1
|
Wardell J, Albright D, Chang C, Plegue MA, Lee JE, Hirschfeld E, Garrity A, Lee JM, DeJonckheere M. Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic. Sci Diabetes Self Manag Care 2024; 50:116-129. [PMID: 38456252 PMCID: PMC11042759 DOI: 10.1177/26350106241232634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care. METHODS A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C. RESULTS Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity. CONCLUSIONS In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports.
Collapse
Affiliation(s)
- Joseph Wardell
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Dana Albright
- Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana
| | - Claire Chang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Melissa A Plegue
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jung Eun Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Joyce M Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
2
|
Sitto HM, Brodsky CN, Wittmann D, Wallner LP, Streur C, DeJonckheere M, Stoffel JS, Cameron AP, Sarma A, Clemens JQ, Ippolito GM. Patient and physician decision-making dynamics in overactive bladder care: A mixed methods study. Neurourol Urodyn 2024; 43:565-573. [PMID: 38334205 PMCID: PMC11054369 DOI: 10.1002/nau.25416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
AIMS Overactive bladder management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision-making. This study investigates patient and physician health beliefs surrounding decision-making and expectations for overactive bladder with the aim of better understanding and ultimately improving decision-making in overactive bladder care. METHODS Patient and physician participants completed a questionnaire followed by a semi-structured interview to assess health beliefs surrounding decision making and expectations for overactive bladder treatment. The semi-structured interview guide, developed in an iterative fashion by the authors, probed qualities of overactive bladder therapies patients and physicians valued, their process of treatment selection, and their experiences with therapies. RESULTS Patients (n = 20) frequently cited treatment invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting overactive bladder therapy. Physicians (n = 12) frequently cited safety/contraindications, convenience, cost/insurance, and patient preference as the most important qualities. In our integration analysis, we identified four key themes associated with decision making in overactive bladder care: frustration with inaccessibility of overactive bladder treatments, discordant perception of patient education, diverging acceptability of expected outcomes, and lack of insight into other parties' decisional priorities and control preferences. CONCLUSIONS While both patients and physicians desire to engage in a shared decision-making process when selecting therapies for overactive bladder, this process is challenged by significant divergence between patient and physician viewpoint across key domains.
Collapse
Affiliation(s)
| | | | | | | | - Courtney Streur
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | - John S. Stoffel
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Anne P. Cameron
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Aruna Sarma
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | | |
Collapse
|
3
|
Bergholtz SE, Kurnot SR, Elahi E, DeJonckheere M, Hawley ST, Owens SR, Salami S, Morgan TM, Lapedis CJ. A longitudinal mixed-methods study of pathology explanation clinics in patients with newly diagnosed localized prostate cancer. Am J Clin Pathol 2024:aqae008. [PMID: 38387034 DOI: 10.1093/ajcp/aqae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES To characterize the role of pathology explanation clinics (PECs) in prostate cancer care and determine their impact on patients, urologic oncologists, and quality of care. METHODS Semistructured interviews with 10 patients with newly diagnosed prostate cancer were conducted before and after a PEC pilot and at the 1- and 6-month follow-up visits. Information about participants' cancer knowledge and anxiety were collected quantitatively. Documented pathologist communications and proper review of outside biopsy slides were collected. Semistructured interviews were also completed with participating urologic oncologists following the pilot. RESULTS Pathology explanation clinics improved participants' understanding of their diagnosis, cognitively and emotionally supporting them first in their urologic oncology visit and later in making an informed treatment decision. Mean knowledge scores were high, and a minority of participants had prostate cancer anxiety. Urologic oncologists noted improved understanding and reduced anxiety among participants, enabling nuanced conversations about prognosis and management during the visit. By ensuring review of outside biopsy slides and communication of clinically significant or unexpected diagnoses, PECs supported high-quality care and patient safety. CONCLUSIONS In this small pilot, PECs positively affected patients with prostate cancer, their clinicians, and the overall care system. Additional studies in larger populations and diverse settings will be useful.
Collapse
Affiliation(s)
- Sarah E Bergholtz
- Department of Pathology & Clinical Labs, Michigan Medicine, Ann Arbor MI, US
| | - Sophia R Kurnot
- Department of Pathology & Clinical Labs, Michigan Medicine, Ann Arbor MI, US
| | - Esha Elahi
- Department of Pathology & Clinical Labs, Michigan Medicine, Ann Arbor MI, US
| | | | - Sarah T Hawley
- Department of Internal Medicine, Michigan Medicine, Ann Arbor MI, US
| | - Scott R Owens
- Department of Pathology & Clinical Labs, Michigan Medicine, Ann Arbor MI, US
| | - Simpa Salami
- Department of Urologic Oncology, Michigan Medicine, Ann Arbor MI, US
| | - Todd M Morgan
- Department of Urologic Oncology, Michigan Medicine, Ann Arbor MI, US
| | - Cathryn J Lapedis
- Department of Pathology & Clinical Labs, Michigan Medicine, Ann Arbor MI, US
- VA Ann Arbor Healthcare System, Ann Arbor, MI, US
| |
Collapse
|
4
|
Bergmans RS, Chambers-Peeple K, Yu C, Xiao LZ, Wegryn-Jones R, Martin A, Dell'Imperio S, Aboul-Hassan D, Williams DA, Clauw DJ, DeJonckheere M. 'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID. J Clin Nurs 2024; 33:162-177. [PMID: 37140186 PMCID: PMC10624641 DOI: 10.1111/jocn.16733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/05/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
AIMS AND OBJECTIVES In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults. BACKGROUND As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients. DESIGN We employed an interpretive description study design. METHODS We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines. RESULTS We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships. CONCLUSION Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management. RELEVANCE TO CLINICAL PRACTICE Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue. NO PATIENT OR PUBLIC CONTRIBUTION While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.
Collapse
Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Christine Yu
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillian Z Xiao
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Riley Wegryn-Jones
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allie Martin
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
5
|
Summerville J, Farahani N, Yalavarthi B, Aboul-Hassan D, Rajgarhia S, Xiao LZ, Yu C, Clauw DJ, Kahlenberg JM, DeJonckheere M, Bergmans RS. A qualitative study on opportunities to improve research engagement and inclusion of Black adults with systemic lupus erythematosus. Lupus 2024; 33:58-67. [PMID: 38047461 PMCID: PMC10842866 DOI: 10.1177/09612033231220168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
In response to racial inequities in systemic lupus erythematosus (SLE), we aimed to identify practical recommendations for increasing engagement and inclusion of Black adults in SLE research. We used a qualitative, interpretive description approach and recruited 30 Black adults diagnosed with SLE in Michigan to participate in semi-structured interviews. Theme development focused on what factors influenced research perceptions and how research did not meet participant needs and expectations. We developed five main themes: (1) Ethical and equitable research. Participants shared how the impacts of past and present-day racism impacted their willingness to participate in research. (2) Trusting researchers to conduct studies and translate findings to health care. Participants had concerns related to researcher intentions and expressed the importance of communicating research outcomes to participants and translating findings to health care. (3) Drug trial beneficence. When considering drug trials, several people did not consider the potential benefits worth the risk of side effects, and some said they would need to consult with their doctor before agreeing to participate. (4) Altruism. Participants explained how the desire to help others was a motivating factor for participating in research and donating biological samples. (5) Research priorities. Participants described a need for better treatments that value their overall health and well-being. Findings indicate that researchers can center the perspectives of Black people with SLE across the research life cycle-beyond a focus on adequate racial diversity among study participants.
