ARIEL COHEN
University of California San Diego

Dissemination through social media can be an effective strategy in developing and strengthening community engagement/awareness of community-driven research programs. One such NIH-funded program is CO-CREATE (Community-Driven Optimization of COVID-19 Testing to Reach and Engage underserved Areas for Testing Equity), which aims to promote equity in COVID-19 testing for underserved communities. We describe use of two social media outlets (Instagram and Twitter) along with a program-specific website to disseminate program information and engage community members in our collaborative work.

The CO-CREATE project focuses on the San Ysidro community, a US/Mexico border region with predominantly Spanish-speaking, Latinx residents receiving care at a federally qualified health center.

CO-CREATE established its social media campaign in 3 stages:
1) developing a strategic plan of action (i.e., selecting appropriate platforms, identifying strategies to increase followers among our target populations of San Ysidro residents, health practitioners, and community organizations, and understanding the best methods for content promotion);
2) creating and disseminating content in line with CO-CREATE’s goals; 3) reviewing data analytics to further adapt and curate online content.

Three social media platforms were deployed as part of the CO-CREATE social media campaign. They were: 1) Instagram (@ucsdcocreateproject), 2) Twitter (@ucsdcocreate), and 3) a public-facing program website (co-create-radx.com). All were launched in January/February 2021. Based on analytics data, Instagram followers have increased by 21.9% between February 4 and March 5. To date, our Instagram page has amassed 111 followers, of which 67.3% identify as female and 67.8% are between the ages of 25-34. Instagram followers are most active on Instagram on Saturday evenings and top locations include San Diego, Chula Vista, Tijuana, which are neighboring regions that are the focus of CO-CREATE. In comparison, the CO-CREATE Twitter page has gained a total of nine followers. With a total of 3 tweets (posts), our average number of impressions (quantity of all the times the tweet has been seen) and engagements (when someone interacts with a tweet) is 63.3 and 5.3, respectively. Finally, the CO-CREATE website has accumulated 93 site sessions, 54 unique visitors, and 283 page views, with an average session duration of two minutes. The most popular page is the “team” page, meaning visitors are most interested in who is involved with the project.

Given the preliminary analysis of our social media outlets, Instagram seems to be the platform with the greatest engagement from our target audiences. Our team will continue to actively reassess our social media strategies to optimize dissemination and engagement. We expect to present rich data as information is gathered on a weekly basis from these three channels.

HANIYA SALEEM SYEDA, MPH
Boston Medical Center

Anxiety disorders are the most prevalent mental health problems affecting children, yet very few children with anxiety receive treatment. Kids FACE FEARS (Face-to-face and Computer-Enhanced Formats Effectiveness study for Anxiety and Related Symptoms) is a hybrid effectiveness-implementation randomized trial comparing therapist-led cognitive-behavioral therapy (CBT) versus self-administered online CBT for anxious youth in pediatric health settings. Screening for anxiety and implementing CBT directly within pediatric health settings, and using online formats, can overcome many traditional barriers to care. Recruitment began in 5 months before the COVID-19 pandemic began, and the study is still underway. This presentation describes the challenges of continuing implementation of a pragmatic clinical trial during a pandemic.

Eligible youth (ages 7-18 years; N=300) are being identified via universal screening and/or anxiety referral in large pediatric health care networks serving primarily racial/ethnic minority children across four regions: Boston, Miami, Baltimore, and Seattle. To maximize generalizability, English and Spanish speaking families are eligible.

To gather information on impacts of the pandemic on implementation of the trial, regional investigators and coordinators provided weekly updates to PIs on: 1) local COVID-related IRB research regulations and changes, 2) COVID-related changes in policies and clinical care at recruitment sites, 3) changes in state legislation related to insurance coverage for telehealth delivery of behavioral healthcare, and 4) barriers to recruitment. Changes to the study design and COVID-19 related challenges were also discussed with the Scientific Steering Committee, as well as with a Parent and Family Advisory Board for feedback.

Adaptions were made to the study design in response to needs identified by investigators, committee members, stakeholders, and the funder which included: 1) allowing therapist-led study arm to allow for inclusion of either telehealth and office-based CBT; 2) including a hybrid model of office-based and telehealth for therapist-led delivery to account for patient preference; 3) flexibility to use secure videoconferencing software for study visits based on participant preference; and 4) the need for assessment questions regarding exposure to COVID-19. Key factors that impacted regional sites’ recruitment success included: 1) state regulation of clinical care settings; 2) lack of IRB restrictions on recruitment and study activities; and 3) clinic’s previous experience with telehealth systems.

The COVID-19 pandemic created unique challenges in continued implementation of a multi-site national pragmatic trial. To improve implementation and foster more patient-centered research, it was crucial to collaborate with all study team members and stakeholders to identify necessary adjustments to the study design.

STEPHANIE PARKS TAYLOR, MD MS
Atrium Health

Prone positioning is an appealing therapeutic strategy for non-intubated hypoxic patients with COVID-19 but its effectiveness remains to be established in randomized controlled trials. As a Learning Health System, Atrium Health desired rapid, rigorous knowledge gain to determine whether an awake-prone positioning strategy should be implemented for hypoxic patients with COVID-19. However, because the awake prone strategy is a complex medical intervention, there are multiple implementation nuances such as adoption, feasibility, and acceptability that may affect successful conduct of a definitive RCT. We designed a pilot study with embedded implementation evaluation to rapidly inform a potential pragmatic RCT. The aim of the APPS pilot trial was to assess feasibility and contextual factors for a large RCT comparing the clinical effectiveness of awake-prone positioning versus usual care for hypoxic adults with COVID-19.

We conducted a cluster randomized pilot trial at a quaternary care teaching hospital. Five inpatient medical teams were randomly allocated to two treatment arms: 1) usual care (UC) alone; or 2) the Awake Prone Positioning Strategy plus usual care. Included patients had positive SARS-CoV-2 testing or suspected COVID-19 pneumonia and oxygen saturation less than 93% or new oxygen requirement of 3 liters per minute or greater and no contraindications to prone positioning. Oxygenation measures included time spent with S/F ratio less than 315. Concurrently, we conducted an embedded implementation evaluation using semi-structured interviews with clinician and patient participants to determine contextual factors relevant to the successful conduct of a future clinical trial. The primary outcomes were drawn from an implementation science framework including acceptability, adoption, appropriateness, effectiveness, equity, feasibility, fidelity, and penetration.

40 patients were included in the cluster randomized trial. For the effectiveness estimate, patients in the Usual Care group spent median 42 hours [95%CI=13-47] of the 48-hour study period below S/F ratio < 315 versus 20 hours [95%CI=6-39]) for patients in the Awake-Prone Positioning Strategy group. Six patients and 7 clinicians participated in interviews. Mixed methods analyses uncovered several barriers relevant to the conduct of a successful definitive RCT, including low patient adherence to prone positioning, large differences between physician-recommended and patient-tolerated prone durations, and physician-reported low acceptability of withholding prone positioning with considerable diffusion of prone positioning into usual care.

Using a novel pilot study design with embedded implementation evaluation, we were able to rapidly identify several barriers that must be addressed to ensure that results of a trial evaluating an awake prone positioning strategy are informative and readily translated into practice.