Facilitating Abortion Services in Primary Care Settings After the Loss of Federal Protections

The Journal of the American Board of Family Medicine · 2026-01-01

INTRODUCTION: Abortion care access became more restricted following the 2022 US Supreme Court decision, Dobbs vs Jackson Women's Health, that eliminated federal protection. We sought to engage healthcare clinicians in states in the Northwestern U.S. with varied abortion regulations to develop strategies for primary care involvement in access to and follow up for abortion care. METHODS: The "Won't Go Back" initiative began in July 2022, recruiting members from the five state WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice Based Research Network (WPRN), Family Medicine Residency Network (FMRN) and Washington state family planning clinics. We completed a cross-sectional needs assessment survey (winter 2022) and virtual convenings (summer 2023). We used descriptive statistics to describe participant demographics, reproductive health services offered, documented needs, and proposed solutions including abortion care education and referral networks. RESULTS: 193 surveys were sent to individual clinicians with 40 responses (21% response rate) from Washington, Idaho, Montana and Alaska. All participants' provided reproductive health services, and 25% offered abortion care. All clinicians wished to support their patients seeking abortion care. Barriers faced by convening attendees included obtaining mifepristone, federal funding restrictions and navigating anti-abortion views. Proposed solutions from survey and convening representatives included creation of a learning collaborative and regional networks of primary care abortion clinicians. CONCLUSION: Survey and convening representatives were interested in enhancing abortion access for their patients. Clinicians faced barriers due to federal and state legal restrictions. Creation of an abortion learning collaborative and referral networks addressing identified barriers can potentially support patients.

Drowning in the Wake

2025-01-01

Inspiring the Next Generation: Challenges and Strategies for Onboarding and Retention in an Undergraduate CubeSat Design Team

Digital Commons - USU (Utah State University) · 2025-08-21

The University of Toronto Aerospace Team (UTAT) Space Systems Division is a fully student levy-funded, student-led undergraduate design team that develops CubeSats with research-oriented payloads. UTAT’s mission is to provide undergraduate students with unique opportunities to develop engineering design skills outside of the classroom, and therefore has a distinct focus on member growth and education. As an undergraduate student team, UTAT faces a unique set of challenges in onboarding members and maintaining a strong knowledge base on the team. These challenges include onboarding members with limited technical experience, equipping them with satellite design skills, and maintaining high interest levels among volunteer members with limited time to contribute. The team has implemented a wide range of strategies related to onboarding and member development over the past two years. Notable examples include hosting workshops and regular work sessions, and employing practice projects for technical skill development. This paper presents these practices in depth and evaluates their impacts using both quantitative and qualitative metrics of team success including retention rates, team demographic data, and individual perceptions of team dynamics. It also evaluates these practices against scientifically backed models, while evaluating the effectiveness of these models in the student team environment. Lessons learned include the importance of emphasizing a culture of inclusivity and psychological safety as well as utilizing workshops and skill-building modules both in the onboarding phase and throughout the year to generate and maintain interest in the team. The practices presented here are relevant and transferable to similar organizations including student teams, industry projects, and research initiatives.

Bands (and Longhouses) of Brothers (and Sisters): Siblinghood Among the Barí of the Maracaibo Basin

Journal of Anthropological Research · 2025-02-20 · 1 citations

Ethnographic evidence from the Barí suggests that for these people the sibling-sibling connection is at least as prominent as the parent-child connection and the husband-wife connection as a foundational kin bond by means of which their overall social organization is constructed. In particular, siblinghood is probably the most important bond in the creation and perpetuation of the local longhouse groups that are the subsistence and residential basis of Barí society, and the assemblages of those local groups that form their territorial federations.