Collapse
Affiliation(s)
- Johari Summerville
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Nikki Farahani
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Bhaavna Yalavarthi
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Deena Aboul-Hassan
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Sia Rajgarhia
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Lillian Z. Xiao
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Christine Yu
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Daniel J. Clauw
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - J. Michelle Kahlenberg
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
| | - Melissa DeJonckheere
- University of Michigan, Medical School, Department of Family Medicine, Ann Arbor, Michigan
| | - Rachel S. Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| |
Collapse
|
6
|
Doan TT, DeJonckheere M, Wright DR, Hutton DW, Prosser LA. Preferences and experiences of pediatricians on implementing national guidelines on universal routine screening of adolescents for major depressive disorder: A qualitative study. Compr Psychiatry 2023; 127:152412. [PMID: 37717343 DOI: 10.1016/j.comppsych.2023.152412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND To explore the preferences of pediatricians for key factors around the implementation of universal routine screening guidelines for major depressive disorder in adolescent patients in a primary care setting. METHOD Semi-structured qualitative interviews were conducted with U.S. pediatricians. Participants were recruited by convenience sampling and snowball sampling. Qualitive data were summarized using thematic analysis to identify themes relevant to preferences around implementing screening strategies for adolescent patients. Recruitment ended upon reaching thematic saturation when no new themes were revealed. RESULTS Of the 14 participants, 11 identified as female, 3 male, 10 white, and 4 Asian. Top themes among pediatrician participants were around the screening modality (14/14 participants), screening validity (14/14), time barriers (14/14), and confidentiality barriers (12/14). Less frequently mentioned themes by pediatricians were workplace coordination and logistics (7/14), alternative starting ages for screening (7/14), more frequent screenings than annual screenings (3/14), and additional clinical training regarding depression diagnosis and treatment (2/14). LIMITATIONS Pool of interviewed participants was limited by diversity in terms of geography, race/ethnicity, or practice settings. CONCLUSIONS To promote the uptake of universal routine screening of adolescent major depression, pediatricians expressed it was important to address key implementation factors regarding the screening modality, screening validity, time constraints, and confidential care concerns in a primary care delivery context. Findings could be used to inform the development of implementation strategies to facilitate depression screening in primary care. Future research is needed to quantitively assess decisions and tradeoffs that pediatricians make when implementing universal screening to support adolescent mental health.
Collapse
Affiliation(s)
- Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Yalavarthi B, Summerville J, Farahani N, Xiao LZ, Yu C, Aboul-Hassan D, Rajgarhia S, Clauw DJ, Kahlenberg JM, DeJonckheere M, Bergmans RS. Recommendations for Improving Systemic Lupus Erythematosus Care From Black Adults: A Qualitative Study. JAMA Netw Open 2023; 6:e2340688. [PMID: 37906190 PMCID: PMC10618846 DOI: 10.1001/jamanetworkopen.2023.40688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
Importance Racial inequities in incidence, morbidity, and mortality are a defining feature of systemic lupus erythematosus (SLE). Health care systems are integral to addressing these inequities. However, qualitative evidence that highlights Black SLE care experiences is limited. Objective To identify opportunities for improving SLE care based on the experiences and perspectives of Black adults with SLE. Design, Setting, and Participants In this qualitative study, an interpretive description approach was used and data were analyzed using inductive thematic analysis. Semistructured interviews with Black adults in Michigan who were diagnosed with SLE were conducted. Interviews occurred from November 2, 2021, to July 19, 2022, and data analysis occurred from May 6, 2022, to April 12, 2023. Main Outcomes and Measures Deidentified transcripts from the interviews were analyzed to develop themes that focused on opportunities to improve quality of care and symptom management. Results The participants included 30 Black adults with SLE (97% women; mean age, 41 years; range, 18-65 years). Four main themes were identified: (1) awareness of SLE signs and symptoms before diagnosis (participants emphasized delays in diagnosis and how knowledge concerning SLE could be limited in their families and communities); (2) patient-clinician interactions (participants faced discrimination in health care settings and talked about the value of coordinated and supportive health care teams); (3) medication adherence and health effects (participants experienced a range of adverse effects from medications that treat SLE and described how monitoring medication use and efficacy could inform tailored care approaches); and (4) comprehensive care plans after diagnosis (participants reported persistent pain and other symptoms despite treatment). In the context of disease management, participants emphasized the importance of behavioral change and the negative impact of social risk factors. Conclusions and Relevance The findings of this qualitative study suggest how limited information about SLE, experiences of racism, treatment regimens, and social risk factors may affect Black people with SLE. Future research should further engage and include Black communities within the context of treatment and intervention development to reduce racial inequities.
Collapse
Affiliation(s)
- Bhaavna Yalavarthi
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Johari Summerville
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Nikki Farahani
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Lillian Z. Xiao
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Christine Yu
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Deena Aboul-Hassan
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Sia Rajgarhia
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Daniel J. Clauw
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| | | | - Melissa DeJonckheere
- Medical School, Department of Family Medicine, University of Michigan, Ann Arbor
| | - Rachel S. Bergmans
- Medical School, Department of Anesthesiology, University of Michigan, Ann Arbor
| |
Collapse
|
8
|
Chuisano SA, Rafferty J, Allen A, Chang T, Diemer M, Harris K, Vaughn LM, Watkins DC, DeJonckheere M. Increasing representation and diversity in health research: A protocol of the MYHealth research training program for high school students. PLoS One 2023; 18:e0281790. [PMID: 37768968 PMCID: PMC10538793 DOI: 10.1371/journal.pone.0281790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Despite decades of calls for increased diversity in the health research workforce, disparities exist for many populations, including Black, Indigenous, and People of Color individuals, those from low-income families, and first-generation college students. To increase representation of historically marginalized populations, there is a critical need to develop programs that strengthen their path toward health research careers. High school is a critically important time to catalyze interest and rebuild engagement among youth who may have previously felt excluded from science, technology, engineering, and mathematics (STEM) and health research careers. METHODS The overall objective of the MYHealth program is to engage high school students in a community-based participatory research program focused on adolescent health. Investigators will work alongside community partners to recruit 9th through 12th graders who self-identify as a member of a group underrepresented in STEM or health research careers (e.g., based on race and ethnicity, socioeconomic status, first generation college student, disability, etc.). MYHealth students are trained to be co-researchers who work alongside academic researchers, which will help them to envision themselves as scientists capable of positively impacting their communities through research. Implemented in three phases, the MYHealth program aims to foster a continuing interest in health research careers by developing: 1) researcher identities, 2) scientific literacy, 3) scientific self-efficacy, and 4) teamwork and leadership self-efficacy. In each phase, students will build knowledge and skills in research, ethics, data collection, data analysis, and dissemination. Students will directly collaborate with and be mentored by a team that includes investigators, community advisors, scientific advisors, and youth peers. DISCUSSION Each year, a new cohort of up to 70 high school students will be enrolled in MYHealth. We anticipate the MYHealth program will increase interest and persistence in STEM and health research among groups that have been historically excluded in health research careers.
Collapse
Affiliation(s)
- Samantha A. Chuisano
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jane Rafferty
- School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alison Allen
- Rockman Et Al, San Francisco, California, United States of America
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew Diemer
- School of Education, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kara Harris
- DePaul University, Chicago, Illinois, United States of America
| | - Lisa M. Vaughn
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- School of Education, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Daphne C. Watkins
- School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
9
|
Ager EE, Sturdavant W, Curry Z, Ahmed F, DeJonckheere M, Gutting AA, Merchant RC, Kocher KE, Solnick RE. Mixed-methods Evaluation of an Expedited Partner Therapy Take-home Medication Program: Pilot Emergency Department Intervention to Improve Sexual Health Equity. West J Emerg Med 2023; 24:993-1004. [PMID: 37788042 PMCID: PMC10527844 DOI: 10.5811/westjem.59506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 10/04/2023] Open
Abstract
Background: Treatment for partners of patients diagnosed with sexually transmitted infections (STI), referred to as expedited partner therapy (EPT), is infrequently used in the emergency department (ED). This was a pilot program to initiate and evaluate EPT through medication-in-hand ("take-home") kits or paper prescriptions. In this study we aimed to assess the frequency of EPT prescribing, the efficacy of a randomized best practice advisory (BPA) on the uptake, perceptions of emergency clinicians regarding the EPT pilot, and factors associated with EPT prescribing. Methods: We conducted this pilot study at an academic ED in the midwestern US between August-October 2021. The primary outcome of EPT prescription uptake and the BPA impact was measured via chart abstraction and analyzed through summary statistics and the Fisher exact test. We analyzed the secondary outcome of barriers and facilitators to program implementation through ED staff interviews (physicians, physician assistants, and nurses). We used a rapid qualitative assessment method for the analysis of the interviews. Results: During the study period, 52 ED patients were treated for chlamydia/gonorrhea, and EPT was offered to 25% (95% CI 15%-39%) of them. Expedited partner therapy was prescribed significantly more often (42% vs 8%; P < 0.01) when the interruptive pop-up alert BPA was shown compared to not shown. Barriers identified in the interviews included workflow constraints and knowledge of EPT availability. The BPA was viewed positively by the majority of participants. Conclusion: In this pilot EPT program, expedited partner therapy was provided to 25% of ED patients who appeared eligible to receive it. The interruptive pop-up alert BPA significantly increased EPT prescribing. Barriers identified to EPT prescribing should be the subject of future interventions to improve provision of EPT from the emergency department.
