Faculty Bibliography

Reciprocal innovation, a model of sustained, multidirectional exchange in which health strategies are adapted, revisited, and refined across contexts, offers a compelling framework to rethink how implementation science can support global health equity by enabling dynamic, multidirectional learning across different contexts. Drawing on the EXTRA-CVD trial, a nurse-led cardiovascular disease prevention intervention designed to extend the HIV treatment cascade in United States (U.S.) HIV clinics, which adapted strategies informed by implementation research in Kenya and the U.S. Veterans Affairs health system, this perspective examines how reciprocal innovation can begin to emerge within existing research structures, as well as where opportunities for deeper exchange remain limited. We identify four operational domains of reciprocal innovation: care delivery strategies, end-user engagement, research methodologies, and research leadership and partnership. Across these domains, we describe how cross-context learning shaped intervention adaptation and site-level implementation in EXTRA-CVD, as well as missed opportunities where more intentional feedback, shared leadership, and methodological exchange could have strengthened multidirectional learning. Taken together, this work highlights both the potential and the practical challenges of reciprocal innovation in implementation research, emphasizing its role in moving beyond unidirectional knowledge transfer toward iterative, context-responsive learning. By embedding structures for iterative feedback, equity-centered governance, and multidirectional learning systems within research and implementation systems, future global partnerships can foster more inclusive, responsive, and sustainable health interventions.

Medical education plays a crucial role in shaping how future physicians understand and approach the prescribing of teratogenic medications to individuals with the capacity for pregnancy. The teaching that we, as medical students, experienced on this topic relied on blanket cautions derived from current guidelines that either warn students to never prescribe teratogenic medications for "women of childbearing age" or to adhere to rigid contraceptive mandates that lack guidance on contraceptive counseling, reproductive goals, or individual risk. This educational approach erases patient diversity and undermines the principles of reproductive justice. As students who are invested in reproductive health both from an educational and personal standpoint, and with our clinical education taking place in an institution and geographic and political context supportive of comprehensive reproductive health, we felt a better approach was possible. We have witnessed thoughtful, nuanced conversations between patients and providers surrounding the friction between patients' fertility goals and treatment options for other medical conditions. We outline three anecdotes that exemplify the discordance between the limited preclinical instruction most of our classmates receive and the clinical practices we have observed that foreground reproductive justice, inclusivity, and patient-provider trust. Moreover, there is a lack of empiric evidence regarding medical students' knowledge and capacity to conduct teratogenic medication counseling. Existing literature reveals a fragmented and simplified approach taken by many clinicians in prescribing these drugs. These shortcomings are related to those that exist in the context of our personal education, and it is likely that medical education on the topic of teratogenicity, contraception, and fertility is institution dependent. Given that best practices and instructions for approaching these counseling situations are not yet formalized, it is reasonable to assume that students are likely graduating from medical school with varied levels of confidence, skill, and training in this area. We find it necessary that reproductive counseling and contraceptive care for patients on teratogenic medications is taught comprehensively to students to reflect our responsibility as physicians to respect individual reproductive goals, provide inclusive and affirming care, and build trust. The individual tension we have identified within our educational experience sheds light on an area of instruction that may hold significant potential in shaping a generation of thoughtful, effective physicians.

PURPOSE/OBJECTIVE:Adolescent and young adult (AYA) oncology patients demonstrate an expressed need for improved sexual health (SH) communication with oncology clinicians, yet these conversations rarely take place, with clinicians identifying lack of education as a key barrier. This work describes the development and revision of a suite of educational modules aiming to improve clinician SH communication. METHODS:Literature review, data collected from prior research by the study team, and expert input from the Children's Oncology Group AYA Sexual Health Task Force were used to develop a series of interactive, online education modules. Clinicians, including physicians and advanced practice providers, were recruited by email across five academic institutions to review the modules and provide feedback through completion of an online open-ended survey. Themes derived from feedback guided module modifications. RESULTS:The initial curriculum consisted of three interactive modules that focused on the importance of addressing SH with AYA patients, how to discuss SH with AYAs, and contraception/safe sex practices during cancer treatment. Fourteen pediatric oncology clinicians reviewed the modules and provided feedback. Collectively, participants described the modules as informative, well-organized, visually appealing, and relevant to clinical practice. Opportunities for improvement included an option to modify the speed of narration, the incorporation of more interactive features to facilitate learner engagement, and the need for additional content on sexual dysfunction. CONCLUSION/CONCLUSIONS:This suite of clinician-focused SH education modules represents a key step in advancing AYA SH care throughout cancer treatment and survivorship. Future work will explore the efficacy of the modules on AYA-clinician SH communication.

