Abstract
Introduction:
Nurses are poised to optimize the benefits of genomic technologies to advance population health. This report characterizes the outcomes of a signature course assignment using the RE-AIM or ConNECT frameworks to promote genomically informed care inclusive of communities historically underrepresented. The utility of the RE-AIM and ConNECT models is conceptually linked with Leininger’s Sunrise Enabler model.
Methods:
The setting was an online, asynchronous professional development course to promote genomic literacy for nurses pursuing or holding a doctorate degree. Projects were coded into categories and population types.
Results:
Data were collected on 176 participants (January 2022 to December 2023). Coding categorized projects as genomic education (112), application to practice (32), or research (32). Seventy-five projects (42.6%) engaged communities historically marginalized. Thirty-four percent of course alumni indicated their projects were completed or underway.
Discussion:
These frameworks have the potential to both integrate genomic science and address diverse population types.
Introduction
Problem Description
As the most trusted health profession (Saad, 2025), nurses must be knowledgeable in genetic and genomic science literacy. Nurses are ideally positioned to maximize the benefits of emerging genomic technologies and improve patient outcomes across all populations. Specifically, nurses have the potential to advance precision health initiatives by engaging stakeholders in health care policy changes, promoting genomic literacy through infrastructure changes, and bridging the gap between research and clinical application (Dreisbach & Koleck, 2020; Kurnat-Thoma et al., 2021; Tonkin et al., 2020). Yet, for various reasons, doctoral prepared nurses and doctoral students often have limited educational opportunities to expand their genomic literacy for both research and practice, as discussed below. In this article, genomics is defined as the study of all genes in the human body and gene interactions with the environment as well as psychosocial and cultural factors (https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics). Genomic literacy is defined as “the capacity to obtain, process, understand, and use genomic information for health-related decision-making” (Hurle et al., 2013, p. 2).
A Hastings Center report (Dolan et al., 2024) offered a critical examination of the unequal distribution of genomic medicine, highlighting the underrepresentation and limited involvement of community members, researchers and health care providers from diverse backgrounds. For example, in 2021, most genomic studies (86%) focused on individuals of European descent, while only 4.8% included participants from multiple ancestries (Fatumo et al., 2022). This lack of diversity not only limits the generalizability of genomic findings but also risks perpetuating health disparities and worsening inequities in health outcomes. Other researchers have recognized the historically inequitable inclusion of diverse populations in genomic research and proposed their own novel framework, built on the principles of community-based participatory research, to optimize inclusive and equitable participant-centered engagement in research (Rebbeck et al., 2022). The nursing profession must also seek frameworks that promote inclusive and equitable genomic care in clinical practice, education, and research. Through this work, we posit that educating nurses to apply implementation frameworks fosters a synergistic, integrated perspective of communities aligned with Leininger’s Sunrise Enabler model (Leininger, 2002), thereby promoting culturally congruent care and improving inclusiveness and health outcomes among historically underserved populations. By applying suggested frameworks to guide the signature course assignment, the projects may have the potential to enhance community participation while recognizing barriers and facilitators that influence health-seeking behaviors, as well as identifying cultural values, beliefs, and social structures that shape health behaviors.
Zureigat et al. (2022) conducted a scoping review of articles (n = 17) focused on educational interventions designed to strengthen genetic and genomic competencies in the nursing workforce. Although all interventions were reported as effective, only three targeted nursing faculty, and four focused on advanced practice nurses. Notably, most educational interventions did not address the knowledge, skills, or competencies required to deliver genomically informed care to diverse populations. All nurses, whether in the classroom, at the bedside, scientific bench, or community health center, must be prepared to translate genomic discoveries across diverse settings and populations to reduce health disparities.
Specific Aims
The aim of the signature assignment in the course was to implement frameworks (i.e., RE-AIM and ConNECT) to promote culturally congruent, genomically informed care and broaden engagement with historically underrepresented communities. Therefore, the purpose of this report is to initiate a discussion about the utility of the RE-AIM and ConNECT models conceptually linked with Leininger’s sunrise model.
Methods
Context
The Genomic Competencies for Nurses from Theory to Application course is a professional development opportunity for nurses possessing or pursuing a doctorate degree. The overarching goal of this self-paced online course is to improve genomic literacy among the nursing profession as well as to identify opportunities for doctoral-level nurses to apply genomic information to research, teaching, and clinical practice to reach all communities. The course is funded by a National Institutes of Health (NIH) grant (R25HG011228) and has been offered at no cost to participants since January 2022. An overview of the online course has been published previously (Kronk et al., 2023).
Participants are recruited through professional organizations (e.g., National Association of Hispanic Nurses, Chi Eta Phi), professional conferences, institutions of higher learning (e.g., St. Louis University and University of Florida), and word-of-mouth. Eligibility criteria require that participants be either nurses holding a doctoral degree or nursing students currently enrolled in a doctoral program. Preference is given for U.S. citizenship or permanent residency per NIH grant guidelines. Participants who complete all modules earn professional contact hours.
