Key Dates

Related Announcements

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May 07, 2020 -  NIH Exploratory/Developmental Research Grant Program (Parent R21 Clinical Trial Required). See NOFO PA-20-194.

May 07, 2020 -  NIH Exploratory/Developmental Research Grant Program (Parent R21 Clinical Trial Not Allowed). See NOFO PA-20-195.

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Issued by

National Institute on Minority Health and Health Disparities (NIMHD)

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Tribal Health Research Office (THRO)

All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.

Division of Program Coordination, Planning and Strategic Initiatives, Office of Disease Prevention (ODP)

Sexual and Gender Minority Research Office (SGMRO)

Purpose

Key Definitions

The term “Mobile Health Clinic (MHC)” refers to a community-based model of healthcare delivery in which health services are delivered from a motorized vehicle within communities. Sometimes referred to as “Mobile Health Units”, “Mobile Clinics”, or described as “Healthcare on Wheels,” the MHC is usually a bus, truck or van that transports medical personnel and contains the clinical resources (e.g., examination table, laboratory supplies for point of care testing, and medical equipment) that are necessary to provide  health care (e.g. primary care, behavioral health, dental, vision, specialized care or other health services).

The term “populations that experience health disparities” refers to the NIH-designated United States (US) health disparity populations which include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, Middle Eastern/North Africans, socioeconomically disadvantaged populations, underserved rural populations, sexual and gender minority groups, and people with disabilities (https://www.nimhd.nih.gov/about/overview/).

The term “multi-level” refers to determinants at two or more socioecological levels of interest (e.g., individual, family, clinician, health care system, community) that are relevant for understanding and addressing minority health and health disparities. This concept is further described under the NIMHD Research Framework (https://www.nimhd.nih.gov/about/overview/research-framework/).

Background

According to the National Academies of Sciences, Engineering, and Medicine (NASEM), access to health care is the “timely use of personal health services to achieve the best possible health outcomes.” Obstacles that limit access to timely high-quality health care disproportionately affect populations that experience health disparities, increase the risk of poor health outcomes, and widen health disparity gaps. Factors that limit access to health care include provider shortages, restrictive office hours, limited transportation options, long travel distances to care, absence of culturally and linguistically appropriate services, having low household income, and being either uninsured or underinsured. Models of care that address barriers to accessing care and improving health outcomes are needed to reduce health disparities and advance health equity.

MHCs have long been a model of community-based healthcare delivery. The estimated 2,000 MHCs in the US serve a large proportion of patients from populations that experience health disparities. Data from 1,229 MHCs throughout the US show that 61.2% of patients are from racial or ethnic minoritized groups, 64.2% either have Medicaid or are uninsured and 31.3% of MHCs are positioned in rural communities. Nationally, the number of MHCs operating during the pandemic increased to expand access to COVID-19 testing and vaccinations in communities at highest risk for poor COVID-19-related outcomes. Now, many of the same MHCs provide a variety of health care and social needs services. The services that individual MHCs offer differ based on the physical design of the MHC vehicle, funding, staffing, and community needs and resources. Approximately 50% of the health care delivered in MHCs is preventive care (e.g., blood pressure screening, immunizations, health education) and over 40% is full range primary care, but behavioral health, dental, vision, mammography screening tests, and specialized care is also delivered. Additionally, MHCs may assist patients in accessing social and health benefits and coordinate follow up care.

Patients who are most likely to use MHCs as their usual source of care are predominantly from populations that experience health disparities. Continued growth of the MHC healthcare delivery model is expected partly due to the Maximizing Outcomes through Better Investments in Lifesaving Equipment for (MOBILE) Health Care Act amendment to the Public Health Service Act. Therefore, understanding the effectiveness of MHCs to improve healthcare access and address the health care needs of populations that experience health disparities is a priority.

Research Objectives

This initiative will support innovative multidisciplinary collaborative research designed to investigate the effectiveness of MHCs in improving healthcare access and addressing the health care needs of populations that experience health disparities and whether they result in improved health outcomes and increased health equity. Projects across the lifespan including children (under 18 years), adults (18 – 64 years), and/or older adults (65 years and older) are encouraged. Proposed projects would be expected to evaluate existing strategies used by MHCs or develop new strategies to advance health equity using one or more of the following outcome measures: (1) optimal clinical health outcomes (e.g., blood pressure control, diabetes control), (2) optimal quality of care (e.g., adherence to evidence-based recommendations for preventive care, diagnosis and disease management), (3) access to care (e.g., comprehensiveness, continuity of care), (4) coordination of care (e.g., timely referrals for imaging and specialty care), (5) community services (e.g., medication assistance, partnerships with community organizations to address social determinants of health), and (6) utilization of health services (e.g., telehealth, urgent care/emergency department visits).

