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Mars S, Ondocsin J, Koester KA, Mars V, Mars G, Ciccarone D. "I Heard of PrEP-I Didn't Think I Needed it." Understanding the Formation of HIV Risk Perception Among People Who Inject Drugs. Cult Med Psychiatry 2024:10.1007/s11013-024-09870-8. [PMID: 39007986 DOI: 10.1007/s11013-024-09870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
Uptake of pre-exposure prophylaxis medication (PrEP) to prevent HIV among people who inject drugs (PWID) remains extremely low in the United States. West Virginia's rising HIV incidence and highest drug overdose rate in the nation makes it an important locus for opioid use and HIV risk interaction. In this pilot study we pioneered the use of Cultural Theory among PWID to understand HIV-related risk perception arising from four contrasting modes of social organization. Carried out during an HIV outbreak, we explored PrEP uptake qualitatively as a window onto risk perception. Of the 26 interviewees, 18 were HIV- and despite the medication's free availability from the health center where recruitment took place, none had taken PrEP, half considering they were not at risk. Intimate couples who showed characteristics of 'enclaves' considered the boundary around themselves protective against HIV, creating a safe space or 'invisible risk group'. Higher HIV risk was perceived among those who were housed compared to those living homeless. Beliefs about the causation of the local HIV outbreak and the validity of scientific research corresponded with characteristics of the contrasting modes of social organization and the approach is promising for informing public health interventions among PWID.
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Affiliation(s)
- Sarah Mars
- Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
| | - Jeff Ondocsin
- Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Valerie Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Gerald Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
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Sosin AN, Carpenter-Song EA. Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America. Health Aff (Millwood) 2024; 43:791-797. [PMID: 38830148 DOI: 10.1377/hlthaff.2024.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.
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Affiliation(s)
- Anne N Sosin
- Anne N. Sosin , Dartmouth College, Hanover, New Hampshire
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Haghighat S, Yazdi K, Mahmoodi-Shan GR, Sabzi Z. The challenges of nursing care for patients with lumbar discectomy: A qualitative study. Nurs Open 2024; 11:e2137. [PMID: 38488403 PMCID: PMC10941564 DOI: 10.1002/nop2.2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024] Open
Abstract
AIM Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy. DESIGN This qualitative study was conducted in 2022 using content analysis. METHODS Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi-structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation. RESULTS The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine-based practice in the healthcare system, futile attempt for team-based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery.
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Affiliation(s)
- Sahar Haghighat
- Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Khadijeh Yazdi
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Zahra Sabzi
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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Uveges MK, Hamilton JB, Pados BF, Thayer WM, Hinds PS, Nolan MT. Being a "Good Parent" to a NICU Infant With a Major Congenital Anomaly. Adv Neonatal Care 2024; 24:14-26. [PMID: 38232327 DOI: 10.1097/anc.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. PURPOSE (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. METHODS A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. IMPLICATIONS FOR PRACTICE NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. IMPLICATIONS FOR RESEARCH Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decision-making beliefs.
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Affiliation(s)
- Melissa K Uveges
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Uveges); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Hamilton); Infant Feeding Care, Wellesley Hills, Massachusetts (Dr Pados); School of Nursing, Johns Hopkins University, Baltimore, Maryland (Mr Thayer); Children's National Health System, Washington, District of Columbia (Dr Hinds); Department of Pediatrics, The George Washington University, Washington, District of Columbia (Dr Hinds); and Conway School of Nursing, The Catholic University of America, Washington, District of Columbia (Dr Nolan)
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Nevedal AL, Wu J, LaVela SL, Harris AHS, Frayne SM, Arnow KD, Barreto NB, Davis K, Eisenberg D. Why may patients with spinal cord injury be overlooked for obesity screening in the Veterans Health Administration? Qualitative research of the perspectives of patients and healthcare providers. Disabil Rehabil 2024; 46:270-281. [PMID: 36591701 DOI: 10.1080/09638288.2022.2159074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/11/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We sought to describe factors influencing reduced rates of obesity screening for patients with spinal cord injury (SCI) in the United States Veterans Health Administration (VA) and to foster potential solutions. MATERIALS AND METHODS Semi-structured interviews with healthcare providers and patients with SCI who were recruited nationally from diverse VAs. We performed rapid qualitative analysis using content analysis of interview data. RESULTS There were 36 providers and 37 patients. We identified provider, patient, and system level barriers to obesity screening for individuals with SCI. Overarching barriers involved provider and patient perceptions that obesity screening is a low priority compared to other health conditions, and body mass index is of low utility. Other obesity screening barriers were related to measuring weight (i.e., insufficient equipment, unknown wheelchair weight, staffing shortages, measurement errors, reduced access to annual screening, insufficient time, patient preference not to be weighed) and measuring height (i.e., insufficient guidance and equipment to this population, measurement errors). CONCLUSIONS Barriers to obesity screenings exist for patients with SCI receiving care in VA. Healthcare provider and patient interviews suggest possible solutions, including standardizing height and weight measurement processes, ensuring equipment availability in clinics, clarifying guidelines, and offering support to providers and patients.IMPLICATIONS FOR REHABILITATIONIndividuals with spinal cord injury (SCI) have higher rates of obesity, but are often overlooked for annual obesity screening, even in clinic settings designed to care for individuals with SCI.Results may help tailor guidelines/education for healthcare and rehabilitation providers offering them guidance for improving obesity screening for individuals with SCI by standardizing weight and height measurement and documentation. To facilitate this, findings highlight the need for resources, such as ensuring clinics have necessary equipment, and increasing patient access to support and equipment.Improving the provision of obesity screening for individuals with SCI is necessary to improve health outcomes and patient satisfaction with care.
