Development and Feasibility of a Community-Based, Culturally Flexible Colorectal Cancer Prevention Program

New insights about community benefit evaluation: Using the Community Health Implementation Evaluation Framework to assess what hospitals are measuring

BACKGROUND

Nonprofit hospitals are required to conduct community health needs assessments (CHNA) every 3 years and develop corresponding implementation plans. Implemented strategies must address the identified community needs and be evaluated for impact.

PURPOSE

Using the Community Health Implementation Evaluation Framework (CHIEF), we assessed whether and how nonprofit hospitals are evaluating the impact of their CHNA-informed community benefit initiatives.

METHODOLOGY

We conducted a content analysis of 83 hospital CHNAs that reported evaluation outcomes drawn from a previously identified 20% random sample ( n = 613) of nonprofit hospitals in the United States. Through qualitative review guided by the CHIEF, we identified and categorized the most common evaluation outcomes reported.

RESULTS

A total of 485 strategies were identified from the 83 hospitals' CHNAs. Evaluated strategies most frequently targeted behavioral health ( n = 124, 26%), access ( n = 83, 17%), and obesity/nutrition/inactivity ( n = 68, 14%). The most common type of evaluation outcomes reported by CHIEF category included system utilization ( n = 342, 71%), system implementation ( n = 170, 35%), project management ( n = 164, 34%), and social outcomes ( n = 163, 34%).

PRACTICE IMPLICATIONS

CHNA evaluation strategies focus on utilization (the number of individuals served), with few focusing on social or health outcomes. This represents a missed opportunity to (a) assess the social and health impacts across individual strategies and (b) provide insight that can be used to inform the allocation of limited resources to maximize the impact of community benefit strategies.

Designing a Digital Culinary Education Intervention for Parents With Low Income

OBJECTIVE

To examine cooking practices, online information-seeking habits, and intervention preferences among parents with low income to inform the development of a digital cooking intervention on the basis of the Healthy Cooking Index.

METHODS

This formative research study included a brief survey followed by in-depth interviews (from February to April, 2021) with parents of a child aged 6-11 years with low income (n = 20; 100% female, 70% African American or Hispanic White). Interview transcripts were analyzed using a semistructured hybrid coding approach.

RESULTS

Three main themes were identified to inform the development of the intervention: (1) current Healthy Cooking Index behaviors, (2) preferences for digital cooking intervention content, and (3) design and delivery preferences. A 7-step process was used to develop the intervention and integrate qualitative findings.

CONCLUSIONS AND IMPLICATIONS

Online culinary programs targeting parents with low income may consider short, mobile-friendly video formats and focus on easy-to-prepare recipes adaptable to family preferences.

Outcomes of a Colorectal Enhanced Recovery After Surgery Protocol Modified for a Diverse and Urban Community

INTRODUCTION

Enhanced recovery after surgery (ERAS) colorectal programs have been shown to improve the length of stay (LOS) without increasing hospital resource utilization at academic centers worldwide. A multidisciplinary ERAS protocol that includes preoperative, intraoperative, and postoperative management guidelines was recently implemented at our urban, racially diverse, and academically affiliated community hospital. A delivery option was provided to reduce barriers to care. Given our unique patient population, the objective of our study was to determine if improvements in outcomes were reproducible in our hospital.

METHODS

This is a retrospective study of patients undergoing elective colectomy at New York-Presbyterian Queens Hospital between January 1, 2015, and December 31, 2020. Patient outcomes were compared between surgeries performed under standard practice (all colectomies prior to April 2017) and those performed after the implementation of the ERAS protocol. Demographic and perioperative data were abstracted from a prospectively derived database used to submit data to the National Surgical Quality Improvement Program. Additional data were obtained from chart review.