Research projects responsive to this NOSI can consist of impact evaluations, implementation studies, retrospective and prospective observational studies, mixed-methods studies, natural experiments, quasi-experimental studies, clinical trials (including cluster-randomized trials and pragmatic trials) and others to assess the impact of MHCs and to delineate aspects of MHCs that are particularly effective. Of particular interest are projects that include research collaborations across multiple MHC sites in different states and communities (e.g., rural and urban), and with different funding sources (e.g., philanthropy and federal or state government) and organizational affiliations (e.g., academic and non-academic) to bolster regional or national generalizability of study findings. Projects must include a focus on one or more populations that experience health disparities. Of specific interest are meritorious applications that focus on racial or ethnic minority populations and/or socioeconomically disadvantaged populations. The intersectionality of race or ethnicity and/or socioeconomically disadvantaged populations with rural populations, sexual and gender minority groups, or people with disabilities, is also a priority.

Areas of Interest

National Institute on Minority Health and Health Disparities (NIMHD)

Examples of potential topic areas include but are not limited to:

• Studies that evaluate the effectiveness of MHCs to improve health outcomes among populations that experience health disparities:
  • Examine differences in receipt of evidence-based preventive care, diagnosis and disease management before and after using the MHC as the usual source of care
  • Examine healthcare or community-level changes in health outcomes (e.g., reductions in emergency department visits, increases in vaccination rates)
  • Compare outcomes for patients who identify the MHC as their usual source of primary health care to outcomes for patients who identify other healthcare delivery models (e.g., private or public stationary primary care clinics, free health clinics, or school-based health centers) as their usual source of primary health care and identify factors associated with measured differences
  • Assess whether outcomes differ among populations that seek care at MHCs (e.g., greater improvement in blood pressure for one population compared to another). Of particular interest are comparisons of populations that experience health disparities and appropriate reference populations
• Studies that evaluate the effectiveness of MHCs in improving access to care, quality of care, and utilization of healthcare services among populations that experience health disparities:
  • Evaluate the effectiveness of strategic MHC placement within a community, operating hours, healthcare service delivery, or workforce composition
  • Evaluate the effectiveness of integrating digital health technology (e.g., telemedicine, retinal imaging, or wearables for glucose or blood pressure monitoring) into MHC healthcare delivery
  • Evaluate the effectiveness of integrating social needs services into MHC healthcare delivery
  • Assess MHC utilization by populations that may not readily seek care in traditional healthcare settings (e.g., people experiencing homelessness, sex workers, migrant workers, transgender individuals, and others)
• Studies that evaluate existing strategies used by MHCs or develop new strategies to (1) reduce health disparities, (2) recruit and retain a diverse MHC workforce or (3) recruit and retain diverse research participants
• Studies that evaluate the role of MHCs in the medical neighborhood and the effect on outcomes
  • Assess the effectiveness of collaborative inter-agency partnerships to expand health and social needs services and improve health outcomes
  • Compare outcomes associated with different collaborative inter-agency partnerships and identify factors associated with measured differences
  • Investigate the intersection and outcomes of a collaborative care model between MHCs, retail clinics and primary care

National Institute of Child Health and Human Development (NICHD) 

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) invites applications that will address questions relevant to the NICHD mission and align with the NICHD Strategic Plan.

• Applications assigned to NICHD must address one or more NICHD priority populations.  These include:
  • Infants, children and adolescents, including individuals transitioning from pediatric to adult health care providers
  • Pregnant, peripartum, postpartum and lactating persons
  • Individuals of reproductive age with regards to gynecologic and reproductive health care
  • Individuals of any age with intellectual and developmental disabilities
  • Individuals of any age with physical disabilities
• NICHD is specifically interested in research that involves partnerships between mobile health clinics (MHCs) and community-based systems that serve NICHD priority populations, such as schools, early care and education settings (e.g. childcare and Head Start programs), and WIC programs. This also includes referrals between MHCs and other primary and secondary prevention resources (e.g. injury prevention/public safety programs, violence/abuse prevention programs, parenting programs, developmental services).
• NICHD is also specifically interested in research addressing the role of MHCs in mitigating the impact of structural ableism (structural and physical features of health care settings that impede access and exacerbate disparities for disabled persons). 

NOTE: Applications assigned to NICHD that address the mission and priorities of other institutes that are not participating in this NOSI will not be prioritized for funding by NICHD.