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Affiliation(s)
- Andrea L Nevedal
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor MI, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare, VA Edward Hines Jr, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan M Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine D Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicolas B Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
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Aldahondo R, Cole R. The Experiences of LGBTQ Healthcare Professionals within Military Medical Culture. Mil Med 2023; 188:e3606-e3612. [PMID: 37523653 DOI: 10.1093/milmed/usad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Creating a positive workplace culture affects patient outcomes and force readiness. An inclusive workplace culture is especially important for lesbian, gay, bisexual, transgender, and queer (LGBTQ) military healthcare professionals, who have historically faced discrimination within the United States military. While research has examined LGBTQ service members' experiences in the military as a whole, there is a gap in the professional literature regarding LGBTQ healthcare workers' experiences within military medicine. METHODS This qualitative phenomenological study explored the experiences of ten LGBTQ military healthcare professionals. We interviewed each participant for one hour. Our research team then coded each interview and came to a consensus on how to organize these codes into emerging themes. We used reflexivity and member checking to increase the credibility of our results. RESULTS Four themes emerged from our data analysis: (1) implicit bias; (2) explicit bias; (3) response to discrimination; and (4) recommendations for improving workplace culture. The participants described both the underlying and outright discrimination they faced at work. They made recommendations for reducing this discrimination through education, training, and increased leadership representation. CONCLUSIONS Our results revealed that LGBTQ healthcare professionals continue to face discrimination in the workplace. This discrimination must be addressed to create an inclusive workplace environment within military medicine, which will enhance force readiness.
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Affiliation(s)
- Ricardo Aldahondo
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Rebekah Cole
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Schippert ACSP, Dahl-Michelsen T, Grov EK, Sparboe-Nilsen B, Silvola J, Bjørnnes AK. Torture survivors' experiences of receiving surgical treatment indicating re- traumatization. PLoS One 2023; 18:e0287994. [PMID: 37847719 PMCID: PMC10581467 DOI: 10.1371/journal.pone.0287994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/18/2023] [Indexed: 10/19/2023] Open
Abstract
Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.
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Affiliation(s)
- Ana Carla S. P. Schippert
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Oslo, Norway
| | | | - Ellen Karine Grov
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bente Sparboe-Nilsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Juha Silvola
- Akershus University Hospital, Oslo, Norway
- Institute of Clinical medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Nkambule E, Wella K, Mbakaya BC. Voice of incarcerated male youths in Malawi's semi-urban prisons: a qualitative study. BMJ Open 2023; 13:e075925. [PMID: 37827730 PMCID: PMC10582849 DOI: 10.1136/bmjopen-2023-075925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Incarcerated male youths in Malawi's detention facilities face multiple threats to their health and well-being. The most common challenges are overcrowding, poor sanitation and a lack of access to basic needs such as adequate food, bedding and healthcare. In addition, youth are vulnerable to sexual abuse. DESIGN A qualitative approach using an exploratory study design was used to explore the experiences of incarcerated male youths in semi-urban prisons. SETTING Two semi-urban prisons in Malawi. PARTICIPANTS Three focus group discussions (each with six participants) with incarcerated youths aged 18 were conducted. RESULTS The following four themes emerged from the data: sexual violence perpetuated by other incarcerated persons; the need for sexual violence communication and prevention; trauma associated with incarceration and youth surviving prison life. The incarcerated male youths reported being given incentives such as extra food and adequate sleeping space in exchange for sexual favours with adult incarcerated people or incarcerated individuals with leadership positions. The victims of sexual abuse have had some difficulties reporting the incidences due to a non-existent reporting system for such matters to prison authorities. CONCLUSIONS This study reveals that the prison environment in Malawi is unsafe, particularly for incarcerated male youths who are at an increased risk of being victims of sexual violence. We recommend that the youths be separated from adults according to the Prison Rape Elimination Act standards. The prison officers should prevent incarcerated youth from having sight or physical contact with adult incarcerated people while in housing units. Policy-makers, prison authorities and researchers must safeguard and empower survivors of sexual violence in prisons.
