West Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity.

Bystander-based sexual violence (SV) prevention trainings are offered on college campuses across the United States to meet federal Title IX requirements, as they have proven to be an effective strategy for violence prevention. Greek-affiliated students (fraternity and sorority members) are at a higher risk of sexual assault than their peers; however, few trainings consider the specific needs of this population, and program adaptations for this high-risk group may be needed. This scoping review identifies and describes the bystander trainings delivered to Greek-affiliated students in the US and Canada. An eight-database search was conducted following PRISMA-ScR guidelines. The review identified 81 unique sources, with 18 meeting the inclusion criteria. Eleven specific training programs were identified, encompassing qualitative, quantitative, and mixed-method studies. The thematic analysis revealed best practices, including the importance of peer leaders, interactive sessions, and tailored content to Greek culture, as well as barriers such as a lack of engagement and an inadequate session length. The review underscores the need for tailored interventions to effectively address the unique cultural characteristics and high-risk nature of Greek-affiliated students. These findings provide valuable insights for improving the design and implementation of bystander interventions to enhance their efficacy in preventing sexual violence within this population.