Problem Solving Treatment for Depression: Development and Randomized Controlled Trial of an Internet-Based Support Tool Created Through Human Centered Design (Preprint)

2025-08-29

<sec> <title>BACKGROUND</title> While Problem Solving Treatment (PST) for depression is an effective psychotherapy in primary care settings, it is not widely used and clinician fidelity to key elements drops quickly following training. Human Centered Design (HCD) is an approach to understanding the needs of product users which can uncover obstacles through the lens of usability. </sec> <sec> <title>OBJECTIVE</title> We sought to identify usability challenges and implementation solutions for both clinicians who wished to deliver PST and their patients, create a solution using HCD methods, and pilot this solution. </sec> <sec> <title>METHODS</title> As part of the University of Washington ALACRITY Center (NIMH-P50MH115837), we applied the Discover, Design, Build, and Test (DDBT) human-centered design framework. Discover, Design, and Build stages included clinician and patient observations and interviews, and identification of themes and support needs for PST. PST-Aid was created as an internet-based app to overcome obstacles to PST. A Type III hybrid effectiveness/ implementation pilot trial of identified solutions was planned with emphasis on its possible implementation benefits. Randomization to training in PST versus the PST-Aid intervention was planned with a new set of providers other than those involved with HCD co-design activities. Usability was assessed through self-assessed survey. Time to clinician certification in PST, their ongoing fidelity to PST, and clinically significant improvement in patient depression severity (PHQ-9 scores) were the primary outcomes of interest. </sec> <sec> <title>RESULTS</title> A range of HCD methods and rapid prototyping cycles were carried out with co-design clinicians (9 undergoing PST training-as-usual and 10 experienced PST clinicians) and their patients (n = 4), which led to a web-based application that served to support and “scaffold” PST tasks as well as provide decision support for both providers and patients (PST Aid app). Usability was acceptable (SUS = 76), and utility was high based on qualitative assessments. In the Test phase, 11 clinical social workers were randomized to study conditions (7 PST Aid, 4 PST as Usual). All PST Aid clinicians were successfully certified as PST practitioners, while only 33% of PST as usual clinicians achieved certification. More clinicians used PST with their patients in the PST Aid group than those in PST as Usual throughout the study period (72% vs. 50%; p&lt;0.05). More participants in the treatment arm (PST Aid; 67%) had scores that improved to below 10 on the PHQ-9 than participants receiving PST as Usual, but this did not reach statistical significance (Fisher's exact test, p = .07). </sec> <sec> <title>CONCLUSIONS</title> We found that a human centered design approach to technology-based "scaffolding" can support the adoption, reach, and sustained fidelity of an evidence-based clinical intervention. Involving clinicians and patients in the design process may enhance the use and adoption of support tools. This pilot lays the groundwork for a large randomized hybrid effectiveness/implementation trial. </sec> <sec> <title>CLINICALTRIAL</title> ClinicalTrials.gov NCT03516513; https://clinicaltrials.gov/study/NCT03516513 </sec>

A rare reaction to a common procedure - anaphylactoid reaction to PEG push pad found in breast tissue markers

International Surgery Journal · 2025-05-28

Polyethylene glycol (PEG) is a synthetic polymer used in a multitude of medical and non-medical settings. Allergy to PEG is a rare but potentially life-threatening condition. We report a case of an anaphylactoid reaction to the PEG component of a breast tissue marker and its subsequent removal using a vacuum assisted biopsy device. We believe this is an important case to draw attention to the fact that PEG is an additive in multiple medications and devices and the product information must be carefully reviewed when planning to administer a medication or device in a patient with a known PEG allergy. This case also highlights the use of vacuum assisted excision as an appropriate non-surgical means of intervention in managing this unusual event.

Artificial Intelligence in Public Health

Primary Care Clinics in Office Practice · 2025-11-16

Harnessing Human-Centered Design for Evidence-Based Psychosocial Interventions and Implementation Strategies in Community Settings: Protocol for Redesign to Improve Usability, Engagement, and Appropriateness