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Affiliation(s)
- Ellen Nkambule
- St John's Institute for Health, Mzuzu, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
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Nkambule E, Wella K, Msosa A, Mbakaya BC, Chilemba E, Msiska G. Patient's experiences of diabetes care at a tertiary health facility in Lilongwe, Malawi. BMC Health Serv Res 2023; 23:1093. [PMID: 37828591 PMCID: PMC10571416 DOI: 10.1186/s12913-023-10039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Little is known about experiences of rural people with diabetes care at a tertiary health facility in low-income settings. Understanding their experiences is essential for developing effective diabetes care interventions. METHODS The study employed a qualitative narrative inquiry. Participants were identified at a diabetes clinic at a tertiary-level healthcare facility. Ten participants from the rural areas attending the diabetes clinic were purposively selected. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using the Riessman approach to thematic narrative analysis. RESULTS In this study, the following four themes emerged: (1) the long pathway to a diagnosis of diabetes; (2) Poverty-related hardships and diabetic clinic attendance; (3) The impact of health worker attitudes and behavior on diabetes care; and (4) Low resources and their impact on self-management. CONCLUSIONS Rural-based patients living with diabetes encounter enormous challenges as they access diabetes care. One of the challenges is delayed diagnosis of diabetes. There is a need to introduce point-of-care (POC) testing to improve diabetes diagnosis. In addition, there is a need to strengthen awareness campaigns among the population so that people are well informed about the signs and symptoms of diabetes to promote early diagnosis. Diabetes care must be decentralized from tertiary hospitals to primary health centers. This will improve access to diabetes care and reduce the burden associated with traveling a long distance to access diabetes care in Malawi.
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Affiliation(s)
- Ellen Nkambule
- St John's Institute for Health, P.O. Box 18, Mzuzu, Malawi.
| | - Kondwani Wella
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
| | - Annie Msosa
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
| | | | - Evelyn Chilemba
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
| | - Gladys Msiska
- Kamuzu University of Health Sciences, P/Bag 1, Lilongwe, Malawi
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Karkon S, O'Shea F, Doran M, McCormack H, Connolly D. Testing the feasibility and acceptability of an online 'Fatigue and Activity Management Education for Work (FAME-W) programme' for individuals with inflammatory arthritis. Musculoskeletal Care 2023; 21:815-826. [PMID: 36929565 DOI: 10.1002/msc.1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Fatigue and Activity Management Education for Work (FAME-W) is a four-week, occupational therapy led programme focussing on fatigue management strategies. FAME-W was designed to be delivered in person; however, due to COVID-19 pandemic it was modified to be an online group-based self-management intervention. The purpose of this study was to test the feasibility and acceptability of the online delivery format of FAME-W. METHODS This was a mixed methods study. Participants were randomly allocated to intervention or control group. Participants in the intervention group received a four-week online FAME-W. The control group participants received a FAME-W handbook. Participants were required to complete questionnaires on work presenteeism, fatigue, mood, Health Related Quality of Life and pain at baseline, and 3 months post-intervention. Participants in the intervention group attended a focus group immediately following the completion of the programme and the control group participated in individual interviews. RESULTS Seven of ten individuals recruited participated in the study. Majority of participants had Rheumatoid Arthritis and were working full-time. The mean age of intervention participants was 53 ± 10.4 and 56.5 ± 3.7 for the controls. All participants in the intervention group had 100% attendance, completed all study measures and activities. Participants had positive comments about the programme format, content, and delivery. Improvements were observed in most measures at follow up. CONCLUSION Results suggest that an online programme to improve work ability was feasible and acceptable to individuals with inflammatory arthritis. The online delivery format was favoured over attending a centre-based programme. The findings support a definitive intervention trial of online FAME-W.
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Affiliation(s)
- Shalaleh Karkon
- Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
| | - Finbar O'Shea
- Rheumatology Department, St James' Hospital, Dublin, Ireland
| | - Michelle Doran
- Rheumatology Department, St James' Hospital, Dublin, Ireland
| | - Hazel McCormack
- Occupational Therapy Department, St James' Hospital, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
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Mars SG, Koester KA, Ondocsin J, Mars V, Mars G, Ciccarone D. 'The High Five Club': Social Relations and Perspectives on HIV-Related Stigma During an HIV Outbreak in West Virginia. Cult Med Psychiatry 2023; 47:329-349. [PMID: 35199277 PMCID: PMC8865492 DOI: 10.1007/s11013-022-09769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
In the United States, HIV outbreaks are occurring in areas most affected by the opioid epidemic, including West Virginia (WV). Cultural Theory contends that multiple cultures co-exist within societies distinguished by their differing intensities of rules or norms of behavior ('grid') or degree of group allegiance/individual autonomy ('group'). Accordingly, we would expect that perceptions about HIV, including stigma, correspond with individuals' grid/group attributes. To explore this, we conducted qualitative interviews with people who inject drugs (PWID) recruited from a WV syringe service program. This paper focuses on our unexpected findings on stigma during a coinciding HIV outbreak. PWID living homeless identified as belonging to a 'street family'. Its members were mutually distrustful and constrained by poverty and drug dependence but despite their conflicts, reported openness between each other about HIV + status. Interviewees living with HIV perceived little enacted stigma from peers since the local outbreak. Contrasting stigmatizing attitudes were attributed to the town's mainstream society. The 'High Five' (Hi-V) Club, expressing defiance towards stigmatizing behavior outside the street family, epitomized the tensions between a desire for solidary and mutual support and a fatalistic tendency towards division and distrust. Fatalism may hinder cooperation, solidarity and HIV prevention but may explain perceived reductions in stigma.
