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In recent years, there have been multiple calls to enhance the population health and health promotion aspects of nursing programs. Further impetus has been provided by passage of the Affordable Care Act in 2010 with its focus on prevention. The need to develop students who can critically think and apply knowledge learned is crucial to the development of nurses who can integrate and apply the concepts of population-focused practice in society and a healthcare system undergoing transformation. This coupled with the ever changing needs of learners requires a different approach to content delivery and presentation. Flipped classroom courses, with an online component, offer the flexibility and technology desired by current undergraduate students. The use of a flipped classroom approach to re-design a population health course in a Midwestern nursing program resulted in stronger course evaluations from students and reflected better student understanding of the relevance of such content in a nursing curriculum. •We compare educational approaches to population health content for nursing students.•We evaluated student outcomes of two different educational approaches.•Flipped classroom designs are effective for delivery of population health content.•The ability to apply population health concepts is essential to nursing practice.

The PERMA model was introduced by Seligman in 2011 to increase and measure well-being. This model defines well-being in terms of Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA). Mental health concerns are common in undergraduate students and may prevent them from obtaining optimal well-being. The purpose of this study was to test whether all five PERMA elements of well-being could be constructed from items within the 2018 Purdue University Student Experience at a Research University (SERU) survey. Using confirmatory factor analysis, all five PERMA constructs were supported and demonstrated good model fit statistics. A second order PERMA well-being construct was built and demonstrated adequate model fit with RMSEA = 0.04. All five constructs were significant at p < .001. Accomplishment had the highest factor loading (0.76) and Meaning had the lowest factor loading (0.25). Results for this study support use of well-being theory in the context of undergraduate students and provides enhanced understanding of well-being characteristics in this population.

IntroductionThe United Nations (UN) Sustainable Development Goal 6 seeks to ensure universal access to safe drinking water by 2030, but vast inequities in access exist, especially among vulnerable communities including limited resource, rural, disaster-affected areas. Flood disasters, exacerbated by the climate crisis, hinder the ability of individuals and families to meet essential drinking water needs and increase their susceptibility to waterborne illnesses. Point-of-use (POU) water treatment is an effective solution for water-insecure populations during and immediately following flood emergencies. However, an initial literature search identified knowledge gaps surrounding implementation of POU water systems. This scoping review aims to synthesise published evidence between January 2015 and July 2025 on barriers and facilitators to utilisation of POU water treatment systems during and immediately following flood-related disasters. The findings will inform efforts to promote resilience and agency among water insecure communities, specifically by equipping them with actionable knowledge on sustainable access to safe drinking water.Methods and analysisThis scoping review will be guided by the work of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Search terms will be identified through an iterative process using the PICOT method and Boolean logic. Four databases—Scopus, PubMed, Web of Science and Google Scholar—with the addition of grey literature from UN agencies and non-governmental organisations focused on water-related issues will be searched. Two independent reviewers will apply a priori eligibility criteria to select studies. Conflicts will be resolved through discussion and a third independent reviewer absent agreement between the first two reviewers. Cohen’s kappa statistic will be calculated to assess inter-rater reliability. Data extraction will be guided by predefined data points, and the Consolidated Framework for Implementation Research will guide evidence synthesis through a solution-based approach.Ethics and disseminationInstitutional research ethics review is not required because no human subjects are involved. Findings will be disseminated through a peer-reviewed publication, a policy brief, conference presentations and infographics for use by organisations serving flood disaster impacted communities.

Because of the importance, and difficulty, of providing public health clinical experiences for baccalaureate nursing students, a small midwestern school of nursing offered students a three-year assignment to agencies serving vulnerable populations. The program allowed for long-term placement of students, instilling in them an understanding of community health as a prime aspect of nursing care. Students mentored students, which enhanced continuity in the agencies. More than 2,000 community members have been served, and students' responses have been overwhelmingly positive.

