Methods
Creation of the Community-University Partnership
A strong partnership began approximately 1 year before the initiation of the described project, when a university faculty member and a community partner from the local public health department both attended a substance use prevention training led by a regional prevention coordinator. At this meeting, the faculty member and community partner discovered their shared interest in working with health care providers to reduce the stigma associated with substance use in the region through education. As a result, the faculty member became involved in several additional regional substance use coalitions to learn more about how the university could contribute to the ongoing grassroots community initiatives active in the area. These relationships with regional coalitions and public health professionals were critical to the faculty member’s focus and to substance use initiatives in the region, leading ultimately to an ongoing partnership and millions of dollars in federal and state grant funding.
Public health professionals responsible for assessing and evaluating health priorities in the region reported that intervening without the support of health care providers in the community had not been effective. Similarly, university faculty were aware of the need to educate the health care community and had the expertise to create relevant training materials, but they found community engagement and referral to community-based resources to be much more successful through a partnership with public health professionals than without this partnership. Realizing that they shared a common desire to educate health care professionals on how they could work together to reduce the impact of the opioid crisis, a faculty member and several public health professionals expanded their team to include additional community and university partners and diverse coalition members. Collectively, they planned continuing medical education (CME) sessions for medical professionals across the region, involving local recovery communities and harm reduction agencies such as the Rural AIDS Action Network whenever possible. The partnerships not only aligned with local community needs but also followed the surgeon general’s 2018 recommendations for local public health departments to bridge gaps and for academic institutions to enhance training opportunities (HHS, 2018).
Planning CME Sessions for Health Care Professionals
University and community partners, in collaboration with local coalitions, designed interprofessional CME sessions focused on using naloxone to reverse opioid overdoses, improving the safety of opioid prescribing and dispensing, and reducing stigma associated with opioid use. These CME sessions brought together experts from health care, public health, and the university to share information about naloxone dispensing, prescribing, and harm reduction practices. Each community coalition had the opportunity to provide input on the CME sessions held in their community, and a representative was invited to each session to share local resources.
The communities in which the CME sessions were conducted had strong histories of interdisciplinary coalition involvement, including community forums and community naloxone training sessions (Palombi, Olivarez, et al., 2019). Community input at these events was used to guide coalition activities as well as public health and university engagement efforts. Despite community members’ notable interest in being trained in naloxone use and opioid overdose first aid, health care providers in these communities demonstrated less interest and engagement in these topics.
Recruitment of Participants
The community and university partners were careful to hold the five CME sessions in geographically diverse locations that were accessible and convenient to community members, such as community colleges and health system centers. Working together and building upon the diverse connections with the communities involved, the team advertised widely and successfully through local coalitions, health care systems, and key leaders to engage a variety of health care professionals.
Local coalitions were engaged throughout this process. In one rural region, the Chemical Abuse Prevention and Education (CAPE) Coalition invited providers throughout their local networks. The CAPE Coalition is made up of law enforcement, treatment providers, public health professionals, people in recovery, insurance agency representatives, and other individuals committed to SUD prevention, intervention, and recovery. The coalition had an interest in this project because they had been working on an event series in a similar vein called “Community Solutions to Substance Abuse.” Each event strived to educate the community on a different substance and the available resources surrounding it. The coalition agreed that educating providers in parallel with other community members would be critical to achieving community-wide improvements in SUD prevention, intervention, and recovery.
Project Activities
Five CME events that focused on safe opioid prescribing and opioid overdose first aid with naloxone were held on five different evenings between October 2017 and December 2017. A meal was provided to attendees at each session to make the events more convenient. A total of 101 health care professionals from rural locations throughout northeastern Minnesota attended one of the five CME sessions. These sessions were conducted in counties with some of the highest opioid overdose rates and opioid prescription rates in Minnesota (Minnesota Department of Health, n.d.); because of this, collected survey data was critical for creating collaborative public health interventions focused on health care providers. Data collected from the CME sessions complemented data collected from focus groups with individuals in SUD recovery to inform the work of community coalitions, treatment and recovery initiatives, and university partnerships.
Public health partners joined the CME sessions to ensure that attendees left each session aware of the additional resources available in their community to assist individuals at risk of an SUD. These resources included access to harm reduction services, local medication take back events and resources, and referral to SUD treatment. Consistent with best practices for community engagement, the approach to these sessions and the subsequent collaborations equitably included the aforementioned community partners, organizational representatives, and researchers in all aspects of the research process.
In addition to learning about available resources, community members were personally introduced to the public health partners and their role within the community. Local public health professionals were also available to answer questions regarding local trends in substance use and treatment as well as local prevention efforts.
These educational sessions were funded by St. Louis County’s State Targeted Response to the Opioid Crisis Grant and facilitated by University of Minnesota faculty. The educational sessions, which were co-organized and cocreated by public health and pharmacy faculty, intended to expand participants’ understanding of the following factors: opioid overdose identification, differences in naloxone formulations, naloxone access, legal considerations, and harm reduction resources to utilize in practice. Health care providers attending the CME sessions included physicians, pharmacists, registered nurses, social workers, and dentists (Figure 1).
Data Collection
Attendees were asked to anonymously complete the following six-question survey, which was created by public health and university partners and driven by community concern:
Figure 1. Health Care Providers Attending Interprofessional CME Sessions 
Do you think that individuals with opioid use disorder are discriminated against by the medical community? If yes, how?
What do your colleagues say should be done about “drug-seeking” behavior? Do you agree with your colleagues?
Do you feel that opioid misuse should be treated as a medical condition or a crime? Please explain.
Are there ways that the medical community could be collaborating to reduce overdose due to opioids? If yes, how?
In what ways do you observe substance use/ opioid use being stigmatized?
Do you think that bias and stigma contribute to the current opioid crisis? If yes, how?was created by public health and university partners and driven by community concern:
Public health professionals and faculty came to a consensus on these questions based on their observations, reports of local trends, and concerns about health care providers’ perceptions of their role in the opioid crisis. The questions were vetted and piloted by a group of six public health and faculty team members. The study was determined to be not human research by the University of Minnesota’s institutional review board.
Data Analysis
Qualitative analysis of the responses was conducted by two student researchers (KM, AD) and two faculty auditors (LP, HB) using a consensual qualitative research (CQR) analytical approach (Hill et al., 2005). The CQR process started with holistic coding in the first round to identify themes in sections of text/paragraphs. Initial domain themes were independently identified by the two student researchers. Domain themes were cross analyzed between the two researchers and were then used as the first iteration list for the next step in code mapping. The code list was updated after consultation with the faculty auditors. Descriptions of domain themes were created and coding subdivisions were identified for the second round of coding. In secondcycle coding, themes became more descriptive, and codes were identified in a line-by-line fashion; this descriptive coding process allowed for the organization of domains. During the second team meeting, consensus was reached and the coders discussed what codes might be combined, noting that some domains were not well represented in the final table. The coders discussed how the research domains might be categorized, and they decided that domains were provider-centric, patient-centric, or both provider- and patient-centric.