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Affiliation(s)
- Sarah G Mars
- Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA.
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Jeff Ondocsin
- Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
| | - Valerie Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Gerald Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
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Goode RW, Godoy SM, Olson K, Berg S, Agbozo B, Gwira R, Xu Y, Wolfe H, Bhutani J, Alexander R. "If I start panicking over having enough, then I start eating too much": Understanding the eating behaviors of SNAP recipients in larger bodies during COVID-19. Eat Behav 2023; 49:101741. [PMID: 37229948 DOI: 10.1016/j.eatbeh.2023.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND/OBJECTIVE Living in a food-insecure household may increase the risk for disordered eating. Though the Supplemental Nutrition Assistance Program (SNAP) was designed to reduce food insecurity, it may increase risk for disordered eating with the frequency in which benefits are distributed. Limited research has explored the lived experiences of managing eating behaviors while on SNAP, particularly among SNAP participants in larger bodies, and during COVID-19. Thus, the purpose of this study is to examine the experiences with eating behaviors among adults with a BMI ≥ 25 kg/m2, and who received SNAP benefits during the COVID-19 pandemic. METHODS Eligible adults were recruited to participate in a semi-structured interview. Interviews were transcribed verbatim and analyzed using thematic analysis and content analysis. RESULTS Participants (N = 16), had a mean (±SD) age of 43.4 ± 10.9 years, and overwhelmingly identified as female (86 %). One-third of the participants were Black. We identified 4 main themes: (1) not having enough money/benefits to cover needs; (2) navigating loss of control and emotional eating; (3) making sure the kids are alright; and (4) still feeling the pressure to manage weight. CONCLUSION Managing eating behaviors while also navigating SNAP benefits is complex and may exacerbate risk of disordered eating.
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Affiliation(s)
- Rachel W Goode
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America; University of North Carolina at Chapel Hill Nutrition Research Institute, 500 Laureate Wy., Kannapolis, NC 28081, United States of America; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah M Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Katie Olson
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Sophia Berg
- Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Campus Box #3270 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, United States of America
| | - Bridgette Agbozo
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Rebecca Gwira
- Georgia State University Department of Counseling and Psychological Services, College of Education & Human Development, Suite 950 30 Pryor St. SW, Atlanta, GA 30303, United States of America
| | - Yiwen Xu
- Statistics & Operations Research University of North Carolina at Chapel Hill, 318 Hanes Hall, CB #3260, Chapel Hill, NC 27599-3260, United States of America
| | - Hannah Wolfe
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Jaspreet Bhutani
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Ramine Alexander
- University of North Carolina at Chapel Hill Nutrition Research Institute, 500 Laureate Wy., Kannapolis, NC 28081, United States of America.
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Cole R, Durning SJ, Reamy BV, Stewart HC, Williamson SS, Rudinsky SL. A Comparison of HPSP and USU Graduates' Preparation for Residency. Mil Med 2023; 188:98-105. [PMID: 37201482 DOI: 10.1093/milmed/usac437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Military medical students enter residency through two main pathways: (1) The Uniformed Services University (USU) and (2) the Armed Services Health Professions Scholarship Program (HPSP). The purpose of this study was to compare how these two pathways prepare military medical students for residency. METHODS We conducted semi-structured interviews with 18 experienced military residency program directors (PDs) in order to explore their perceptions of the preparedness of USU and HPSP graduates. We used a transcendental phenomenological qualitative research design to bracket our biases and guide our data analysis. Our research team coded each of the interview transcripts. We then organized these codes into themes, which served as the results of our study. RESULTS Five themes emerged from our data regarding the residents' preparedness: (1) Ability to navigate the military culture, (2) understanding of the military's medical mission, (3) clinical preparation, (4) ability to navigate the Military Health System (MHS), and (5) teamwork. The PDs described how USU graduates better understand the military's medical mission and are more easily able to navigate the military culture and the MHS because of their lived experiences during military medical school. They also discussed the various levels of clinical preparation of HPSP graduates, in contrast to the USU graduates' more consistent skills and abilities. Finally, the PDs believed both groups to be strong team players. CONCLUSIONS USU students were consistently prepared for a strong start to residency because of their military medical school training. HPSP students often experienced a steep learning curve because of the newness of the military culture and MHS.