The course begins with an optional primer module on the basics of genetics and genomics, followed by six topic-specific learning modules based on Essential Competencies for Nurses with Graduate Degrees (American Nurses Association, 2011). In the final module of the course, content is provided on Professional Role and Leadership competencies based on the American Nurses Association (ANA) Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (American Nurses Association, 2011). This module helps the participant explore their professional trajectory in genetics and genomics as a nurse within academia, research, and clinical care delivery. Ethical leadership opportunities in genetics and genomics were emphasized to improve practice innovation, influence health care policy, and ultimately improve patient health care outcomes.
Educational Intervention
After reviewing all materials presented in the final module, participants are instructed to design a ‘Next Steps’ project that includes a genomic or epigenetic component that would improve patient health care outcomes, practice innovations, and/or influence policy. Participants are provided with background and content on the RE-AIM (Glasgow et al., 1999) and ConNECT (Alcaraz et al., 2017) frameworks to organize their projects. Content and resources demonstrating the application of these frameworks are provided in the module along with sample templates (see Tables 1 and 2). The course does not require participants to execute the ‘Next Steps’ project but rather to articulate an idea participants may pursue in the future as they apply content from the course to their professional areas of expertise or interest.
RE-AIM Template Dimensions With Interrogative Prompts.
ConNECT Template Key Principles With Declarative Prompts.
The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was developed with the intent to appraise public health initiatives (Glasgow et al., 1999). RE-AIM is specifically designed to improve the translation of research into practice and to foster sustainable, impactful health interventions. RE-AIM is one of the most widely applied planning and evaluation frameworks across populations, settings, and health conditions (Glasgow et al., 2019). Indeed, the National Institute of Health National Cancer Institute scores evidenced-based cancer control programs using the RE-AIM criteria (https://ebccp.cancercontrol.cancer.gov/index.do).
The ConNECT transdisciplinary framework offers five broad principles: (a) Integrating Context; (b) Fostering a Norm of Inclusion; (c) Ensuring Equitable Diffusion of Innovations; (d) Harnessing Communication Technology; and (e) Prioritizing Specialized Training (Alcaraz et al., 2017). Initially developed to foster health equity in behavioral medicine, the ConNECT framework has since been adopted across other disciplines, including nursing, while guiding efforts to translate research into equitable practice (Menon et al., 2019; Nair et al., 2023).
Study of the Intervention
This report provides a descriptive analysis of the signature assignment embedded within the Genomic Competencies for Nurses from Theory to Application course. Participants were required to design a project that integrated a genomically informed care approach into their area of research, teaching, or practice. The assignment represented the culminating activity of the course, requiring learners to synthesize genomic knowledge across populations of their choice.
Variables and Measures
Participant demographics (i.e., race, gender, doctoral status, and self-identification from underrepresented group). Collected with course enrollment.
Project categories (i.e., education, practice, and research), obtained through inductive coding by authors.
Focal population for project, obtained through inductive coding by authors.
Self-assessment on acquiring Module 6 learning objectives collected at the time of module completion using a nonvalidated, author-developed five-point Likert-type scale (i.e., poor, fair, good, very good, and excellent).
Project completion status collected using a team developed, nonvalidated, 1-year postcourse survey. Alumni from each cohort were contacted 1-year after their course closed.
Analysis
Descriptive statistics (e.g., frequencies and percentages) were used to characterize participant demographics and project distribution within the two frameworks. Inductive coding was applied to the content analysis of the ‘Next Step’ projects that were guided by either the RE-AIM or ConNECT frameworks. Two members of the author team (R.K. and S.P.) independently reviewed and coded the data into general categories and population types. Discrepancies in coding were discussed and resolved through iterative consensus meetings until full agreement was reached among all authors. Final coding decisions were documented, and categories were refined collaboratively by the entire author team to ensure analytic rigor and trustworthiness.
Ethical Considerations
The evaluation was approved as exempt by the Duquesne University Institutional Review Board, considered educational research. Informed consent was obtained electronically, and course participants could opt in or out of their data being included in course-related publications. Participant confidentiality was maintained with data stored in a secure, password-protected electronic database.
Results
Description of Participants
Table 3 provides demographic information on the 176 participants who completed the course within the first four cohorts, January 2022 through December 2023.
Demographic Data of 176 Participants, Presented as Percentages.
Description of Projects
Projects were classified into three primary categories: education, practice, and research. The education category encompassed interventions aimed at clinical populations, clinical staff, formal academic environments, or community-based settings. An illustrative example includes the development of a 30-min podcast providing introductory genomics content for registered nurses within a hospital network. The practice category involved the application of interventions within health care systems; for example, patient surveys assessing interest in pharmacogenomic testing. The research category comprised formally structured scientific studies, such as genetic testing initiatives investigating the 22q11.2 deletion syndrome variant, which predisposes individuals to schizophrenia. Each category was further subdivided by population types, as detailed in Table 4. This classification facilitated systematic evaluation and reporting across diverse project types within the scope of genomically informed, culturally congruent care.