Collapse
Affiliation(s)
- Emily E Ager
- University of Michigan, School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - William Sturdavant
- University of Michigan, School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Zoe Curry
- Vanderbilt University Medical Center, School of Medicine, Department of Emergency Medicine, Nashville, Tennessee
| | - Fahmida Ahmed
- University of Michigan, School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Melissa DeJonckheere
- University of Michigan, School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Andrew A Gutting
- University of Michigan, Michigan Medicine, Department of Clinical Quality, Ann Arbor, Michigan
| | | | - Keith E Kocher
- University of Michigan, School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | | |
Collapse
|
10
|
Dell'Imperio SG, Aboul-Hassan D, Batchelor R, Chambers-Peeple K, Clauw DJ, DeJonckheere M, Bergmans RS. Vaccine perceptions among Black adults with long COVID. Ethnicity & Health 2023; 28:853-873. [PMID: 37005013 PMCID: PMC10524107 DOI: 10.1080/13557858.2023.2191914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Low uptake of COVID vaccines within Black communities is a concern given the stark racial inequities associated with the pandemic. Prior research details COVID vaccine perceptions within the general population and Black communities specifically. However, Black individuals with long COVID may be more or less receptive to future COVID vaccination than their peers without long COVID. The impact of COVID vaccination on long COVID symptoms is still controversial, since some studies suggest that vaccination can improve long COVID symptoms, whereas other studies report no significant change in symptoms or a worsening of symptoms. In this study, we aimed to characterize the factors influencing perceptions of COVID vaccines among Black adults with long COVID to inform future vaccine-related policies and interventions. DESIGN We conducted 15 semi-structured, race-concordant interviews over Zoom with adults who reported physical or mental health symptoms that lingered for a month or more after acute COVID infection. We transcribed and anonymized the interviews and implemented inductive, thematic analysis to identify factors influencing COVID vaccine perceptions and the vaccine decision-making process. RESULTS We identified five themes that influenced vaccine perceptions: (1) Vaccine safety and efficacy; (2) Social implications of vaccination status; (3) Navigating and interpreting vaccine-related information; (4) Possibility of abuse and exploitation by the government and scientific community; and (5) Long COVID status. Safety concerns were amplified by long COVID status and mistrust in social systems due to mistreatment of the Black community. CONCLUSIONS Among the factors influencing COVID vaccine perceptions, participants reported a desire to avoid reinfection and a negative immune response. As COVID reinfection and long COVID become more common, achieving adequate uptake of COVID vaccines and boosters may require approaches that are tailored in partnership with the long COVID patient community.
Collapse
Affiliation(s)
| | - Deena Aboul-Hassan
- Department of Anesthesiology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Daniel J Clauw
- Department of Anesthesiology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Rachel S Bergmans
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Tsunawaki S, Abe M, DeJonckheere M, Cigolle CT, Philips KK, Rubinstein EB, Matsuda M, Fetters MD, Inoue M. Primary care physicians' perspectives and challenges on managing multimorbidity for patients with dementia: a Japan-Michigan qualitative comparative study. BMC Prim Care 2023; 24:132. [PMID: 37370035 DOI: 10.1186/s12875-023-02088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Multimorbidity management can be extremely challenging in patients with dementia. This study aimed to elucidate the approaches of primary care physicians in Japan and the United States (US) in managing multimorbidity for patients with dementia and discuss the challenges involved. METHODS This qualitative study was conducted through one-on-one semi-structured interviews among primary care physicians, 24 each from Japan and Michigan, US. Thematic and content analyses were performed to explore similarities and differences among each country's data. RESULTS Primary care physicians in Japan and Michigan applied a relaxed adherence to the guidelines for patients' chronic conditions. Common challenges were the suboptimal consultation time, the insufficient number or ability of care-coordinating professionals, patients' conditions such as difficulties with self-management, living alone, behavioral issues, and refusal of care support. Unique challenges in Japan were free-access medical systems and not being sure about the patients' will in end-of-life care. In Michigan, physicians faced challenges in distance and lack of transportation between clinics and patients' homes and in cases where patients lacked the financial ability to acquire good care. CONCLUSIONS To improve the quality of care for patients with multimorbidity and dementia, physicians would benefit from optimal time and compensation allocated for this patient group, guidelines for chronic conditions to include information regarding changing priority for older adults with dementia, and the close collaboration of medical and social care and community resources with support of skilled care-coordinating professionals.
Collapse
Affiliation(s)
- Shinji Tsunawaki
- Omaezaki Family Medicine Center, Omaezaki, Shizuoka, Japan
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
| | - Michiko Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | | | - Christine T Cigolle
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System (VAAAHS) Geriatric Research, Ann Arbor, MI, USA
| | - Kristin K Philips
- Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System (VAAAHS) Geriatric Research, Ann Arbor, MI, USA
| | - Ellen B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Masakazu Matsuda
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
- Kikugawa Family Medicine Center, Kikugawa, Shizuoka, Japan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- The School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Machiko Inoue
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan.
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| |
Collapse
|
12
|
Lin YK, Agni A, Chuisano S, de Zoysa N, Fetters M, Amiel SA, Pop-Busui R, DeJonckheere M. 'You have to use everything and come to some equilibrium': a qualitative study on hypoglycemia self-management in users of continuous glucose monitor with diverse hypoglycemia experiences. BMJ Open Diabetes Res Care 2023; 11:e003415. [PMID: 37349107 PMCID: PMC10314535 DOI: 10.1136/bmjdrc-2023-003415] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Although continuous glucose monitoring systems (CGMs) can help reduce hypoglycemia, about one-quarter of people with type 1 diabetes (T1D) who use CGMs still either spend at least 1% of the time with dangerously low blood glucose or develop severe hypoglycemia. This study explored experiences around hypoglycemia self-management in people who are living with T1D and using CGMs to identify factors contributing to hypoglycemia development. RESEARCH DESIGN AND METHODS Purposive sampling and semistructured interviews with 28 respondents with T1D and using CGMs were conducted to explore experiences around hypoglycemic episodes and hypoglycemia self-management during CGM use. Open coding and thematic analysis were employed to identify emergent themes related to hypoglycemia experiences. RESULTS About one-third of respondents each respectively spent 0%, 0.1%-0.9% and ≥1% of time in level 2 hypoglycemia; 39% had impaired awareness of hypoglycemia and 32% had severe hypoglycemia in the past 6 months. Four themes were generated: (1) prioritizing symptoms over CGM data (subthemes: hypoglycemia symptoms for confirming hypoglycemia and prompting management actions; minimal management actions without hypoglycemia symptoms); (2) distraction from the demands of daily life; (3) concerns about hypoglycemia management choices (subthemes: fear of rebound hyperglycemia; other health consequences related to sugary food consumption; aversions to treatment foods and treatment food consumption); and (4) social influences on management choices (subthemes: positively perceived social support and inclusion; unwanted attention to oneself or concerns about inconveniencing others; social stigma and criticism related to hypoglycemia and CGM use). CONCLUSIONS Despite using CGMs, people with T1D can face a complex biopsychosocial process of managing hypoglycemia. Interventions for addressing psychosocial and behavioral barriers are needed to improve hypoglycemia self-management in those who continue to face challenges in minimizing hypoglycemia while using CGMs.