Communities across the United States are implementing strategies to support recovery from the opioid epidemic. One rural community in the Midwest with high rates of opioid use and hepatitis C adopted a recovery-oriented systems of care approach to achieve community resilience. While multiple definitions of community resilience exist, including identification of characteristics and elements of community resilience, little is found in the literature about resilience relative to the opioid epidemic. The purpose of this study was to determine how individuals, families and the community describe resilience from this epidemic to support development of a recovery-focused online data sharing hub. A community-engaged approach guided by a community resilience framework was used for this qualitative research. Three 60-min focus groups were conducted using pre-determined questions concerning what indicators reflect recovery and what data is available or desired. A grounded theory approach was used by two researchers independently to code and analyze transcripts of the recorded sessions and written notes to identify common categories. 28 individuals including those in active or long-term recovery and community service providers participated in focus group sessions. Nine categories of indicators were identified. This research project identified meaningful indicators of recovery at the individual, family, and community level, conveying an overall picture of the effectiveness of recovery efforts in this county. These results supported development of a data sharing hub to disseminate evidence of resilience and effective approaches to prevention and treatment of this public health crisis.

This brief report describes factors that impact the effectiveness of Medicare’s Annual Wellness Visit (AWV). Patients who participated in an AWV at a large accountable care organization were contacted monthly via phone for up to 1 year to discuss their health promotion efforts. Data from visit narratives and secondary review of AWV documentation by researchers indicate that improved efforts are needed to ensure personalization of recommendations and support patient health promotion efforts. Enhancement of the AWV process, workflow redesign, and development of strategies to provide ongoing support between AWVs are vital to improve AWV outcomes. •Primary care nurse practitioners play a strong role in prevention for older adults.•Tailoring and personalization of annual wellness visit recommendations are limited.•Practice improvements are recommended to enhance annual wellness visit outcomes.•Many older adults need ongoing regular support for health promotion efforts.

Advanced Practice Nurses (APNs) can contribute to health prevention efforts with older adults by utilizing a health risk appraisal (HRA) during the Medicare Annual Wellness Visit. This study examined APN perceptions and practices concerning use of HRAs during Annual Wellness Visits (N = 51). Results indicate that respondents agree it is important to collaboratively identify risks and develop a personalized prevention plan, but only a small percentage (7.8%) use HRA data to do so. Reported concerns include reimbursement and time; further work on how to best integrate HRAs into APN practice to enhance prevention efforts with older adults is critical. •Despite being available since 2011, Medicare’s Annual Wellness Visit (AWV) is underutilized.•The AWV includes a health risk appraisal (HRA) that can enhance health promotion efforts.•Research related to AWV/HRA implementation and use by advanced practice nurses (APNs) is limited.•Integration of AWVs/HRAs into APN practice can enhance health promotion efforts with older adults.

One mandate of the Affordable Care Act is continued support of workplace wellness programs. A tool used to encourage behavior change is a health risk appraisal (HRA). However, research indicates there is limited benefit to HRAs unless supported by additional health interventions. The purpose of these two pilot studies was to examine effects of the individual HRA personalized feedback, including the perceived value of the feedback and its influence on behavior change. Six months after completing and receiving HRA personalized feedback, participants in two separate Indiana organizations answered survey questions about the HRA value, motivational influence, and ability to prompt behavior change. Descriptive statistics, chi-square tests, analyses of variance, and factor analysis were used to analyze the influence of various factors and test the relationship between HRA generated feedback and these characteristics. The majority of respondents indicated the HRA was helpful with 69% (Study 1, n = 51) and 63% (Study 2, n = 116) of the respondents reporting an attempted behavior change. Preliminary results indicate that completion of an HRA with feedback alone may be beneficial in prompting behavior change.

Importance The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. Objective To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference’s association with geographic and temporal factors. Design, Setting, and Participants This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Exposure Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Main Outcomes and Measures Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. Results A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%];P < .001) or other screening tests (46 [1.0%]P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). Conclusions and Relevance In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.