JMIR Research Protocols · 2024-12-02 · 5 citations

BACKGROUND: Although substantial progress has been made in establishing evidence-based psychosocial clinical interventions and implementation strategies for mental health, translating research into practice-particularly in more accessible, community settings-has been slow. OBJECTIVE: This protocol outlines the renewal of the National Institute of Mental Health-funded University of Washington Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center, which draws from human-centered design (HCD) and implementation science to improve clinical interventions and implementation strategies. The Center's second round of funding (2023-2028) focuses on using the Discover, Design and Build, and Test (DDBT) framework to address 3 priority clinical intervention and implementation strategy mechanisms (ie, usability, engagement, and appropriateness), which we identified as challenges to implementation and scalability during the first iteration of the center. Local redesign teams work collaboratively and share decision-making to carry out DDBT. METHODS: All 4 core studies received institutional review board approval by June 2024, and each pilot project will pursue institutional review board approval when awarded. We will provide research infrastructure to 1 large effectiveness study and 3 exploratory pilot studies as part of the center grant. At least 4 additional small pilot studies will be solicited and funded by the center. All studies will explore the use of DDBT for clinical interventions and implementation strategies to identify modification targets to improve usability, engagement, and appropriateness in accessible nonspecialty settings (Discover phase); develop redesign solutions with local teams to address modification targets (Design and Build phase); and determine if redesign improves usability, engagement, and appropriateness (Test phase), as well as implementation outcomes. Center staff will collaborate with local redesign teams to develop and test clinical interventions and implementation strategies for community settings. We will collaborate with teams to use methods and centerwide measures that facilitate cross-project analysis of the effects of DDBT-driven redesign on outcomes of interest. RESULTS: As of January 2025, three of the 4 core studies are underway. We will generate additional evidence on the robustness of DDBT and whether combining HCD and implementation science is an asset for improving clinical interventions and implementation strategies. CONCLUSIONS: During the first round of the center, we established that DDBT is a useful approach to systematically identify and address chronic challenges of implementing clinical interventions and implementation strategies. In this subsequent grant, we expect to increase evidence of DDBT's impact on clinical interventions and implementation strategies by expanding a list of common challenges that could benefit from modification, a list of exemplary solutions to address these challenges, and guidance on using the DDBT framework. These resources will contribute to broader discourse on how to enhance implementation of clinical interventions and implementation strategies that integrate HCD and implementation science. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/65446.

Recruiting Community Health Centers for Implementation Research: Challenges, Implications, and Potential Solutions