General Categories and Population Types of Projects.
More than one in four participants (26%) who completed the course identified themselves as belonging to an underrepresented population. Among those participants, 61% (n = 28) chose to focus their project on topics involving similarly underrepresented populations. In addition, 37% (n = 47) of participants from predominantly represented populations in genomics chose to focus their project ideas on underrepresented populations. Using either the ConNECT or RE-AIM frameworks, 75/176, 42.6% of projects were identified as having the potential to engage populations less frequently reached in genomic care. Table 5 provides descriptions of several projects focused on underrepresented populations.
Sample Project Descriptions by Category.
Postcourse Survey and 1-Year Follow-up
Postcourse survey data for Module 6 (Table 6) indicate that learning objectives were consistently achieved. In the 1-year follow-up survey of course alumni (N = 176), 108 (61.4%) completed the survey. Among these respondents, the proportion reporting that they had completed or were in the process of completing a project was as follows: Cohort 1 = 51% (n = 14); Cohort 2 = 56% (n = 9); Cohort 3 = 53% (n = 16); and Cohort 4 = 64% (n = 22). In total, 61 projects, spanning genomically diverse foci, were either completed or in progress. In summary, 56% of survey respondents, representing 34.6% of all course alumni included in this report, indicated that their signature projects were completed or underway.
Percentage of Learning Objectives Rated as Good, Very Good, or Excellent (N = 176).
Discussion
Summary
The purpose of this report was to characterize the outcomes of a signature assignment situated within an online professional development course. Our results indicate that application of the RE-AIM and ConNECT frameworks may have guided course participants in selecting varied educational, clinical, and research designs for populations historically underrepresented in genomics education, research, and practice. Both frameworks appear to support the design of genomically inclusive and equitable interventions across population types, including those historically underrepresented in genomic advancements.
These frameworks have the potential to both integrate genomic science and address diverse population types, including variations in culture, ability, disease status, and other identities (e.g., veteran status). Both the RE-AIM and ConNECT frameworks may lend themselves to a culturally congruent care approach and align closely with the various cultural, social, and environmental factors outlined in Leininger’s Sunrise Enabler formerly known as Leininger’s Sunrise Model (Leininger, 2002; McFarland, 2018) (Table 7). Leininger’s Sunrise Model (Leininger, 2002) informs culturally tailored intervention designs; ConNECT (Alcaraz et al., 2017) ensures participatory processes and equity-driven strategies; and RE-AIM (Glasgow et al., 1999) evaluates real-world impact and scalability. Conceptually, these frameworks may provide an integrated approach having the potential to strengthen the cultural relevance, effectiveness, and sustainability of nursing interventions (Figure 1).
How the Sunrise Enabler Encompasses RE-AIM and ConNECT Dimensions Within a Gnomically Informed Care Approach.
A conceptual model integrating sunrise, RE-AIM, and ConNECT frameworks to strengthen cultural relevance, effectiveness, and sustainability of nursing interventions.
The question remains as to why some course participants, from both represented and underrepresented groups in nursing, chose to focus on marginalized communities. Although the RE-AIM and ConNECT frameworks were provided to guide the project process, no specific transcultural theory, model, or approach was incorporated. It is possible that something in their past education and clinical experience may have influenced their decision to include underrepresented people and communities in the ‘Next Step’ assignment. It is encouraging to consider that transcultural nursing knowledge and actions may be taking hold for participants in the course regarding the value of including underrepresented groups in a potential effort to decrease health disparities.
Strengths and Limitations
This was an isolated educational assignment within a professional development course delivered to a select group of doctoral-level nurses. Nurses opted into the course, which introduced the potential for self-selection bias, and their data were self-reported. Some contextual elements may have influenced outcomes and sustainability of the proposed projects. This was an asynchronous, self-paced online course. Participants remained in their own personal and professional settings; therefore, content within each module may or may not have influenced project ideas. We cannot rule out that there were other factors that influenced the participants’ choice of population for their project ideas such as personal interests or variables beyond our knowledge or control. In addition, experience suggests the nursing profession tends to foster more inclusive, holistic approaches to care.
Conclusions
We are unaware of any other reports that characterize the outcomes of a signature assignment using the RE-AIM and ConNECT models to promote culturally congruent care within genomics. Using these frameworks may have enhanced the ongoing contributions of the nursing profession to provide culturally congruent care. Further exploration of the congruency of these two models with Leininger’s Sunrise Model is warranted (Figure 1). Future examinations of education interventions in the area of genomic literacy should include longer-term follow-up with transcultural outcome measures.
Footnotes
Acknowledgements
We wish to acknowledge the dedication of the course participants and their enthusiastic engagement.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication was supported by the National Human Genome Research Institute of the National Institutes of Health under Award Number R25HG011228. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.