Office of Disease Prevention (ODP)

The ODP is the lead office at the NIH responsible for assessing, facilitating, and stimulating research in disease prevention. In partnership with the 27 NIH Institutes and Centers (ICs), the ODP strives to increase the scope, quality, dissemination, and impact of NIH-supported prevention research. The ODP is interested in providing co-funding support for research that has strong implications for disease and injury prevention and health equity and that includes innovative and appropriate research design, measurement, and analysis methods. For this NOSI, ODP is interested in collaborative research to investigate mobile health clinics as a delivery model for evidence-based preventive services, particularly prospective multi-site clinical trials to address disparities in the receipt of preventive services. The ODP does not award grants; therefore, applications must be relevant to the objectives of at least one of the participating NIH ICs listed in this announcement. Please contact the relevant IC Scientific/Research Contact(s) listed for questions regarding IC research priorities and funding. The ODP only accepts co-funding requests from NIH ICs. For additional information about ODP, please refer to the ODP Strategic Plan.

Sexual & Gender Minority Research Office (SGMRO)

The SGMRO develops and coordinates health- and research-related activities for sexual and gender minority (SGM; defined for NIH research in NOT-OD-19-139) populations independently and in conjunction with the NIH institutes, centers, and offices and serves as a liaison with the research community to ensure SGM populations are considered and represented in relevant activities across the agency. The SGMRO does not have grant-making authority or administer grants. The office can only support grants deemed scientifically meritorious after review by one of the institutes or centers (ICs) participating in this announcement and after a co-funding request is initiated through the IC. Please reach out to the relevant scientific/research contact(s) identified in this announcement with any questions about IC-specific research priorities and funding. More SGM- and SGMRO-specific information is available in the NIH Strategic Plan to Advance Research on the Health and Well-being of Sexual and Gender Minorities FY 2021-2025 and on the office’s Research Resources webpage.

For this NOSI, SGMRO encourages research across the life course that focuses on the impacts of MHCs on health outcomes, care, and service utilization of SGM individuals and SGM people who are members of other populations that experience health disparities and inequities. When appropriate, SGMRO encourages consideration and incorporation of SGM research-relevant concepts (e.g., minority stress, social safety, intersectionality, stigma), research strategies (e.g., community-led or -engaged research, trauma-informed research, strengths-based approaches), and frameworks (e.g., SGM Health Disparities Research Framework, NIMHD Research Framework).

Tribal Health Research Office (THRO)

The Tribal Health Research Office (THRO) serves as the central point of contact at NIH for federally recognized American Indian and Alaska Native (AI/AN) Tribes throughout the United States (U.S.) and is the synergistic hub for all Tribal health research activities and research workforce development at NIH. The mission of THRO is to improve Native health, enhance capacity for health research in Native communities, and promote opportunities for the next generation of AI/AN researchers. THRO does not have grant-making authority or administer grants. The office can only support grants deemed scientifically meritorious after review by one of the institutes or centers (ICs) participating in this announcement and after a co-funding request is initiated through the IC.

For this NOSI, THRO is interested in supporting multidisciplinary collaborative studies that investigate effectiveness of Mobile health Clinics (MHCs) in improving healthcare access and/or health care needs for American Indian and Alaska Native (AI/AN) populations and whether this results in improved health outcomes and/ health equity for AI/ANs. 

Proposals for this NOSI will not be considered if:

• Focus is not on one or more populations that experience health disparities
• MHCs are outside the US and its territories
• Exclusively qualitative
• Focus is solely on mobile health technology (e.g., mHealth)
• Creating a new MHC (only existing MHCs are allowed)

Application and Submission Information

Applicants must select the IC and associated NOFO to use for submission of an application in response to this NOSI. The selection must align with the IC requirements listed in order to be considered responsive to that NOFO. Non-responsive applications will be withdrawn from consideration for this initiative. In addition, applicants using NIH Parent Announcements (listed below) will be assigned to those ICs on this NOSI that have indicated those NOFOs are acceptable and based on usual application-IC assignment practices.

This notice applies to due dates on or after February 5, 2025, and subsequent receipt dates through November 17, 2027. 

Submit applications for this initiative using one of the following notices of funding opportunity (NOFO) or any reissues of these announcements through the expiration date of this notice. Each IC will only consider applications submitted to NOFOs specified in that IC's Areas of Interest.

All instructions in the How to Apply - Application Guide and the notice of funding opportunity used for submission must be followed, with the following additions:

• For funding consideration, applicants must include “NOT-MD-24-022” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.

Inquiries

Please direct all inquiries to the Scientific/Research, Peer Review, and Financial/Grants Management contacts in Section VII of the listed notice of funding opportunity.

Scientific/Research Contact(s)

Dolly Penn White, MD, MSCR
National Institute on Minority Health and Health Disparities (NIMHD)
Telephone: 301-496-8676
Email: [email protected]

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Priscilla Grant, JD
National Institute on Minority Health and Health Disparities (NIMHD)
Telephone: 301-594-8412
Email: [email protected]