BACKGROUND:Efficacy of health-care based Early Relational Health (ERH) parenting interventions like PlayReadVIP and Smart Beginnings, are well-established, but limited research has examined parental perceptions of impact. OBJECTIVE:To explore parents' perceptions of how PlayReadVIP and SB support their parenting, generally and during the COVID-19 pandemic. METHODS:Nested sample of low-income parents enrolled in a two-site RCT of Smart Beginnings (SB), in New York City, NY (n = 40, 93% Latino) and Pittsburgh, PA (n = 40, 80% Black) and a single-site RCT of PlayReadVIP, Supporting Parents And Raising Resilient Kids (SPARRK), in Flint, MI (n = 40, 45% Black, 38% White). Interviews were audio taped and transcribed. Transcripts were coded using an iterative process of textual analysis until thematic saturation was reached. RESULTS:Four themes emerged: (1) Caregivers valued learning new, foundational parenting practices; (2) became more child-centered; (3) felt increased self-efficacy and empowerment; and (4) identified PlayReadVIP and SB as sources of support. CONCLUSIONS:Parents valued the ERH-aligned skills and concepts they learned in PlayReadVIP and SB and viewed the programs as sources of social support. Findings can inform and strengthen pediatric primary care-based parenting programs and have implications for feasibility, acceptability, and scaling of evidence-based and layered ERH programs. CLINICAL TRIAL REGISTRATION/BACKGROUND:Clinicaltrials.gov, NCT02459327, NCT03945552 https://clinicaltrials.gov/study/NCT02459327 , https://clinicaltrials.gov/study/NCT03945552 . IMPACT/CONCLUSIONS:Qualitative study demonstrating that parents value and learn Early Relational Health (ERH) skills from health-care based preventive parenting interventions. Findings inform adaptation, engagement, and scaling. Efficacy of parenting interventions (PlayReadVIP, Smart Beginnings) are well-established, but limited research has examined parental perceptions of impact. This study explores parents' experience with these programs to better understand core components and identify areas for adaptation and refinement. This study builds on prior quantitative work to demonstrate parents' perceived impact of and value in PlayReadVIP and Smart Beginnings. Parents reported participation in these programs/models resulted in enhancements to ERH, mind-mindedness, social support, and mental health.

INTRODUCTION/BACKGROUND:Parenting self-efficacy (PSE) is correlated with positive parenting and child outcomes, but may be reduced in stressful settings. Community factors affecting PSE are not well understood. The community of Flint, Michigan, endured significant stressors, including the Flint Water Crisis (FWC), and disproportionate effects of the COVID-19 pandemic. This study examines how these superimposed stressors affect PSE in families in Flint. METHODS:This study was a secondary, cross-sectional analysis of 291 infants and caregivers. Baseline surveys included sociodemographics, stress, and PSE. Primary predictors were FWC and COVID-19 distress. Primary outcome was PSE. Bivariate analyses were used to examine the association between FWC and COVID-19 distress with PSE, and multiple linear regression to control for sociodemographics. RESULTS:Both increased COVID-19 distress and FWC distress had significant inverse association with PSE in bivariate analyses, and predicted PSE (COVID-19 distress, β -.18, p <.01, and FWC distress, β -.18, p <.05) in multiple linear regression. A significant interaction was found between FWC distress and COVID-19 distress. Simple slope analyses indicated that COVID-19 distress predicted reduced PSE only for high FWC-distress group (β -.22, p <.01). DISCUSSION/CONCLUSIONS:Results show COVID-19 distress and FWC distress both had independent negative associations with PSE, but FWC distress moderated the effect of COVID-19 distress on PSE, indicating that families more affected by previous stressors were more vulnerable to the effects of COVID-19 distress, while those less affected were resilient to subsequent stressors. Future interventions should target disinvestment, prevent community stressors, and support exposed families.

