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Background: While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions., Methods: This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members ( n  = 17)., Results: All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators., Conclusions: Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Moore, Callaghan-Koru, Vincenzo, Patton, Spear, Riklon, Alik, Padilla Ramos, Takamaru, McElfish and Curran.)

Background: COVID-19 has disproportionately affected Pacific Islander communities, with disparities in the prevalence of infection, serious illness, and death compared to non-Hispanic whites in the US. Marshallese Pacific Islanders face significant COVID-19 disparities., Design and Methods: This exploratory study aimed to understand Marshallese community attitudes about the COVID-19 vaccine to identify and implement culturally relevant strategies to encourage vaccine uptake. Data were collected from 17 participants in three focus groups., Results: Using content analysis, researchers identified two global themes: (1) barriers to vaccination and (2) facilitators of COVID-19 vaccine uptake. Within these themes, participants described fear, lack of knowledge about vaccines, negative perceptions of the COVID-19 vaccine, health concerns, and transportation as barriers to vaccination. Participants described several factors influencing vaccine behavior, including location of and personnel at vaccine clinics, vaccine experiences, the need for trusted information, positive perceptions, cultural leaders, and mandates., Conclusions: The qualitative study makes a significant contribution as the first to report community perceptions and experiences related to the COVID-19 vaccine in Marshallese participants' own words. Findings show that cultural influencers and brokers are crucial bridges for public health messaging related to COVID-19 vaccination targeted to this vulnerable and underserved population. Culturally appropriate and effective public health messaging can help achieve vaccine equity and improve COVID-19-related health disparities in the Marshallese community., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: Diabetes self-management education and support (DSMES) is effective for reducing health complications among people with type 2 diabetes (PWD). However, standard DSMES interventions have not been effective for Marshallese Pacific Islanders., Methods: A culturally adapted Family-DSMES intervention for Marshallese PWD was implemented in churches in Hawaii and Washington state and delivered by Marshal-lese community health workers. We assessed changes in hemoglobin A1c (HbA1c), body mass index (BMI), and blood pressure from pre-to post-intervention (12 weeks)., Results: One hundred eighty-five (185) participants-99 PWD and 86 family members-completed classes and had valid pre-and post-intervention HbA1c data. For PWD, there were significant decreases in HbA1c (-0.69%; p=.0000) and BMI (-0.38; p=.008)., Discussion: The clinically and statistically significant reduction in HbA1c among PWD adds evidence for the effectiveness of family models of DSMES. Results will be used to inform future interventions and research studies with Marshallese and other Pacific Islander communities.

This article explores the experiences of Marshallese diasporic migrants in the United States (U.S.) during the COVID-19 pandemic in relation to material hardship and community-led relief efforts. Focus groups with 53 Marshallese migrants in three states revealed that material hardship, including food and housing insecurity, inadequate healthcare, and difficulty paying bills, intensified among their communities during the pandemic. In response, Marshallese community-based groups provided relief to their fellow community members, including food, cash assistance, and personal protective equipment. The findings fit a pattern of intensified hardship and community-led relief among marginalized communities in the U.S. during the COVID-19 pandemic., Competing Interests: Disclosure Statement: No potential competing interest was reported by the authors.

Background: Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method., Methodology: Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests., Results: The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access., Conclusion: A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities., Competing Interests: Dr. Sheena CarlLee reports owning some Pfizer stock. The remaining authors reported no potential conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)