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Affiliation(s)
- Rebekah Cole
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Steven J Durning
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Brian V Reamy
- Department of Family Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Hannah C Stewart
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | | | - Sherri L Rudinsky
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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14
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Best NC, Donahue E, Agran PF, Munk K, Rochelle NF, Billimek J. Exploration of California School Nurse perspectives on the impact of COVID-19. Public Health Nurs 2023; 40:394-403. [PMID: 36880197 PMCID: PMC10164127 DOI: 10.1111/phn.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To explore in a sample of school nurses (SN) in California the impact of the COVID-19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID-19, and moral distress levels among school nurses. DESIGN AND METHODS Nineteen (N = 19) school nurses who work in K-12 schools in California, USA participated in a mixed-methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021. RESULTS Five themes emerged: (1) role of the SN during the COVID-19 pandemic, (2) coordination with school administration, (3) COVID-19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic. CONCLUSION The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID-19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics.
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Affiliation(s)
- Nakia C. Best
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, California
| | - Eden Donahue
- School Nurses of California Foundation, Newport Beach, California
- California State Polytechnic University, Humboldt, Arcata, California
| | - Phyllis F. Agran
- Department of Pediatrics, University of California, Irvine, Irvine, California
| | - Kirsten Munk
- School Nurses of California Foundation, Newport Beach, California
- California State University, Sacramento, Sacramento, California
| | - Na’imah F. Rochelle
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, California
| | - John Billimek
- Department of Family Medicine, University of California, Irvine, Irvine, California
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15
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Knoepke CE, Siry-Bove B, Mayton C, Latimer A, Hart J, Allen LA, Daugherty SL, McIlvennan CK, Matlock DD, Khazanie P. Variation in Left Ventricular Assist Device Postdischarge Caregiver Requirements: Results From a Mixed-Methods Study With Equity Implications. Circ Heart Fail 2022; 15:e009583. [PMID: 35862012 PMCID: PMC9388601 DOI: 10.1161/circheartfailure.122.009583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) evaluation includes a psychosocial assessment, conducted by social workers (SWs) on the advanced heart failure multidisciplinary team. Postdischarge caregiving plans are central to psychosocial evaluation. Caregiving's relationship with LVAD outcomes is mixed, and testing patients' social resources may disadvantage those from historically undertreated groups. We describe variation in policies defining adequate caregiving plans post-LVAD implant and possible impacts on patients from marginalized groups. METHODS This was a 2-phase sequential mixed-methods study: (1) phase 1, survey of US-based LVAD SWs, describing assessment structure and policies guiding candidacy outcomes; and (2) phase 2, individual interviews with SWs to further describe how caregiving plan adequacy impacts LVAD candidacy. RESULTS Sixty-seven SWs returned surveys (rr=47%) from unique programs. Caregiving plan inadequacy (n=30) was the most common psychosocial dealbreaker. When asked what duration of caregiving is required, 23% indicated ≥3 months, 27% 4 to 12 weeks, and 30% <4 weeks. Two reported no duration requirement, 6 stated an indefinite 24/7 commitment was necessary. Across 22 interviews, SWs mirrored that caregiving plans were the most common psychosocial contraindication. How caregiving is operationalized varied. Participants voiced a tension between extended caregiving improving outcomes and the sense that some people of color, women, or low socioeconomic status patients struggle to meet stringent requirements. CONCLUSIONS Policies regarding adequate duration of 24/7 caregiving vary, but inadequate caregiving plans are the most common psychosocial contraindication. Participants worry about patients' ability to meet restrictive requirements, particularly from historically undertreated groups. This highlights a need to operationalize quality caregiving, standardize assessment, and support medically appropriate patients with strained social resources.
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Affiliation(s)
- Christopher E Knoepke
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Bonnie Siry-Bove
- Department of Emergency Medicine (B.S.-B.), University of Colorado Anschutz Medical Campus, Aurora
| | - Caitlin Mayton
- School of Social Work, Virginia Commonwealth University, Richmond (C.M.)
| | - Abigail Latimer
- College of Nursing, University of Kentucky, Lexington (A.L.)
| | - Jan Hart
- Ascension St. Vincent Medical Center, Indianapolis, IN (J.H.)
| | - Larry A Allen
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Stacie L Daugherty
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora.,Institute for Health Research, Kaiser Permanente Colorado, Aurora (S.L.D.)
| | - Colleen K McIlvennan
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora
| | - Daniel D Matlock
- Division of Geriatric Medicine (D.D.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Prateeti Khazanie
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora
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Abstract
Qualitative data analysis should be embedded in routine health service measurement, management and organizational practices. The rigorous use of such analyses should become an institutional norm, comparable to the routine use of quantitative data. Our case is intended to have general relevance, but we develop it by reference to person-centred care and patient-centred outcome measures (PCOMs). The increased use of qualitative data analysis of individualized PCOMs is a crucial complementary counterweight to steps towards the standardization of PCOMs. More broadly, our argument is that health care organizations cannot make confident judgements about whether they are offering appropriate care without collecting qualitative data on what matters to individual patients. Introducing properly supported and conducted qualitative data analyses is important in its own right, and also helps underpin the validity and usefulness of quantitative measurement.
