We reviewed 27 studies on adults with a refugee background resettled from Africa published between 1999 and 2017 to appraise their methodological issues for survey research. Out of 27 studies, eleven used a single sampling method (referral = 1, convenience = 10), and 16 relied on multiple sampling methods, many of which were combinations of referral and convenience. The two most salient recruitment strategies found were building trusted relationships with the community (n = 15), and using recruiters who were culturally and linguistically matched to the refugee communities of interest (n = 14). Fifteen studies used existing data collection instruments, while in 13 studies, researchers developed their own data collection instruments. In-person or phone interviews using bilingual interviewers (n = 21) were the most frequently used mode of data collection, followed by a self-administered survey (n = 7). Our review presents methodological gaps in current refugee health studies, such as limited use of probability sampling approach due to system barriers, lack of information in community engagement and recruitment processes, and insufficient considerations of unique culture and experiences of refugee communities when developing or adapting the instruments. Efforts can be made to guide and facilitate appropriate reporting and development of more scientifically robust survey methodologies for refugee health studies, as well as to improve registration system infrastructure that may help identify these hidden populations more effectively.

Traumatic events can have a detrimental impact on individuals' health and well-being. Ensuring traumainformed care (TIC) in key community sectors is an important step in addressing trauma. We conducted an organizational assessment to identify the strengths and needs of organizations in implementing TIC in three sectors located in a Midwestern mid-size city: first responder organizations, health care institutions, and a child welfare agency. Using an explanatory sequential mixed-methods design, middle-level managers (n = 118) from the three sectors participated in online surveys and follow-up focus groups (n = 25). We assessed participants' self-reported experiences across the following organizational domains: staff training (knowledge and skills), leadership commitment, organizational policies, and staff supervision. Sectors differed in their organizational strengths and needs related to the TIC. The first responder organizations reported well-established policies and de-briefing programs, with a greater need for trauma-informed training and practical support. Healthcare institutions reported high levels of training in patient screening and referrals, but expressed less effective communication within the organization and unstructured resources for TIC services. The child welfare sector showed the highest level of understanding about TIC through their strong internal training programs, but challenges exist in applying the training to daily practice and dealing with vicarious trauma for staff. We discuss the implications of these findings and suggest sector-specific organizational strategies. Public Significance StatementThis article identifies organizational strengths and needs in relation to providing trauma-informed services in the three key service sectors of the community: first responder, healthcare, and child welfare services. Our findings will help readers acknowledge and develop sector-specific strategies to transform organizations to be trauma informed.

Background Evidence-based colorectal cancer screening (CRCS) interventions have not been broadly adopted in rural primary care settings. Co-production of implementation strategies through a bundled approach may be promising in closing this gap by helping rural healthcare practitioners select and implement the best fitting CRCS interventions to the local context. This paper describes the process and outcomes of co-development and delivery of the bundled implementation strategy to improve adoption and implementation of CRCS interventions with two rural clinics. Methods We used a bundle of implementation strategies with a core focus on academic-clinical partnership development (strategy 1) and Plan-Do-Study-Act cycles (strategy 2) to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and implementation that improves CRCS. We also developed an implementation blueprint for each clinic (strategy 3) through an online blueprinting process based on adapted “Putting Public Health Evidence in Action” (PPHEA) training curriculum. Clinic physicians and staff (n = 7) were asked to evaluate the bundled approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the bundled approach, we collected implementation outcomes and limited intervention effectiveness of the CRCS evidence-based interventions (EBIs) developed through the process. Results Our co-production strategy yielded a prototype online blueprinting process consisting of 8 distance-learning PPHEA modules that guide selection and implementation of EBIs tailored to CRCS. Modules were delivered to clinic participants with minor adaptations, using PDSA cycle to improve quality of module contents and formats. Overall, participants in both clinics reported positive reactions toward the bundled approach. Both clinics reported improvements in how they perceived the characteristics of the innovation (the bundled approach) to tailor selected CRCS EBIs. As a result of the bundled strategies, each clinic selected and adopted specific EBI(s) with the varying degrees of implementation and CRCS outcomes. Conclusions The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of EBIs to improve CRCS.

Background: Evidence-based colorectal cancer screening (CRCS) interventions exist, but have not been broadly adopted in rural primary care settings. Participatory adoption and implementation strategies may be promising in closing this gap through a clinical-academic partnership to guide rural practitioners to locate, select, and implement CRCS interventions that align with local context. We developed a prototype strategy adapted from the National Cancer Institute’s ‘Putting Public Health Evidence in Action’ curriculum in collaboration with two rural clinics to facilitate systems change related to CRCS. This paper describes the process of co-development and delivery of a systems-focused strategy to improve adoption, implementation, and sustainability of CRCS interventions. Methods: We used a bundle of implementation strategies with a core focus on academic-clinical partnership development and Plan-Do-Study-Act cycles to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and systems-change processes that improve CRCS rates. Clinic physicians and staff (n=7) at the rural clinics were asked to evaluate the approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the systems-change process, we conducted key-stakeholder interviews (n=5) to assess feasibility and acceptability on content/delivery format and plans for ongoing implementation of CRCS evidence-based interventions (EBIs). Results: Electronic blueprints for CRCS EBI selection and implementation (8 modules) were developed and followed by an online forum/live-streaming conference to allow for CRCS tailoring. The two clinics used different learning approaches: one completed the modules together while the other completed the modules separately to cover material before a group video conference. Across all modules, participants in both clinics reported positive reactions toward the systems-change modules. Both clinics reported improvements in how they perceived the characteristics of the modules and the participatory approach to tailor selected CRCS EBIs. Through the process both clinics developed a specific EBI implementation plan. Interview participants reported that the approach was feasible and acceptable, and provided suggestions for further improvements on content, delivery, and format of the approach.Conclusions: The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of evidence-based approaches to improve CRCS.