Collapse
Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Annika Agni
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Samantha Chuisano
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Michael Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
13
|
Chua KP, Thorne MC, Brummett CM, DeJonckheere M. Surgeons' Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems. JAMA Netw Open 2023; 6:e2315633. [PMID: 37234007 DOI: 10.1001/jamanetworkopen.2023.15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Importance An intervention in 2021 at a tertiary medical center found that the implementation of evidence-based default dosing settings for opioid prescriptions written in electronic health record systems was associated with reduced opioid prescribing to adolescents and young adults aged 12 to 25 years undergoing tonsillectomy. It is unclear whether surgeons were aware of this intervention, whether they thought the intervention was acceptable, or whether they believed similar interventions were feasible to implement in other surgical populations and institutions. Objective To assess surgeons' experiences and perspectives regarding an intervention that changed the default number of doses for opioid prescriptions to an evidence-based level. Design, Setting, and Participants This qualitative study was conducted at a tertiary medical center during October 2021, 1 year after implementation of the intervention, in which the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy was lowered to an evidence-based level. Semistructured interviews were conducted with otolaryngology attending and resident physicians who had cared for the adolescents and young adults undergoing tonsillectomy after implementation of the intervention. Factors that play a role in opioid prescribing decisions after surgery and participants' awareness of and views on the intervention were assessed. The interviews were coded inductively and a thematic analysis was performed. Analyses were conducted from March to December 2022. Exposure Change in the default dosing settings for opioid prescriptions written in an electronic health record system to adolescents and young adults undergoing tonsillectomy. Main Outcomes and Measures Surgeons' experiences and perspectives regarding the intervention. Results The 16 otolaryngologists interviewed included 11 residents (68.8%), 5 attending physicians (31.2%), and 8 women (50.0%). No participant reported noticing the change in the default settings, including those who wrote opioid prescriptions with the new default number of opioid doses. From the interviews, 4 themes regarding surgeons' perceptions and experiences of the intervention emerged: (1) opioid prescribing decisions are influenced by patient, procedure, physician, and health system factors; (2) defaults may substantially influence prescribing behavior; (3) support for the default dosing setting intervention depended on whether it was evidence-based and had unintended consequences; and (4) changing the default dosing settings is potentially feasible in other surgical populations and institutions. Conclusions and Relevance These findings suggest that interventions to change the default dosing settings for opioid prescriptions may be feasible to implement in a variety of surgical populations, particularly if the new settings are evidence-based and if unintended consequences are carefully monitored.
Collapse
Affiliation(s)
- Kao-Ping Chua
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Marc C Thorne
- Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor
| | - Chad M Brummett
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
| | | |
Collapse
|
14
|
Mizokami-Stout K, Thompson HM, Hurren K, Leone V, Piatt GA, Lee JM, Pop-Busui R, DeJonckheere M. Clinician Experiences With Hybrid Closed Loop Insulin Delivery Systems in Veterans With Type 1 Diabetes: Qualitative Study. JMIR Diabetes 2023; 8:e45241. [PMID: 36989019 PMCID: PMC10132000 DOI: 10.2196/45241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Hybrid closed loop (HCL) insulin pumps adjust insulin delivery based on input from a continuous glucose monitor. Several systems are FDA approved and associated with improved time in range, reduction in hemoglobin A1c, and decreased incidence of hypoglycemia. Major diabetes guidelines differ in their strength of recommendations regarding the use of HCL systems. Overall, limited information about the factors that influence HCL pump clinical decision-making is available, especially among endocrinology clinicians. OBJECTIVE The study objective is to describe the knowledge and attitudes, network support, and self-efficacy regarding HCL insulin delivery systems among endocrinology clinicians in one Veterans Affairs (VA) Healthcare System in the Midwest. METHODS Following a descriptive approach, this qualitative study used semistructured interviews and inductive thematic analysis. All endocrinologists, endocrinology fellows, and nurses in the endocrinology and metabolism department at one VA Healthcare System in the Midwest were invited to participate in one-on-one phone interviews. Thematic analysis explored clinician perspectives on HCL insulin pump systems. RESULTS Participants (n=11) had experience within VA and university health care system endocrinology clinics. From their experiences, 4 themes were identified involving the evaluation and assessment of insulin pump candidates, prescribing challenges, clinical benefits of HCL pumps, and overall clinician confidence. CONCLUSIONS Findings suggest that clinicians believe HCL systems have significant glycemic benefits but are not appropriate for all patients, especially those with cognitive impairment. HCL pump initiation is a multi-step process requiring an interdisciplinary team of health care clinicians to ensure patient and pump success. Furthermore, HCL systems improve clinician confidence in overall diabetes management.
Collapse
Affiliation(s)
- Kara Mizokami-Stout
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, United States
| | - Holly M Thompson
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, United States
| | - Kathryn Hurren
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, United States
| | - Virginia Leone
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Joyce M Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
15
|
Bergholtz SE, Kurnot SR, DeJonckheere M, Hawley ST, Owens SR, Lapedis CJ. A Mixed-Methods Study of Clinicians' Attitudes Toward Pathology Explanation Clinics. Am J Clin Pathol 2023; 159:437-447. [PMID: 36821476 DOI: 10.1093/ajcp/aqac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES To characterize the attitudes of treating clinicians toward pathology explanation clinics (PECs). METHODS Clinicians from a tertiary care academic medical center were asked, "How interested would you be in having your patient meet with a pathologist to discuss their pathology report and see their tissue under the microscope?" Clinicians ranked their interest, then expanded on concerns and benefits in a semistructured interview. Audio recordings of interviews were transcribed and analyzed using a qualitative thematic approach. RESULTS A total of 35 clinicians were interviewed, with 83% reporting some level of interest in PECs. Clinicians felt that highly educated and motivated patients were most likely to benefit from a PEC. Clinicians recognized that PECs could improve understanding and emotional processing but that the patient's information needs must be balanced with the potential for cognitive overload and emotional distress. When integrating the pathologist into the care team, clinicians worried about the pathologist's communication skills, care fragmentation, and increased clinician workload. If performed well, clinicians felt PECs had the potential to increase clinician efficacy and improve quality of care. CONCLUSIONS Overall, clinicians are interested in PECs when they fulfill a patient's information needs and are optimally performed.
Collapse
Affiliation(s)
| | | | | | - Sarah T Hawley
- Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, US
| | | | - Cathryn J Lapedis
- Departments of Pathology.,Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, US
| |
Collapse
|
16
|
Jacob J, Aintabi D, DeJonckheere M, Cohen-Mekelburg SA, Allen JI, Irani DN, Fendrick AM, Waljee AK, Higgins PDR, Berinstein JA. Inflammatory bowel disease patient concerns and experiences on transition to home-based infusions during the COVID-19 pandemic. Res Social Adm Pharm 2022; 18:4138-4143. [PMID: 35871146 PMCID: PMC9238022 DOI: 10.1016/j.sapharm.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/12/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, the CDC issued guidance advising patients and providers to adopt social distancing practices such as home-based infusions (H-BI). METHODS We performed a mixed methods evaluation to summarize perceptions, concerns, and experiences with H-BI among all inflammatory bowel disease patients 18-90 years of age who transitioned to home-based infliximab or vedolizumab infusions between March to July 2020 at a tertiary care center. Semi-structured interviews were conducted and analyzed using an iterative, inductive thematic approach. Baseline characteristics and outcome on safety, COVID-19 transmission, delays in infusions, and H-BI persistence were collected. RESULTS Of the 57 participants who transitioned to H-BI, 20 (33%) responded. Four major categories and six major themes related to expectations, experience, perceived safety, and logistical factors were identified. Initial perceptions were mixed, however these resolved. One patient developed COVID-19, one patient experienced an adverse event, 12 (21%) patients experienced an infusion delay, and 6 (11%) patients transitioned from H-BI. DISCUSSION Despite mixed initial perceptions, respondents had a positive experience with most respondents planning to continue H-BI after the pandemic resolves. Several real-world actionable barriers were identified related to scheduling, communication between stakeholders, and nursing quality. No major safety concerns were identified.