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Affiliation(s)
- Alan Cribb
- Professor of Bioethics and Education, Centre for Public Policy Research, 121212King's College London, UK
| | - Thomas Woodcock
- Improvement Science Fellow, Faculty of Medicine, 4957Imperial College London, UK
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17
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Borelli JL, Cervantes BR, Hecht HK, Marquez CM, DePrado R, Torres G, Robles A, Chirinos N, Leal F, Montiel GI, Pedroza M, Guerra N. Barreras y Soluciones: Lessons learned from integrating research-based clinical techniques into a community agency serving low-income Latinx immigrant families. FAMILY PROCESS 2022; 61:108-129. [PMID: 34405407 DOI: 10.1111/famp.12712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
Barriers facing effective science-to-practice translation have led scholars to conduct early-stage intervention research within community organizations. We describe our experiences developing a manualized parent-youth attachment-based group therapy intervention within a community health organization dedicated to serving low-income Latinx immigrant families, Latino Health Access (LHA), in which services are rendered by trained community workers (promotores). By conducting a qualitative analysis of interviews with all members of this academic-community partnership (research [Principal Investigator, student researchers] and community agency team members [Administrators, promotores]), we discuss the challenges and opportunities that this collaboration has generated. The results led both the research and community teams to question assumptions about the basic skills, values, and attitudes that underlie the integration of science and practice. We will share the insights that have helped to promote connection and understanding among the stakeholders and the efforts made to support the progress and successes of developing community interventions.
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Affiliation(s)
| | | | - Hannah K Hecht
- University of California, Irvine, Irvine, California, USA
| | | | - Rosy DePrado
- Latino Health Access, Santa Ana, California, USA
| | - Gina Torres
- Latino Health Access, Santa Ana, California, USA
| | | | | | | | | | | | - Nancy Guerra
- University of California, Irvine, Irvine, California, USA
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18
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Lowe E, Banner D, Estefan A, King-Shier K. Being Uncertain: Rural-Living Cardiac Patients' Experience of Seeking Health Care. QUALITATIVE HEALTH RESEARCH 2022; 32:609-621. [PMID: 33840281 DOI: 10.1177/10497323211005431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Secondary prevention strategies reduce disease progression to heart failure. Rural cardiac patients typically have less access to health care resources to support them in managing secondary prevention, and services to improve quality of life tend to be lacking in rural settings. The study aim was to examine the process that rural cardiac patients go through to access health care and cardiac rehabilitation (CR) following myocardial infarction (MI). In-depth interviews with 11 post-MI participants using Straussian grounded theory were undertaken. Analysis revealed a linear process from hospital discharge to maintaining health. There were five elements: comfort with health information, relationship with health care providers, social support, taking ownership, and availability of/for CR. The core category was "being uncertain." Findings can be used to identify ways to improve access and address uncertainty stemming from a lack of perceived information and supports following discharge.
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Affiliation(s)
- Erin Lowe
- University of Calgary, Calgary, Alberta, Canada
- Red Deer College, Red Deer, Alberta, Canada
| | - Davina Banner
- University of Northern British Columbia, Prince George, British Columbia, Canada
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19
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Lanka E, Rostron A, Singh P, Lanka S. Introduction to the Special Issue Call for Qualitative Research Tutorials in Contemporary Administration Studies: An Editorial. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2022. [DOI: 10.1590/1982-7849rac2022210333.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Lanka E, Rostron A, Singh P, Lanka S. Introdução à Chamada de Artigos Tutoriais de Pesquisa Qualitativa em Estudos de Administração Contemporânea para Edição Especial da RAC: Um Editorial. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2022. [DOI: 10.1590/1982-7849rac2022210333.por] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Pear VA, Schleimer JP, Tomsich E, Pallin R, Charbonneau A, Wintemute GJ, Knoepke CE. Implementation and perceived effectiveness of gun violence restraining orders in California: A qualitative evaluation. PLoS One 2021; 16:e0258547. [PMID: 34665820 PMCID: PMC8525775 DOI: 10.1371/journal.pone.0258547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Uptake of gun violence restraining orders (GVROs), which temporarily prohibit the possession and purchase of firearms and ammunition from individuals at particularly high risk of harming themselves or others with a firearm, has been slow and heterogenous across California. Insights into the implementation process and perceived effectiveness of the law could guide implementation in California and the many states that have enacted or are considering enacting such a law. METHODS We conducted 21 semi-structured interviews with 27 key informants, including judges, law enforcement officers, city and district attorneys, policy experts, and firearm violence researchers. Analysis of transcripts was guided by grounded theory and the Consolidated Framework for Implementation Research (CFIR). FINDINGS The following constructs emerged within 4 CFIR domains as salient features of implementation: 1) implementation characteristics: risk of violence, cost, and adaptability; 2) outer setting: interagency coordination and local firearm ideology; 3) inner setting: readiness for implementation and law enforcement firearm culture; and 4) implementation process: planning and engaging with those involved in implementation. Key informants perceived the law to be effective, particularly for preventing firearm suicide, but agreed that more research was needed. While most indicated that the law resulted in positive outcomes, concerns about the potential for class- and race-based inequities were also raised. CONCLUSIONS Implementation of the GVRO law in California was hampered by a lack of funding to support local proactive implementation efforts. This resulted in ad hoc policies and procedures, leading to inconsistent practices and widespread confusion among those responsible for implementation. In states that have not begun implementation, we recommend dedicating funding for implementation and creating local procedures statewide prior to the law's rollout. In California, recommendations include providing training on the GVRO law-including an explication of agency-specific roles, responsibilities, and procedures-to officers, city attorneys, and civil court judges.