RESULTS

Six hundred five elective colectomies were performed by 12 surgeons (range 1-228 cases) during the study period. Of these, 22 were performed open (41% followed ERAS), 467 were performed laparoscopically (57% followed ERAS), and 116 were performed robotically (74% followed ERAS). The average patient age was 64 y. Of which, 55% were male; 34% were Asian, 27% were non-Hispanic Caucasian, 27% were Hispanic, and 11% were Black or African American (all P-values > 0.05 for ERAS versus non-ERAS). Average duration of procedure was longer in the ERAS group (262 min versus 243 min, P = 0.04), although when stratified by procedure type, this relationship held true only for laparoscopic procedures. Hospital LOS was significantly shorter in the ERAS group (4.3 versus 5.4 d, P < 0.001) and this relationship held true for procedures performed both laparoscopically (4.2 versus 5.3 d, P = 0.01) and robotically (4.1 versus 5.1 d, P = 0.04). Of the ERAS group, patients who opted for delivery of ERAS components (n = 205) had the shortest LOS when compared to patients who picked up components (n = 91) or opted out of ERAS (n = 309) (4.1 versus 4.4 versus 5.2 d, P = 0.003). No significant differences were found for 30-d mortality, 30-d readmission, wound infection, or other postoperative complications (all P-values > 0.05).

CONCLUSIONS

Implementation of an ERAS protocol in an urban, diverse, academically affiliated community hospital is associated with reductions in LOS for colectomies performed both laparoscopically and robotically. Facilitating ERAS compliance with a delivery option was also associated with improvements in hospital LOS. Preoperative nutrition supplementation was not associated with outcomes. No differences in mortality, readmission rates, or rates of postoperative complications were found.

The Relationship Between Covid-19 Risk Perception and Vaccine Hesitancy in Cancer Patients: The Moderating Role of Externalizing Traits

Objective

This mixed-methods study aimed to explore the role of externalizing traits in moderating the relationship between COVID-19 risk perception and vaccine hesitancy in patients diagnosed with cancer. A community-based participatory approach - comprising a preliminary qualitative inquiry and a subsequent cross-sectional research - was used to promote effective vaccination campaigns.

Method

12 people diagnosed with cancer and 7 cancer professionals were recruited for the qualitative inquiry, 356 people either under cancer treatment or in follow-up care for the cross-sectional research.A phenomenological analysis explored the transcripts of two focus groups. The cross-sectional research tested the hypothesis emerged during the previous qualitative inquiry through self-reported questionnaires and moderated regression.

Results

Phenomenological analysis suggested a pivotal role of externalizing traits in vaccine hesitancy. Moderated regression revealed how the association between risk perception and vaccine hesitancy is moderated by externalizing traits, even when controlled for treatment adherence.

Conclusions

In the present study we found a stronger relationship between risk perception and vaccine hesitancy for patients with higher levels of externalizing traits. We suggest that vaccination campaigns should be personality-informed to offer individualized and effective solutions. Patients with externalizing traits may cope dysfunctionally with vaccination campaigns.

Cooking After Cancer: the Structure and Implementation of a Community-Based Cooking Program for Cancer Survivors

Cancer survivors are a growing population that may particularly benefit from nutrition and lifestyle interventions. Community-based programs teaching healthy cooking skills are increasingly popular and offer an opportunity to support survivors within communities. The objective of this study is to describe the curriculum and implementation of a cooking class program designed for cancer survivors, housed within an established community-based organization. First, we evaluated the class curriculum for specific constructs. An evidence-based measure of healthy cooking constructs, the Healthy Cooking Index (HCI), was used to analyze included recipes and revealed both summative cooking quality scores and individual constructs underlying the overall curriculum. Second, a self-report questionnaire based on the HCI was conducted during the first and last class of the 6-week series. This allowed for a comparison between baseline cooking practices of participants and class curricula, as well as changes in reported practices after class participation. Using the HCI items and coding system, we found the curriculum focused on seven recurring constructs (measuring fat and oil, using citrus, herbs and spices, low-fat cooking methods, olive oil, and adding fruit and vegetables). Baseline reports demonstrated that many participants already practiced the main constructs driving the curriculum. As a potential result of this overlap, no changes in practices were found between the first and last session among class participants. Cooking classes for cancer survivors should be structured to not only reinforce positive existing behaviors but also to promote other healthy cooking practices and reduce less healthy behaviors such as using red meat and animal fats. The HCI can be used to understand the underlying constructs of existing cooking class curricula and current practices of survivor populations, allowing for a more tailored approach to practical nutrition education in this high-risk group.