Collapse
Affiliation(s)
- Janson Jacob
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Daniel Aintabi
- Department of Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Shirley A Cohen-Mekelburg
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA; Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - John I Allen
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - David N Irani
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - A Mark Fendrick
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA; Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA; Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Jeffrey A Berinstein
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.
| |
Collapse
|
17
|
Bergmans RS, Chambers-Peeple K, Aboul-Hassan D, Dell'Imperio S, Martin A, Wegryn-Jones R, Xiao LZ, Yu C, Williams DA, Clauw DJ, DeJonckheere M. Opportunities to Improve Long COVID Care: Implications from Semi-structured Interviews with Black Patients. Patient 2022; 15:715-728. [PMID: 35907120 PMCID: PMC9362503 DOI: 10.1007/s40271-022-00594-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Long coronavirus disease (COVID) is an emerging condition that could considerably burden healthcare systems. Prior qualitative studies characterize the experience of having long COVID, which is valuable for informing care strategies. However, evidence comes from predominantly White samples. This is a concern because underrepresentation of Black patients in research and intervention development contribute to racial inequities. OBJECTIVE To facilitate racial equity in long COVID care, the purpose of this qualitative study was to inform the development of care strategies that are responsive to the experiences and perspectives of Black patients with long COVID in the United States of America. METHODS Using convenience sampling, we conducted race-concordant, semi-structured, and open-ended interviews with Black adults (80% female, mean age = 39) who had long COVID. We transcribed and anonymized the recorded interviews. We analyzed the transcripts using inductive, thematic analysis. Theme development focused on who can help or hinder strategies for reducing health inequities, what should be done to change care policies or treatment strategies, and when are the critical timepoints for intervention. RESULTS We developed four main themes. Participants reported challenges before and after COVID testing. Many participants contacted primary care physicians as a first step for long COVID treatment. However, not all respondents had positive experiences and at times felt dismissed. Without a qualifying diagnosis, participants could not obtain disability benefits, which negatively influenced their employment and increased financial hardship. CONCLUSIONS There are possible targets for improving long COVID care, from COVID testing through to long-term treatment plans. There is a need to increase long COVID awareness among physicians. Diagnosis and a standardized treatment plan could help patients avoid unnecessary healthcare utilization and obtain comprehensive support.
Collapse
Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA.
| | - Keiyana Chambers-Peeple
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Deena Aboul-Hassan
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Samantha Dell'Imperio
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Allie Martin
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Riley Wegryn-Jones
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Lillian Z Xiao
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Christine Yu
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| |
Collapse
|
18
|
Zhen‐Duan J, Gade N, Falgas‐Bagué I, Sue KL, DeJonckheere M, Alegría M. Using a structural vulnerability framework to understand the impact of COVID-19 on the lives of Medicaid beneficiaries receiving substance use treatment in New York City. Health Serv Res 2022; 57:1104-1111. [PMID: 35340033 PMCID: PMC9111318 DOI: 10.1111/1475-6773.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate how the COVID-19 pandemic impacted low-income individuals with substance use disorder (SUD) in New York City (NYC) during the beginning of the pandemic, using a structural competency and structural vulnerability theoretical framework and a qualitative research approach. DATA SOURCES Primary qualitative data were collected from racial/ethnic minority adults enrolled in Medicaid receiving outpatient substance use treatment (e.g., medication, counseling) in NYC. STUDY DESIGN Semi-structured in-depth qualitative interviews (N = 20) were conducted during "stay-at-home" orders in NYC, the first epicenter of the COVID-19 pandemic in the United States. Interviews were conducted over the phone during the earlier stages of the pandemic, between April 2020 and June 2020. DATA COLLECTION/EXTRACTION METHODS Semi-structured in-depth interviews were conducted and audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS Three themes were yielded from our thematic analysis: (1) COVID-19 heightened food insecurity and housing conditions increased risks of infection; (2) stay-at-home orders limited access to resources but had positive impacts in strengthening social relationships and reducing substance use triggers; and (3) although COVID-19 created challenges for treatment, most described that SUD care improved during the pandemic. CONCLUSIONS While COVID-19 exacerbated numerous structural vulnerabilities among low-income individuals with SUD, programmatic adaptations to COVID-19 SUD care, including telehealth and loosening restrictions around medications for opioid use disorders mitigated past difficulties that patients had faced. Reducing structural vulnerabilities for Medicaid patients will require continuation of telehealth treatment delivery, retaining flexible medication regulations, and mobilizing community resources to mitigate economic disparities.
Collapse
Affiliation(s)
- Jenny Zhen‐Duan
- Disparities Research Unit, Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Neerav Gade
- Disparities Research Unit, Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Department of Community HealthTufts UniversityMedfordMassachusettsUSA
| | - Irene Falgas‐Bagué
- Disparities Research Unit, Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Kimberly L. Sue
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | | | - Margarita Alegría
- Disparities Research Unit, Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
19
|
Ager E, Sturdavant W, DeJonckheere M, Gutting A, Merchant R, Kocher K, Solnick R. 189 Emergency Department Clinician Perspectives on a Pilot Emergency Department-Based Expedited Partner Therapy Program: A Qualitative Study. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
20
|
Griauzde DH, O'Brien A, Yancy WS, Richardson CR, Krinock J, DeJonckheere M, Isaman DJM, Vanias K, Shopinski S, Saslow LR. Testing a very low-carbohydrate adaption of the Diabetes Prevention Program among adults with prediabetes: study protocol for the Lifestyle Education about prediabetes (LEAP) trial. Trials 2022; 23:827. [PMID: 36176003 PMCID: PMC9524018 DOI: 10.1186/s13063-022-06770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention's National Diabetes Prevention Program (NDPP) aims to help individuals with prediabetes avoid progression to type 2 diabetes mellitus (T2DM) through weight loss. Specifically, the NDPP teaches individuals to follow a low-fat, calorie-restricted diet and to engage in regular physical activity to achieve ≥ 5% body weight loss. Most NDPP participants, however, do not achieve this weight loss goal, and glycemic control remains largely unchanged. One promising opportunity to augment the NDPP's weight loss and glycemic effectiveness may be to teach participants to follow a very low-carbohydrate diet (VLCD), which can directly reduce post-prandial glycemia and facilitate weight loss by reducing circulating insulin and enabling lipolysis. To date, there have been no high-quality, randomized controlled trials to test whether a VLCD can prevent progression to T2DM among individuals with prediabetes. The aim of this study is to test the effectiveness of a VLCD version the NDPP (VLC-NDPP) versus the standard NDPP. We hypothesize the VLC-NDPP will demonstrate greater improvements in weight loss and glycemic control. METHODS We propose to conduct a 12-month, 1:1, randomized controlled trial that will assign 300 adults with overweight or obesity and prediabetes to either the NDPP or VLC-NDPP. The primary outcome will be glycemic control as measured by change in hemoglobin A1c (HbA1c) from baseline to 12 months. Secondary outcomes will include percent body weight change and changes in glycemic variability, inflammatory markers, lipids, and interim HbA1c. We will evaluate progression to T2DM and initiation of anti-hyperglycemic agents. We will conduct qualitative interviews among a purposive sample of participants to explore barriers to and facilitators of dietary adherence. The principal quantitative analysis will be intent-to-treat using hierarchical linear mixed effects models to assess differences over time. DISCUSSION The NDPP is the dominant public health strategy for T2DM prevention. Changing the program's dietary advice to include a carbohydrate-restricted eating pattern as an alternative option may enhance the program's effectiveness. If the VLC-NDPP shows promise, this trial would be a precursor to a multi-site trial with incident T2DM as the primary outcome. TRIAL REGISTRATION NCT05235425. Registered February 11, 2022.
