Abstract FR495: Pre-Study Barrier Assessment for Resident-Led Screening in the Trials for Inclusion, Diversity, and Equity with Internal Medicine Study: Identifying Challenges Using the Consolidated Framework for Implementation Research

Background: The Trials for Inclusion, Diversity, and Equity with Internal Medicine (TIDE-IM) study, within the American Heart Association’s DIVERSE Network, seeks to improve diversity and shorten screening-to-enrollment times for hypertension trials in a large resident-run clinic in Atlanta, Georgia. Before launch we conducted a barrier assessment to guide implementation planning. Methods: A mixed-methods barrier assessment, including surveys and focus groups, was conducted. The CFIR framework, with its five domains: Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Process, guided the evaluation. Eighty internal medicine residents were randomized into three screening arms: coordinator-led, Deep 6 AI-led, or resident-led with champion support. Challenges in recruitment implementation were identified. Results: Barriers arose across all CFIR domains. Intervention Characteristics: residents reported workflow complexity and limited adaptability of the artificial-intelligence platform. Outer Setting: inadequate protected time and competing clinical duties limited participation. Inner Setting: variable clinic staffing and inconsistent feedback structures impeded adoption. Characteristics of Individuals: many residents had minimal research experience and discomfort addressing health-equity messaging. Process: unclear communication channels and absence of real-time performance metrics hindered iterative improvement. Conclusions: The CFIR-based pre-study barrier assessment highlighted several challenges that could impede resident-led screening efforts, particularly in relation to complex technology, support structures, and resident confidence. These findings informed targeted interventions, such as enhanced training and mentorship, to improve the screening process before the study's launch. This approach provides valuable insights into how resident involvement can be optimized in clinical trials aimed at reducing healthcare disparities.