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Affiliation(s)
- Veronica A. Pear
- Department of Emergency Medicine, Violence Prevention Research Program, UC Davis School of Medicine, Sacramento, California, United States of America
| | - Julia P. Schleimer
- Department of Emergency Medicine, Violence Prevention Research Program, UC Davis School of Medicine, Sacramento, California, United States of America
| | - Elizabeth Tomsich
- Department of Emergency Medicine, Violence Prevention Research Program, UC Davis School of Medicine, Sacramento, California, United States of America
| | - Rocco Pallin
- Department of Emergency Medicine, Violence Prevention Research Program, UC Davis School of Medicine, Sacramento, California, United States of America
| | - Amanda Charbonneau
- Department of Emergency Medicine, Violence Prevention Research Program, UC Davis School of Medicine, Sacramento, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| | - Garen J. Wintemute
- Department of Emergency Medicine, Violence Prevention Research Program, UC Davis School of Medicine, Sacramento, California, United States of America
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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22
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Gomez-Vidal C, Gomez AM. Invisible and unequal: Unincorporated community status as a structural determinant of health. Soc Sci Med 2021; 285:114292. [PMID: 34411968 DOI: 10.1016/j.socscimed.2021.114292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
Despite increasing awareness of the importance of political determinants of health, place-based research has not interrogated one of the most common political statuses: the impact of living in a community without municipal incorporation. In 2010 an estimated 37% of the U.S. population lived in an unincorporated area; despite their ubiquity, unincorporated communities are largely absent from the public health literature. Residents of unincorporated areas typically do not have their own local (e.g., city or municipal) government. This lack of representation leads to political exclusion and diminished access to resources, especially for low-income communities of color, Furthermore, by not disaggregating health data to unincorporated communities, residents are subsumed into county or census tract data that may not be reflective of their community's composition or context. Without jurisdictional distinction in research, there is no accountability for the manufacturing of health inequities in unincorporated communities . In the absence of empirical research on unincorporated communities, this paper uses the Commission on Social Determinants of Health (CSDH) Framework of the World Health Organization to argue that lack of municipal status is a structural determinant of health responsible for social conditions which generate cumulative health risks for residents. This includes using existing evidence on social conditions typical of unincorporated communities to describe patterns of residential segregation, neighborhood disadvantage, and environmental hazards that may increase residents' exposure to unhealthy environments in unincorporated communities. Finally, we provide an agenda for future public health research that can begin to address this health and racial equity gap for low-income unincorporated communities of color who have, until now, been absent in health equity discourse.
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Affiliation(s)
- Cristina Gomez-Vidal
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA.
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23
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Winters A, Hooley C, Gopalan G. Absorptive capacity in child welfare: A qualitative study with child welfare staff eliciting key factors for evidence-based practice adoption. JOURNAL OF PUBLIC CHILD WELFARE 2021; 16:704-723. [PMID: 36386436 PMCID: PMC9642977 DOI: 10.1080/15548732.2021.1959489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 06/16/2023]
Abstract
Child Welfare (CW) provides an array of services to meet the needs of families, requiring agencies to be malleable in their ability to absorb new practices. Absorptive capacity (ACAP) refers to the routines and processes in which an organization acquires, assimilates, and applies new knowledge. ACAP has yet to be the focus of implementation research in CW settings. This exploratory study elicited feedback from CW staff in determining factors to consider when absorbing a new practice. Themes of logistic support, agency culture, and feedback from families emerged. Findings offer insights for CW agencies to consider when adopting a new practice.