Collapse
Affiliation(s)
- Dina H Griauzde
- Department of Internal Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 16-371C, Ann Arbor, MI, 48109-2800, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
| | - Alison O'Brien
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caroline R Richardson
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jamie Krinock
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deanna J M Isaman
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Kaitlyn Vanias
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | | | - Laura R Saslow
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| |
Collapse
|
21
|
Mavragani A, Ling G, Wray D, DeJonckheere M, Mizokami Stout K, Saslow LR, Fenske J, Serlin D, Stonebraker S, Nisha T, Barry C, Pop-Busui R, Sen A, Richardson CR. Continuous Glucose Monitoring With Low-Carbohydrate Nutritional Coaching to Improve Type 2 Diabetes Control: Randomized Quality Improvement Program. J Med Internet Res 2022; 24:e31184. [PMID: 35107429 PMCID: PMC8851329 DOI: 10.2196/31184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/16/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality globally, with adverse health consequences largely related to hyperglycemia. Despite clinical practice guideline recommendations, effective pharmacotherapy, and interventions to support patients and providers, up to 60% of patients diagnosed with T2DM are estimated to have hemoglobin A1c (HbA1c) levels above the recommended targets owing to multilevel barriers hindering optimal glycemic control. OBJECTIVE The aim of this study is to compare changes in HbA1c levels among patients with suboptimally controlled T2DM who were offered the opportunity to use an intermittently viewed continuous glucose monitor and receive personalized low-carbohydrate nutrition counseling (<100 g/day) versus those who received usual care (UC). METHODS This was a 12-month, pragmatic, randomized quality improvement program. All adult patients with T2DM who received primary care at a university-affiliated primary care clinic (N=1584) were randomized to either the UC or the enhanced care (EC) group. Within each program arm, we identified individuals with HbA1c >7.5% (58 mmol/mol) who were medically eligible for tighter glycemic control, and we defined these subgroups as UC-high risk (UC-HR) or EC-HR. UC-HR participants (n=197) received routine primary care. EC-HR participants (n=185) were invited to use an intermittently viewed continuous glucose monitor and receive low-carbohydrate nutrition counseling. The primary outcome was mean change in HbA1c levels from baseline to 12 months using an intention-to-treat difference-in-differences analysis comparing EC-HR with UC-HR groups. We conducted follow-up semistructured interviews to understand EC-HR participant experiences with the intervention. RESULTS HbA1c decreased by 0.41% (4.5 mmol/mol; P=.04) more from baseline to 12 months among participants in the EC-HR group than among those in UC-HR; however, only 61 (32.9%) of 185 EC-HR participants engaged in the program. Among the EC-HR participants who wore continuous glucose monitors (61/185, 32.9%), HbA1c was 1.1% lower at 12 months compared with baseline (P<.001). Interviews revealed themes related to EC-HR participants' program engagement and continuous glucose monitor use. CONCLUSIONS Among patients with suboptimally controlled T2DM, a combined approach that includes continuous glucose monitoring and low-carbohydrate nutrition counseling can improve glycemic control compared with the standard of care.
Collapse
Affiliation(s)
| | - Grace Ling
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Wray
- Twine Clinical Consulting LLC, Park City, UT, United States
| | - Melissa DeJonckheere
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kara Mizokami Stout
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.,Department of Internal Medicine Division of General Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Internal Medicine Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, United States
| | - Laura R Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jill Fenske
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - David Serlin
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Spring Stonebraker
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tabassum Nisha
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Colton Barry
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rodica Pop-Busui
- Department of Internal Medicine Division of General Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
22
|
Boehnke KF, Yakas L, Scott JR, DeJonckheere M, Litinas E, Sisley S, Clauw DJ, Williams DA, McAfee J. A mixed methods analysis of cannabis use routines for chronic pain management. J Cannabis Res 2022; 4:7. [PMID: 35016733 PMCID: PMC8750808 DOI: 10.1186/s42238-021-00116-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/26/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The wide heterogeneity of available cannabis products makes it difficult for physicians to appropriately guide patients. In the current study, our objective was to characterize naturalistic cannabis use routines and explore associations between routines and reported benefits from consuming cannabis. METHODS We performed a mixed methods analysis of n=1087 cross-sectional survey responses from adults with self-reported chronic pain using cannabis for symptom management in the USA and Canada. First, we qualitatively analyzed responses to an open-ended question that assessed typical cannabis use routines, including administration routes, cannabinoid content, and timing. We then sub-grouped responses into categories based on inhalation (smoking, vaporizing) vs. non-inhalation (e.g., edibles). Finally, we investigated subgroups perceptions of how cannabis affected pain, overall health, and use of medications (e.g., substituting for opioids, benzodiazepines). Substitutions were treated as a count of medication classes, while responses for both pain and health were analyzed continuously, with - 2 indicating health declining a lot or pain increasing a lot and 2 indicating that health improved a lot or pain decreased a lot. RESULTS Routines varied widely in terms of administration routes, cannabinoid content, and use timing. Overall, 18.8%, 36.2%, and 45% used non-inhalation, inhalation, and non-inhalation + inhalation routes, respectively. Those who used inhalation routes were younger (mean age 46.5 [inhalation] and 49.2 [non-inhalation + inhalation] vs. 56.3 [inhalation], F=36.1, p<0.001), while a higher proportion of those who used non-inhalation routes were female (72.5% non-inhalation vs. 48.3% inhalation and 65.3% non-inhalation + inhalation, X2=59.6, p<0.001). THC-rich products were typically used at night, while CBD-rich products were more often used during the day. While all participants reported similarly decreased pain, participants using non-inhalation + inhalation administration routes reported larger improvements in health than the non-inhalation (mean difference = 0.32, 95% CI: 0.07-0.37, p<0.001) and inhalation subgroups (mean difference = 0.22, 95% CI: 0.07-0.37, p=0.001). Similarly, the non-inhalation + inhalation group had significantly more medication substitutions than those using non-inhalation (mean difference = 0.62, 95% CI: 0.33-0.90, p<0.001) and inhalation administration routes (mean difference = 0.45, 95% CI: 0.22-0.69, p<0.001), respectively. CONCLUSIONS Subgrouping medical cannabis patients based on administration route profile may provide useful categories for future studies examining the risks and benefits of medical cannabis.
Collapse
Affiliation(s)
- Kevin F Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Laura Yakas
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Ryan Scott
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Daniel J Clauw
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David A Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jenna McAfee
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
23
|
Zhen-Duan J, DeJonckheere M, Bignall WJR, Galván J, Saavedra N, Gorn SB. Interpersonal Violence and Psychological Well-Being: Perspectives of Low-Income Patients, Social Workers, and Medical Doctors in Mexico City, Mexico. J Interpers Violence 2022; 37:681-704. [PMID: 32306834 PMCID: PMC10501303 DOI: 10.1177/0886260520915543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The violence epidemic in Mexico is becoming more widespread. Using a social-ecological framework, the current study sought to understand interpersonal violence among those impoverished communities in Mexico City, Mexico. Participants were recruited from Community Health Centers located within districts that were densely populated, had high rates of poverty and marginalization, and where people experience complex social needs. Semi-structured interviews were conducted with patients, social workers, and medical doctors (N = 15) who were either receiving or providing services in these centers. Data were analyzed using an inductive, thematic approach. Analysis resulted in three themes: (a) interpersonal violence permeates all settings in which people live and interact; (b) social and cultural factors increase the risk of becoming a perpetrator or victim of interpersonal violence; and (c) interpersonal violence is closely intertwined with mental health. Rapid changes within gender roles and expectations in Mexico, combined with widening income inequality, are shifting dynamics within families that may be inherently linked to interpersonal violence. Our findings support the conceptualization of interpersonal violence at the four levels of the social-ecological framework: individual, relationship, community, and societal. Prevention and interventions for violence reduction must be applied across the four levels simultaneously. Community-level efforts should go toward strengthening existing community health centers and equipping primary care providers with training and resources on the screening and triaging of patients encountering interpersonal violence.
