In the United States, there are substantial barriers to youth nature access and environmental education (EE). These barriers may lead to racial, geographic, and socioeconomic disparities in both nature contact and environmental awareness. This study investigated the impacts of a Photovoice EE intervention on the environmental perceptions, STEM-capacity, and environmental awareness of 335 low-income, urban youth (ages 9–15). Youth were assigned to one of two intervention groups, a Photovoice EE intervention group or an EE intervention group without a Photovoice activity, or a control group. The Photovoice activity revealed that participants perceived the environment in three major subthemes: social, natural, and built. Photovoice participants expressed both positive and negative sentiments toward their environment. After the EE intervention, Photovoice participants experienced greater improvements in STEM-capacity scores than those who participated in the EE intervention without the Photovoice activity ( p = .04). Further, EE participants experienced improved STEM-capacity and environmental awareness scores ( p < .001), while a control group of youth who did not participate in the EE intervention did not experience any significant improvements in STEM-capacity or environmental awareness. Study results suggest that the Photovoice activities may be associated with improved learning outcomes. Larger intervention studies are necessary to confirm the benefits of Photovoice in Environmental Education.

The COVID-19 pandemic has widened the health disparities between urban and rural communities as rural populations face more limited health care capacities and worse COVID-19 outcomes than their urban counterparts. When this article was written, congress was debating continuing federal funds for free COVID-19 testing, vaccines, and treatment. In this article, we discuss the potential consequences rural communities may experience should such funding fail to be approved. Peer-reviewed literature and our research indicate these budget cuts could harm rural communities' financial distress, risk of severe disease outcomes, and trust in health care systems, making continued funding for public health resources critical for vulnerable rural communities.

Background Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. Objective This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. Methods We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. Results In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. Conclusions We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers’ circumstances.

BACKGROUND Metastatic breast cancer (MBC) remains incurable despite significant treatment advances. Coordinating care for patients with MBC can be challenging given the various treatment options, available clinical trials, and frequent need for ancillary services. To optimize the care of those with MBC, we designed an academic and community practice collaborative care model based on the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program developed at the Dana Farber Cancer Institute entitled Project ADAPT. OBJECTIVE To describe the implementation science-based study design and innovative components of Project ADAPT. METHODS Project ADAPT utilizes the Dynamic Adaptation Process informed by the Exploration, Preparation, Implementation, and Sustainment framework. Washington University School of Medicine (WUSM) partnered with three community hospitals in the St. Louis region covering rural and urban settings. The Exploration and Preparation phases provide patient and provider feedback on current referral practices to finalize the approach for the Implementation phase. At the Implementation phase, we will enroll patients with MBC at these three community sites to evaluate potential collaborative care at WUSM and assess the impact of this collaborative care model on referral satisfaction and acceptability for patients with MBC and their providers. Patients may then return to their community site for care or continue to receive part of their care at WUSM. We are incorporating virtual and digital health strategies in our approach to improving MBC care coordination to minimize the patient burden. RESULTS The Exploration phase is ongoing. As of August 2021, we have recruited 21 patient and provider participants to complete surveys of the current collaborative care process at WUSM. Throughout this phase and in preparation for the Implementation phase, we have iteratively updated and refined our surveys for the Implementation phase based on testing of our data collection instruments. Our partner sites are in various stages of the single Institutional Review Board (IRB) approval process, which involves a signed reliance agreement between the institutions as well as a site registration and study application process. We have ongoing engagement with all partner sites, which helped solidify our participant recruitment strategies and design patient-friendly recruitment materials. In addition, we have included a patient advocate on the research team. Members of the research team have launched a single IRB Support Network at WUSM to create a repository of the single IRB procedures to streamline partner sites’ onboarding process and facilitate enhanced collaboration across institutions. CONCLUSIONS With this robust model, we expect that patients with MBC will receive optimal care regardless of geographical location and will improve the patient and provider experiences when navigating the health systems

Background Metastatic breast cancer (MBC) remains incurable despite significant treatment advances. Coordinating care for patients with MBC can be challenging given the various treatment options, available clinical trials, and frequent need for ancillary services. To optimize MBC care, we designed a project for adapting and developing an academic and community practice collaborative care model for MBC care (Project ADAPT), based on the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program developed at Dana Farber Cancer Institute. Objective We aim to describe the implementation science–based study design and innovative components of Project ADAPT. Methods Project ADAPT uses the Dynamic Adaptation Process informed by the Exploration, Preparation, Implementation, Sustainment framework. Washington University School of Medicine (WUSM) partnered with 3 community hospitals in the St. Louis region covering rural and urban settings. The exploration and preparation phases provide patient and provider feedback on current referral practices to finalize the approach for the implementation phase. At the implementation phase, we will enroll patients with MBC at these 3 community sites to evaluate potential collaborative care at WUSM and assess the impact of this collaborative care model on referral satisfaction and acceptability for patients with MBC and their providers. Patients may then return to their community site for care or continue to receive part of their care at WUSM. We are incorporating virtual and digital health strategies to improve MBC care coordination in order to minimize patient burden. Results The exploration phase is ongoing. As of August 2021, we have recruited 21 patient and provider participants to complete surveys of the current collaborative care process at WUSM. Using a 2-tailed paired t test, 44 patients (including 10 patients from the exploration phase) and 32 oncologists are required to detect an effect size of 0.5 with 80% power at a level of significance of .05. Throughout this phase and in preparation for the implementation phase, we have iteratively updated and refined our surveys for the implementation phase based on testing of our data collection instruments. Our partner sites are in various stages of the single institutional review board (IRB) approval process. We have ongoing engagement with all partner sites, which has helped solidify our participant recruitment strategies and design patient-friendly recruitment materials. In addition, we have included a patient advocate on the research team. Members of the research team have launched a single IRB Support Network at WUSM to create a repository of the single IRB procedures in order to streamline the partner site onboarding process and facilitate enhanced collaboration across institutions. Conclusions With this robust model, we expect that patients with MBC will receive optimal care regardless of geographical location and the model will improve patient and provider experiences when navigating the health system. International Registered Report Identifier (IRRID) DERR1-10.2196/35736

BACKGROUND Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations like urban and rural areas. OBJECTIVE To identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and summarize findings to inform future messaging. METHODS We purposively sampled by region (urban or rural) and participant type (general public or healthcare professional) to survey participants about their opinions on four COVID-19 health messages. We designed the survey and analyzed data following pragmatic health equity implementation approaches. Following qualitative analysis of surveys, we designed new COVID-19 messages incorporating participant feedback and redistributed the messages via short survey. RESULTS Sixty-seven participants enrolled: 31 from the rural Southeast Missouri “Bootheel,” 27 from urban St. Louis, and 9 St. Louis healthcare professionals. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Healthcare professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health literate communications. We reached 83.1% of participants for message redistribution, and most had overwhelmingly positive responses to the new messages. CONCLUSIONS We suggest new methods for community involvement in the creation of health messaging through the use of short online survey. We identify areas of improvement for future health messaging like re-affirming the preventive practices advertised early in a crisis, framing messages to allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages for readers that are applicable to their circumstances.