrey F.; Carroll, Aaron E.; Wiehe, Sarah; Fortenberry, J. Dennis; Pediatrics, School of MedicineObjective: To identify key elements of an outreach strategy for a youth contraception navigator program designed to help young people overcome barriers to contraception access. Methods: A human-centered design approach was used to engage adolescents aged 15-17 in co-design sessions. Human-centered design techniques, such as affinity diagramming and model building were used to inform key elements of the communication model and the final outreach strategy messages. Results: Messages focused on the individual, normalizing talking about birth control, acknowledging the challenges to obtaining birth control, explaining how the navigator program works resonate with young people. Having images of diverse participants, offering information about birth control, and showing images of reputable sources will enhance trust. Conclusions: A name (IN Control) and key elements of an outreach strategy were determined for the navigator program. It is important to work with key stakeholders and co-design the optimal strategy and messages to assure that the intended audience is reached, and the desired behavior change is achieved. Innovation: Human-centered design techniques can be used to provide insight into programmatic outreach strategies for a contraception navigator program to increase their impact and ultimate success.Item Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment(Office of the Vice Chancellor for Research, 2012-04-13) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah; Zollinger, TerryUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program.Item Community engagement of adolescents in the development of a patient-centered outcome tool for adolescents with a history of hypospadias repair(Elsevier, 2019-10-01) Chan, K. H.; Panoch, J.; Carroll, A.; Downs, S.; Cain, M. P.; Frankel, R.; Cockrum, B.; Moore, C.; Wiehe, Sarah; Urology, School of MedicineIntroduction: Hypospadias may lead to long-term issues with urination, sexual function and psychosocial well-being. Limited evidence exists regarding the healthcare communication preferences of male adolescents regarding sensitive topics. Objective: The purpose of this qualitative study was to explore the healthcare communication preferences of male adolescents regarding sensitive topics (e.g. urinary and sexual issues) and engage them in in the initial stages of development a patient-centered outcomes tool for adolescents with a history of hypospadias repair. Study Design: A multi-disciplinary team with communication design expertise, pediatric urology experts, and health services researchers developed a self-reported toolkit for adolescent patients who had hypospadias repair as children. The toolkit featured short writing/diagramming exercises and scales to facilitate participant reflections about genital appearance, urination, sexual function and psychosocial well-being. We recruited students from two local high schools for two focus groups to obtain feedback about the usability/acceptability of the toolkit’s appearance/content. We inquired about language preferences and preferred format and/or setting for sharing sensitive information with researchers. The focus groups were audio recorded, professionally transcribed, checked for accuracy and analyzed by two coders using qualitative content analysis. Major themes and subthemes were identified and representative quotes were selected. Results: We conducted two focus groups in January 2018 with 33 participants, ages 14-18. Participants preferred language that would make patients feel comfortable as well as serious, clinical language rather than slang terms/sexual humor (Extended Summary Table). They recommended avoidance of statements implying that something is wrong with a patient or statements that would pressure the patient into providing answers. They suggested fill-in-the-blank and open-ended responses to encourage freedom of expression and colorful graphics to de-emphasize the test-like appearance of the toolkit. Most participants preferred a toolkit format to a one-on-one interview to discuss sensitive topics such as urinary or sexual issues. Participants would prefer either a male interviewer or would like to have a choice of interviewer gender for individual qualitative interviews, and they recommended a focus group leader with a history of hypospadias repair. Discussion: This study provides a rich description of a group of male high school students’ experiences with healthcare providers and researchers. Its qualitative design limits generalizability and our findings may not be similar to adolescents with a history of hypospadias repair. Conclusion: We used focus group feedback on the toolkit prototype to refine the tool for use in a future study of adolescents with history of hypospadias repair.Item Community Engagement of Adolescents in the Development of a Patient-Centered Outcomes Tool for Adolescents with a History of Hypospadias Repair(Elsevier, 2019) Chan, Katherine H.; Panoch, Janet; Carroll, Aaron; Downs, Stephen; Cain, Mark P.; Frankel, Richard; Cockrum, Brandon; Moore, Courtney; Wiehe, Sarah; Pediatrics, School of MedicineIntroduction Hypospadias may lead to long-term issues with urination, sexual function and psychosocial well-being. Limited evidence exists regarding the healthcare communication preferences of male adolescents regarding sensitive topics. Objective The purpose of this qualitative study was to explore the healthcare communication preferences of male adolescents regarding sensitive topics (e.g. urinary and sexual issues) and engage them in in the initial stages of development a patient-centered outcomes tool for adolescents with a history of hypospadias repair. Study Design A multi-disciplinary team with communication design expertise, pediatric urology experts, and health services researchers developed a self-reported toolkit for adolescent patients who had hypospadias repair as children. The toolkit featured short writing/diagramming exercises and scales to facilitate participant reflections about genital appearance, urination, sexual function and psychosocial well-being. We recruited students from two local high schools for two focus groups to obtain feedback about the usability/acceptability of the toolkit’s appearance/content. We inquired about language preferences and preferred format and/or setting for sharing sensitive information with researchers. The focus groups were audio recorded, professionally transcribed, checked for accuracy and analyzed by two coders using qualitative content analysis. Major themes and subthemes were identified and representative quotes were selected. Results We conducted two focus groups in January 2018 with 33 participants, ages 14-18. Participants preferred language that would make patients feel comfortable as well as serious, clinical language rather than slang terms/sexual humor (Extended Summary Table). They recommended avoidance of statements implying that something is wrong with a patient or statements that would pressure the patient into providing answers. They suggested fill-in-the-blank and open-ended responses to encourage freedom of expression and colorful graphics to de-emphasize the test-like appearance of the toolkit. Most participants preferred a toolkit format to a one-on-one interview to discuss sensitive topics such as urinary or sexual issues. Participants would prefer either a male interviewer or would like to have a choice of interviewer gender for individual qualitative interviews, and they recommended a focus group leader with a history of hypospadias repair. Discussion This study provides a rich description of a group of male high school students’ experiences with healthcare providers and researchers. Its qualitative design limits generalizability and our findings may not be similar to adolescents with a history of hypospadias repair. Conclusion We used focus group feedback on the toolkit prototype to refine the tool for use in a future study of adolescents with history of hypospadias repair.
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