Collapse
Affiliation(s)
| | | | | | - Jorge Galván
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
| | | | | |
Collapse
|
24
|
Lapedis CJ, Kroll-Wheeler L, DeJonckheere M, Johnston D, Owens SR. Broadening the Scope: A Qualitative Study of Pathologists' Attitudes Toward Patient-Pathologist Interactions. Am J Clin Pathol 2021; 156:969-979. [PMID: 33948623 DOI: 10.1093/ajcp/aqab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study qualitatively explored and described pathologists' attitudes toward patient interaction. METHODS In a survey to pathologists, we asked, "How interested would you be in meeting with patients to discuss their pathology report and show them microscopic images of their tissue?" Then, we asked "Why," followed by a free-text box. We asked pathologists to assume that their time would be adequately compensated and that patients' treating clinicians had already told them their diagnosis. Physician age, gender, rank, and type of practice were also collected. RESULTS We surveyed 197 pathologists, 86% of whom were either definitely interested or interested in meeting with patients. Interest level did not differ by age, gender, or rank but was higher in academic practices than in community practices. Thematic analysis showed that pathologists believed that meeting with patients could impact (1) patients, through cognitive and emotional pathways; (2) pathologists, through patient contact and job satisfaction; and (3) the field of pathology, through quality of care and a redefined image of the specialty. CONCLUSIONS Pathologists' interest level in meeting with patients was high. Potential impacts on patients, pathologists, and the field of pathology were identified.
Collapse
|
25
|
Norcott A, Chan CL, Nyquist L, Bynum JP, Min L, Fetters MD, DeJonckheere M. Behaviours of older adults and caregivers preparing for elective surgery: a virtually conducted mixed-methods research protocol to improve surgical outcomes. BMJ Open 2021; 11:e048299. [PMID: 34663655 PMCID: PMC8524274 DOI: 10.1136/bmjopen-2020-048299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Older adults (age ≥65 years) are pursuing increasingly complex, elective surgeries; and, are at higher risk for intraoperative and postoperative complications. Patients and their caregivers frequently struggle with the postoperative recovery process at home, which may contribute to complications. We aim to identify opportunities to intervene during the preoperative period to improve postoperative outcomes by understanding the preparatory behaviours of older adults and their caregivers before a complex, elective surgery. METHODS AND ANALYSIS As a result of the COVID-19 pandemic, we will conduct this study via telephone and videoconferencing. Using a multiphase mixed-methods research design, we will collect data on 10-15 patient-caregiver dyads from a pool of older adults (across a spectrum of cognitive abilities) scheduled for an elective colorectal surgery between 1 July 2020 and 30 May 2021. We will collect quantitative and qualitative data before (T1, T2) and after (T3, T4) surgery. Preoperatively, participants will each complete a cognitive assessment and a semi-structured qualitative interview that focuses on their preparatory behaviours (T1). They will then answer questionnaires about mood, self-efficacy and home environment (T2). Three weeks following hospital discharge, participants will complete another qualitative interview focusing on a comparison of preoperative and postoperative preparedness (T3). Researchers will also collect information about the patient's medical conditions, the postoperative complications and healthcare utilisation from the patient's chart 30 days following discharge (T4). We will code and conduct thematic analysis of the qualitative data to identify salient themes. Quantitative data will be analysed using basic descriptive statistics to characterise the participants. We will integrate the qualitative and quantitative findings using results from the quantitative scales to group participants and with use of joint display analysis. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Michigan IRB. Study findings will be disseminated through peer-reviewed journals and presentations at conferences.
Collapse
Affiliation(s)
- Alexandra Norcott
- Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chiao-Li Chan
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Linda Nyquist
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P Bynum
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Lillian Min
- Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa DeJonckheere
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
26
|
DeJonckheere M, Joiner KL, Ash GI, Savoye M, Adams M, Weinzimer SA, Sadler LS, Grey M. Youth and Parent Perspectives on the Acceptability of a Group Physical Activity and Coping Intervention for Adolescents With Type 1 Diabetes. Sci Diabetes Self Manag Care 2021; 47:367-381. [PMID: 34610760 DOI: 10.1177/26350106211040429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine youth and parent perspectives on the acceptability of Bright 1 Bodies, a group physical activity and coping intervention for adolescents with type 1 diabetes mellitus (T1DM). METHODS Adolescents participated in 12 weekly sessions of moderate to vigorous physical activity and discussion with peers with T1DM. Adolescents completed an exit survey measuring satisfaction with the intervention on a 5-point Likert scale. Semistructured interviews were conducted with adolescents and at least one parent. Qualitative description was used to develop themes that summarize the acceptability of the intervention. RESULTS Mean scores for survey subscales were: 4.5 (SD = 0.39) for program components and strategies, 4.4 (SD = 0.44) for comfort with the intervention, and 4.3 (SD = 0.62) for instructors. Themes included: (1) adolescents and parents valued being around others with T1DM and their families, (2) the intervention helped adolescents gain knowledge and reinforce diabetes self-management behaviors, (3) challenges included convenience and sustaining participant engagement, and (4) adolescents intended to sustain physical activity and diabetes self-management behaviors after the intervention. CONCLUSIONS Adolescents and parents viewed the intervention as acceptable across multiple domains. Participants valued the group aspect of the intervention, and future interventions would benefit from integrating social interactions with others with T1DM.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Kevin L Joiner
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Garrett I Ash
- Veterans Affairs Connecticut Healthcare System, Newington, Connecticut.,Center for Medical Informatics, Yale University, New Haven, Connecticut
| | - Mary Savoye
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Mackenzie Adams
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | | | - Lois S Sadler
- School of Nursing, Yale University, New Haven, Connecticut
| | - Margaret Grey
- School of Nursing, Yale University, New Haven, Connecticut
| |
Collapse
|
27
|
DeJonckheere M, McKee MM, Guetterman TC, Schleicher LS, Mulhem E, Panzer K, Bradley K, Plegue MA, Rapai ME, Green LA, Zazove P. Implementation of a Hearing Loss Screening Intervention in Primary Care. Ann Fam Med 2021; 19:388-395. [PMID: 34546945 PMCID: PMC8437567 DOI: 10.1370/afm.2695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Hearing loss (HL) is underdiagnosed and often unaddressed. A recent study of screening for HL using an electronic prompt showed efficacy in increasing appropriate referrals for subsequent testing. We build on the results of this study using a qualitative lens to explore implementation processes through the perspectives of family medicine clinicians. METHODS We collected clinic observations and semistructured interviews of family medicine clinicians and residents who interacted with the HL prompt. All data were analyzed using thematic, framework, and mixed methods integration strategies. RESULTS We interviewed 27 clinicians and conducted 10 observations. Thematic analysis resulted in 6 themes: (1) the prompt was overwhelmingly viewed as easy, simple to use, accurate; (2) clinicians considered prompt as an effective way to increase awareness and conversations with patients about HL; (3) clinician and staff buy-in played a vital role in implementation; (4) clinicians prioritized prompt during annual visits; (5) medical assistant involvement in prompt workflow varied by health system, clinic, and clinician; (6) prompt resulted in more conversations about HL, but uncertain impact on patient outcomes. Themes are presented alongside constructs of normalization process theory and intervention outcomes. CONCLUSION Integration of a HL screening prompt into clinical practice varied by clinician buy-in and beliefs about the impact on patient outcomes, involvement of medical assistants, and prioritization during clinical visits. Further research is needed to understand how to leverage clinician and staff buy-in and whether implementation of a new clinical prompt has sustained impact on HL screening and patient outcomes.