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Affiliation(s)
- Andrew Winters
- University of Louisville, Kent School of Social Work, Louisville, KY, 40292
| | - Cole Hooley
- Brigham Young University, School of Social Work, Provo, UT 84602
| | - Geetha Gopalan
- City University of New York, Silberman School of Social Work at Hunter College, New York, NY 10035
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24
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Carroll A, Chan D, Thorpe D, Levin I, Bagatell N. A Life Course Perspective on Growing Older With Cerebral Palsy. QUALITATIVE HEALTH RESEARCH 2021; 31:654-664. [PMID: 33213304 PMCID: PMC7883004 DOI: 10.1177/1049732320971247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite most children with cerebral palsy (CP) now living within typical life spans, little is known about how the effects of CP unfold across the life course and impact participation in everyday life during adulthood. In this study, we explored the experiences of 38 adults growing older with CP. Data were gathered using semi-structured interviews focused on participants' engagement in activities in their community and analyzed using a life course perspective to deepen our understanding of the experiences of our participants. We found that individual agency, family and social contexts, as well as larger sociocultural contexts all shaped participants' experiences as they grew older. The findings highlight the usefulness of the life course perspective for understanding how the effects of a diagnosis of CP unfold over time. Further use of this perspective can better inform health care services to meet the needs of adults with CP aging with a lifelong disability.
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Affiliation(s)
- Amanda Carroll
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dara Chan
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Deborah Thorpe
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ilana Levin
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nancy Bagatell
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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25
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Schneider-Kamp A. The Potential of AI in Care Optimization: Insights from the User-Driven Co-Development of a Care Integration System. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211017992. [PMID: 34027695 PMCID: PMC8150466 DOI: 10.1177/00469580211017992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
Transitions from one level of care to another are complex processes that pose medical and organizational risks and depend on care integration between different providers. This qualitative study investigated user experiences with an existing digital system for care integration between hospitals and nursing homes, and the potential of artificial intelligence to contribute to its optimization. The findings reveal challenges regarding (a) untimely information, (b) irrelevant information, (c) confusing information, (d) missing information, (e) information overload, and (f) information multiplicity. Artificial intelligence could address these by (i) identifying and verifying low-quality information, (ii) targeting information for different user groups, (iii) visually summarizing relevant information, and (iv) jointly presenting multiple versions. The implications of these findings extend beyond the context of care integration, presenting empirical evidence for the importance of qualitative health research in, and a model for, determining the scope and design of future artificial intelligence solutions to optimize (health)care processes.
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26
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Massazza A, Brewin CR, Joffe H. Feelings, Thoughts, and Behaviors During Disaster. QUALITATIVE HEALTH RESEARCH 2021; 31:323-337. [PMID: 33228498 PMCID: PMC7753093 DOI: 10.1177/1049732320968791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Thoughts, feelings, and behaviors during traumatic events, that is, peritraumatic reactions, are key to post-trauma psychopathology development. Qualitative research is required to investigate whether existing quantitative methods capture the range and complexity of peritraumatic reactions as described by survivors. Semi-structured interviews were conducted with 104 earthquake survivors. Participants reported experiencing various peritraumatic reactions (M = 21, range = 6-43). The survivors' accounts confirmed presence and overall phenomenological characteristics of commonly studied peritraumatic reactions such as dissociation, distress, mental defeat, and immobility. In addition, novel and understudied reactions were identified: cognitive overload, hyperfocus, and emotion regulation, as well as positive affect. Finally, a number of cross-cutting phenomena were identified such as the social nature of many reactions and survivors evaluating their reactions as difficult to put into words. These findings have implications for the conceptualization of peritraumatic reactions, for trauma-focused psychotherapeutic interventions, and for the wellbeing of disaster survivors.
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Affiliation(s)
- Alessandro Massazza
- Research Department of Clinical,
Educational and Health Psychology, University College London, London, United
Kingdom
| | - Chris R. Brewin
- Research Department of Clinical,
Educational and Health Psychology, University College London, London, United
Kingdom
| | - Helene Joffe
- Research Department of Clinical,
Educational and Health Psychology, University College London, London, United
Kingdom
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27
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Hayashi P, Abib G, Hoppen N, Wolff LDG. Processual Validity in Qualitative Research in Healthcare. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060750. [PMID: 34845941 PMCID: PMC8640329 DOI: 10.1177/00469580211060750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Knowledge development has been continuously challenging. Qualitative research seems to be promising; however, there are difficulties and complexities involved, one of which is validity. Qualitative research is based on different paradigms, ontologies, theories, and methods, and validity assessment may vary. We argue that processual validity can positively influence qualitative health care research. Processual validity is a methodological construction that involves all research steps, including those before and after data collection and analysis. We selected a processual validity model and two cases to illustrate its use and demonstrate processual validity’s importance and applicability. One case explores the gap between medical education and patients’ needs in primary health care. Other studies focus on health care improvements in hospitals. Our results highlight the benefits of processual validity to ensure the transparency and reliability of the research process and provide evidence of the findings to positively influence thinking and the execution of qualitative research in health care.
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Affiliation(s)
| | | | - Norberto Hoppen
- Vale do Rio dos Sinos University, São Leopoldo, Rio Grande do Sul, Brazil
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Simwaka A, Kabuluzi E, Munkhondya B, Ngoma L, Kunkeyani H, Mbeya Munkhondya TE, Msiska G. Mixed perceptions of women on care in maternal and child healthcare settings in Lilongwe, Malawi. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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