Health Equity · 2024-02-01 · 6 citations

Contributions to the Literature Under-resourced clinics (e.g., community health centers) wishing to participate in implementation research may be unable to do so because of financial and staffing resource limitations, and thus may be under-represented in implementation science results. This may introduce bias that limits study findings' generalizability, impacts evidence-based intervention adoption in similar care settings, and exacerbates health inequities. Recruitment bias is well studied in patient-randomized trials but not in clinic-randomized trials. This article presents two examples of studies seeking to recruit under-resourced clinics and highlights challenges inherent to recruiting such clinics in implementation science trials, and potential ramifications for study generalizability and health equity. Editorial Implementation science generates knowledge about effective approaches for supporting the adoption and sustainment of evidence-based interventions (EBIs).1 Maximizing the external validity (and generalizability) of randomized trials' findings in implementation research requires recruiting study sites that represent the settings where adoption of a given EBI is desired.2 Recruitment to clinic-randomized trials may be challenging, however, when the care settings of interest are under-resourced clinics such as community health centers (CHCs), with the potential to exacerbate health inequities. As the nation's health care safety net, CHCs serve >30 million socioeconomically vulnerable patients regardless of ability to pay, often operating with very limited financial and staffing resources.3 Achieving health equity will require optimizing EBI implementation in this setting.4 Yet although CHCs may recognize the value of taking part in EBI implementation trials, their resource limitations may prohibit study participation.5 This may result in such settings' under-representation in implementation research, introducing potential recruitment bias, weak evidence on EBI implementation in under-resourced settings,6 study findings that are not generalizable to the under-represented populations served by CHCs, and a threat that health inequities will be perpetuated.6?8 Recruitment bias in patient-randomized trials is well studied and known to adversely impact study findings' generalizability.7 As far less is known about recruitment bias in clinic-randomized trials, we present insights from two recent implementation studies targeting evidence-based perinatal care delivery in CHCs, and call for action to address this critical knowledge gap. The Maternal Infant Dyad-Implementation (MInD-I) study, a clinic-randomized trial testing implementation of the Collaborative Care Model to treat perinatal depression in CHCs, aimed to recruit 20 primary care clinics from OCHIN's Practice-based Research Network, which at the time included 123 health systems across 19 states. Of 36 eligible clinics invited to participate, 67% (n=24) expressed initial interest in participation, but ultimately only 28% (n=10) agreed to participate. Linking Inter-professional Newborn and Contraception Care (LINCC), a trial testing implementation of a model wherein postpartum contraceptive care is scheduled at newborn care visits, aimed to recruit 10 clinics affiliated with AllianceChicago, a Health Center Controlled Network including 45 safety-net clinics across 18 states at the time. Of 19 eligible clinics invited to participate, 89% (n=17) expressed initial interest in participation, but ultimately only 26% (n=5) agreed to participate. In both studies, clinics were asked to allocate protected time for multiple staff involved with implementation and study-related activities as a required component of participation. LINCC provided compensation to participating clinics; MInD-I did not. In both trials, only half of the recruitment goal was achieved. Most sites that declined (85%; 64%) cited lack of capacity (e.g., staffing, time), competing clinical priorities, or insufficient leadership buy-in as the primary reason for not participating. One medical director noted, ?We appreciate the concept of the performance improvement study and the clinical training offered; however, participation will require additional resources of various staff ? that we do not have.? A second medical director noted, ?We have multiple competing projects in flight right now and realize that we do not have the resources to make this project successful.? Health Equity Implications The examples presented here demonstrate that even when CHCs are interested in trial participation, they may lack capacity to do so, especially if the targeted EBIs involve multiple complex implementation steps (e.g., intensive workflow changes). The costs of covering staff time to train and carry out practice change can be substantial,8 so when deciding on research participation, CHC leadership must balance the costs of diverting resources (e.g., loss of revenue for provider time) against the EBI's potential benefits and the feasibility of its post-study sustainment. Here, many clinic leaders recognized the potential benefits of study participation, but ultimately declined to participate given resource limitations and concerns about impacts on clinic operations. This aligns with prior research showing that CHCs' research participation can be inhibited by resource constraints, including the inability to provide the up-front resources (e.g., personnel, time) often required for study engagement.5,8,9 Under-representation of CHCs in implementation science trials may threaten trial results' external validity, creating knowledge gaps about how to equitably disseminate EBIs in such settings. Ensuring that implementation research does not inadvertently widen health inequities in targeted outcomes in the communities served by these care settings will require understanding why and how under-resourced health care organizations participate in implementation-related trials. Adding complexity, a tension in implementation science is that providing financial resources to help study sites implement an EBI may increase the feasibility of CHCs' study participation, but also lead to study results that do not reflect real-world implementation outcomes, as such implementation resources would not be available outside of a study context. Yet when studies do not provide resources to enable CHCs to participate, there is a risk that CHCs will be excluded from research, which could limit generalizability of study findings in these settings and exacerbate health inequities, analogous to how recruitment bias impacts patient-randomized trials. Solutions to Consider These examples and prior research suggest some potential strategies for promoting CHC participation in implementation trials. Researchers might design studies with an equity lens, focus on interventions highly adaptable to under-resourced settings, use research funds to engage and compensate clinicians as constituents or co-investigators, and/or incorporate nonmonetary incentives (e.g., continuing medical education credits, electronic health record training).4,6,9,10 In recruitment, research teams might adopt flexible, multimodal outreach methods that build participant buy-in, and plan for a substantial investment of time and resources for recruitment activities.9 These recommendations should also be considered by funders, who could adjust funding models to enable clinician engagement as described above and address known research capacity gaps in under-resourced settings. These recommendations are a starting point for engaging CHCs in implementation trials. Research is needed to better understand CHC-specific participation determinants, the implications of recruitment bias in clinic-randomized implementation studies, and strategies that address participation barriers without impacting results. As CHC patient populations are highly likely to benefit from effective EBI implementation, their inclusion in implementation research is essential to ensure the generalizability of study findings to these settings and their patients?and to improve the equitable implementation of EBIs. Consent for Publication We obtained written permission to include the two medical directors' quotes noted in the Results section.

Implementation cost analysis of collaborative care for perinatal mental health in community health centers

Research Square · 2024-11-27 · 1 citations