Home Cooking Quality Assessment Tool Validation Using Community Science and Crowdsourcing Approaches

OBJECTIVE

To refine a measure of home cooking quality (defined as the usage level of practices with the potential to influence the nutrient content of prepared foods) and conduct a construct validation of the revised tool, the Healthy Cooking Questionnaire 2 (HCQ2).

DESIGN

Two validation approaches are described: (1) a community science approach used to refine and validate Healthy Cooking Questionnaire (HCQ) constructs, and (2) responses to the revised HCQ (HCQ2) in a sample of Amazon Mechanical Turk (MTurk) workers to determine questionnaire comprehension.

SETTING

The Community Scientist Program at the University of Texas MD Anderson Cancer Center facilitated discussion groups to refine the HCQ questions and validate constructs. MTurk workers were subsequently recruited to complete the refined survey so that comprehension and associations with demographic variables could be explored.

PARTICIPANTS

Ten community scientists participated in the refinement of the HCQ. The revised tool (HCQ2) was completed by 267 adult US-based MTurk workers.

VARIABLES MEASURED

Demographics, HCQ concepts, HCQ2, Self-Reported Questionnaire Comprehension.

ANALYSIS

Comprehension items were examined using descriptive statistics. Exploratory analysis the relationships between cooking quality and demographic characteristics, meal type, cooking frequency, as well as patterns of food preparation behavior was conducted on the MTurk sample RESULTS: The HCQ was refined through activities and consensus-building. MTurk responses to the HCQ2 indicated high comprehension and significant differences in cooking quality scores by demographic factors.

CONCLUSIONS AND IMPLICATIONS

This study refined and validated a self-report measure of cooking quality. Cooking quality measures offer critical evaluation methods for culinary programs.

Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study

Background

Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship.

Objective

We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families.

Methods

We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research’s Healthy Recipes, The Children’s Hospital of San Antonio’s Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center’s Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features.

Results

Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos.

Conclusions

The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience.

Primary Prevention of Prescription Drug Misuse Among Culturally and Linguistically Diverse Suburban Communities

Comprehensive strategies for prescription drug misuse must reach culturally and linguistically diverse suburban populations to effectively combat the ongoing opioid epidemic. The purpose of this study was to conduct a community needs assessment and inform the development and implementation of culturally appropriate primary prevention strategies for community-based interventions, specifically related to medication disposal practices. Three data collection techniques were utilized: key informant interviews (n = 4), intercept surveys (n = 71), and focus group discussions (n = 8; 61 participants). To accommodate linguistically diverse subpopulations, surveys and focus groups were available in English, Spanish, Arabic, Russian, and Hindi. Participants were overwhelmingly female (survey: 70%/FGD: 84%), ethnic minorities (survey: 61%/FGD: 66%), and, on average, middle-aged [survey: 52 years (SD: 19)/FGD: 54 (15)]. Approximately one in three survey respondents (30%) had heard of drug-take back events, and one in ten (10%) had participated. Non-English speakers were less likely to both perceive a community problem with prescription drugs (β = - .35; p < .001) and be aware of take-back opportunities (β = - .23; p = .038). Focus group participants expressed confusion about appropriate medication disposal methods, identifying potential sources of conflicting information. Recent media coverage and political events have heightened stigma towards non-English speaking and non-native peoples, increasing their fear of law enforcement and other perceived threats. To encourage community engagement in take-back events, we identified multiple ways, such as multilingual materials and marketing campaigns, which may help marginalized suburban subpopulations feel less threatened and more included in prescription drug misuse prevention activities.