OBJECTIVE:To examine if variation in session format and content of a prenatal obesity prevention program is associated with fruit and vegetable (FV) voucher redemption in Hispanic/Latino pregnant participants. METHODS:A secondary analysis of participants who received FV vouchers in a single-arm feasibility trial. We used linear regressions to assess associations between program session format (group vs individual) and FV voucher redemption rate, with session content (nutrition vs other lifestyle content [e.g., stress management or physical activity]) as a secondary predictor. RESULTS:Participants (n = 131) who attended a greater percentage of sessions in group format had increased voucher redemption rates (B = 0.37 [95% confidence interval, 0.05-0.70]. P = 0.03). Attending a higher percentage of group sessions with nutrition content rather than other lifestyle content was associated with a higher redemption rate (B = 0.19 [95% confidence interval, 0.002-0.38], P = 0.05). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Pairing FV voucher distribution with nutrition counseling delivered in a group format may increase utilization of FV vouchers.

BACKGROUND:Results from blood pressure (BP) control interventional trials can inform clinicians and health systems pursuing better BP control, but they must be interpreted cautiously. OBJECTIVE:Deconstruct the observed drop in systolic BP (SBP) into components attributable to increased adherence to previously prescribed medications, regression to the mean, and initiation of new medications. DESIGN/METHODS:Secondary analysis of BP Home, a pragmatic randomized controlled trial. PARTICIPANTS/METHODS:Patients owning a smartphone who reported uncontrolled BP at their last clinic visit (> 145 mmHg) and a desire to lower their BP by > 10 mmHg. INTERVENTIONS/METHODS:In BP Home, participants were randomly assigned to receive one of two devices for self-measurement of BP and followed for up to 24 months via electronic health records (EHR). APPROACH/METHODS:The primary outcome was EHR-recorded office SBP. We fit SBP trajectories for each participant using linear mixed models, and estimated the contributions of medication adjustments, and increased adherence to pre-existing BP medications due to their enrollment in a research study (i.e., a Hawthorne effect). Regression to the mean was calculated for each participant as the difference between their last measured pre-enrollment SBP and their modeled SBP trajectory at enrollment. KEY RESULTS/RESULTS:Among participants taking BP medications at enrollment, we estimated an average immediate drop in SBP of -4.2 mmHg (95% CI, -5.1 to -3.3; p < 0.001) at enrollment, explainable by increased medication adherence following study enrollment. Starting a new medication class post-enrollment resulted in an SBP drop of -4.1 mmHg (95% CI, -5.3 to -2.8; p < 0.001). The average expected regression to the mean was -3.9 (95% CI, -4.4 to -3.3; p < 0.001). CONCLUSIONS:A significant portion of BP reductions in trials may stem from increased adherence to pre-existing medications arising from enrollment in a research study and enhanced awareness of their elevated BP. NIH TRIAL REGISTRY NUMBER/UNASSIGNED:NCT03796689 (registered on 2019-01-04).

BackgroundPersons living with dementia (PLWD) and their care partners face unique challenges in participating in research studies. Community Engagement Studios (CES) provide a framework for researchers to work directly with community members, considered as Community Experts, who experience conditions under study to enhance research design, implementation, and dissemination.ObjectiveWe describe our experience conducting CES with PLWD and their care partners and lessons learned.MethodsPLWD and their care partners participated in three CES between July and December 2022; one in New Hampshire in English and two in New York, one of which was in Spanish. We followed the CES Toolkit guidance, which involves 1) inviting experts/stakeholders (PLWD and their care partners) to a consultative meeting, 2) preparing a presentation (interview guide) and facilitating the meeting, and 3) receiving and analyzing feedback from participants.Results12 community members (6 PLWD and 6 care partners) participated in our three studios. Three study design factors were identified during the CES: recruitment process (trust and communication with the research team), participants' autonomy, and trust and communication with clinicians. Spanish language community members raised similar issues to those in the English-speaking CES. However, Spanish language participants also noted the potential impact of interpreters during clinic visits.ConclusionsCES were feasible, informative, and well-received by PLWD and led to changes in our study design. We describe strategies for engaging care partners and PLWD, Community Experts, to elicit valid and valuable recommendations for making research studies more relevant and impactful.