Collapse
Affiliation(s)
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | - Elie Mulhem
- Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Kathleen Bradley
- Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mary E Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
28
|
Greenwood-Ericksen M, DeJonckheere M, Syed F, Choudhury N, Cohen AJ, Tipirneni R. Implementation of Health-Related Social Needs Screening at Michigan Health Centers: A Qualitative Study. Ann Fam Med 2021; 19:310-317. [PMID: 34264836 PMCID: PMC8282295 DOI: 10.1370/afm.2690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient's health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. METHODS Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. RESULTS We interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients' needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. CONCLUSIONS FQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.
Collapse
Affiliation(s)
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Faiyaz Syed
- Michigan Primary Care Association, Lansing, Michigan
| | | | - Alicia J Cohen
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.,Center of Innovation in Long Term Services and Supports for Vulnerable Populations, Providence VA Medical Center, Providence, Rhode Island.,Departments of Family Medicine and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Renuka Tipirneni
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
29
|
Johnson E, DeJonckheere M, Oliverio A, Brown KS, Van Sparrentak M, Wu JP. A theoretical model of contraceptive decision-making and behaviour in diabetes: A qualitative application of the Health Belief Model. Diabet Med 2021; 38:e14434. [PMID: 33078420 PMCID: PMC8053733 DOI: 10.1111/dme.14434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/14/2020] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
AIM People with diabetes have contraceptive needs that have been inadequately addressed. The aim of this qualitative study was to develop a theoretical model that reflects contraceptive decision-making and behaviour in the setting of diabetes mellitus. METHODS We conducted semi-structured, qualitative interviews of 17 women with type 1 or type 2 diabetes from Michigan, USA. Participants were recruited from a diabetes registry and local clinics. We adapted domains from the Health Belief Model (HBM) and applied reproductive justice principles to inform the qualitative data collection and analysis. Using an iterative coding template, we advanced from descriptive to theoretical codes, compared codes across characteristics of interest (e.g. diabetes type), and synthesized the theoretical codes and their relationships in an explanatory model. RESULTS The final model included the following constructs and themes: perceived barriers and benefits to contraceptive use (effects on blood sugar, risk of diabetes-related complications, improved quality of life); perceived seriousness of pregnancy (harm to self, harm to foetus or baby); perceived susceptibility to pregnancy risks (diabetes is a 'high risk' state); external cues to action (one-size-fits-all/anxiety-provoking counselling vs. personalized/trust-based counselling); internal cues to action (self-perceived 'sickness'); self-efficacy (reproductive self-efficacy, contraceptive self-efficacy); and modifying factors (perceptions of biased counselling based upon one's age, race or severity of disease). CONCLUSIONS This novel adaptation of the HBM highlights the need for condition-specific and person-centred contraceptive counselling for those with diabetes.
Collapse
Affiliation(s)
- Emily Johnson
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
- Institute of HealthCare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Andrea Oliverio
- Department of Internal Medicine – Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Kathryn S. Brown
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | | | - Justine P. Wu
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
- Institute of HealthCare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Author of Correspondence Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, Michigan 48104, 734-998-7120,
| |
Collapse
|
30
|
DeJonckheere M, Waselewski M, Amaro X, Frank A, Chua KP. Views on COVID-19 and Use of Face Coverings Among U.S. Youth. J Adolesc Health 2021; 68:873-881. [PMID: 33896552 PMCID: PMC8061118 DOI: 10.1016/j.jadohealth.2021.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Little is known about the views of U.S. youth on COVID-19 or their use of face coverings. Closing this gap could facilitate messaging to promote COVID-19 risk mitigation behaviors. METHODS In July 2020, a five-question text message survey was sent to 1,087 youth aged 14-24 years. Questions assessed youths' perceptions regarding the likelihood of contracting COVID-19, the potential impact of contracting COVID-19 on their lives, the possibility of spreading COVID-19 to others, and their use of face coverings around others with whom they do not live. Coding was conducted to assign responses to discrete categories and to identify common themes. RESULTS Of 1,087 eligible participants, 797 (73.3%) were included in analyses. Of these participants, 27.3% believed they would likely contract COVID-19 in the next few months, 90.3% believed contracting COVID-19 would have a moderate or significant impact on their lives, 86.0% were moderately or very concerned about spreading COVID-19, and 89.2% reported wearing face coverings all or most of the time. Factors affecting face covering use included the desire to avoid contracting and spreading COVID-19, peer influence, and policy mandates. CONCLUSIONS Youths' perceptions regarding the risk of contracting COVID-19 varied, but most believed their lives would be adversely impacted if this occurred. Most youth were concerned about spreading COVID-19 and wore face coverings, but many made exceptions to face covering use when around close contacts. Public health campaigns may be most effective if they leverage positive peer influence and appeal to youths' desire not to spread COVID-19 to others.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Abby Frank
- Community High School, Ann Arbor, Michigan
| | - Kao-Ping Chua
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan.
| |
Collapse
|
31
|
Vaughn LM, DeJonckheere M. The Opportunity of Social Ecological Resilience in the Promotion of Youth Health and Wellbeing: A Narrative Review. Yale J Biol Med 2021; 94:129-141. [PMID: 33795989 PMCID: PMC7995941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Youth experience adversity that increases their risk for immediate and long-term health consequences. Resilience has traditionally been conceptualized as an internal disposition or trait that supports youth to overcome that risk and avoid the negative impact on their health and wellbeing. However, this model of resilience overemphasizes the role of the individual and their capacity to control their environment, while minimizing the integral role of relational, social, structural, and cultural contexts in which they live. Instead, social ecological resilience (SER) emphasizes the influence of social and environmental factors on individual processes and outcomes and offers different pathways for preventive interventions to promote youth health and wellbeing. Within preventive medicine, it is important for researchers and practitioners to understand the processes that support or impede SER, particularly in youth when adversity can impact health throughout the lifespan. The purpose of this review was to examine the contributions and scope of the SER model in research on youth, with the goal of advancing SER-informed research and interventions within preventive medicine. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach as a guiding framework, we conducted a narrative review of the literature. The review characterizes 37 existing studies across the fields of education, psychology, and social work in terms of topic, focal population, methods, use of SER, and implications. We conclude with recommendations for future applications of SER to promote the health and wellbeing of youth.
Collapse
Affiliation(s)
- Lisa M. Vaughn
- Cincinnati Children’s Hospital Medical
Center/University of Cincinnati College of Medicine, Joint appointment,
University of Cincinnati, Educational and Community-Based Action Research,
Cincinnati, OH, USA,To whom all correspondence should be addressed:
Lisa M. Vaughn, PhD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet
Ave. ML 2008, Cincinnati, OH 45229; Tel: 513-636-9424, Fax: 513-636-7967;
| | | |
Collapse
|
32
|
Enggaard H, Laugesen B, DeJonckheere M, Fetters MD, Dalgaard MK, Lauritsen MB, Zoffmann V, Jørgensen R. Impact of the Guided Self-Determination Intervention among Adolescents with Co-Existing ADHD and Medical Disorder: A Mixed Methods Study. Issues Ment Health Nurs 2021; 42:87-98. [PMID: 32669013 DOI: 10.1080/01612840.2020.1780528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adolescents with ADHD are at increased risk of having a co-existing medical disorder. Research shows that having co-existing ADHD and a medical disorder interferes with the adolescents' daily life, creating a dual task that cannot be managed as two independent disorders. Interventions to support adolescents in managing the dual task of living with co-existing ADHD and medical disorder are needed. The Guided-Self-Determination intervention might be suitable for this population, as it is an empowerment-based intervention facilitating patient involvement and self-management of a disease. The purpose of this study was to evaluate how the Guided Self-Determination intervention impacted 10 adolescents with ADHD and a co-existing medical disorder. The study used a convergent mixed methods design. Quantitative data measuring support from nurses, support from parents, and self-management were collected though self-reported questionnaires at baseline, 3 months, and 6 months and were analyzed with descriptive statistics. Qualitative data capturing the adolescents' experiences of the intervention and the intervention's impact on support from nurses, parents, and self-management were collected through semi-structured interviews and analyzed thematically. Results of the quantitative and qualitative analyses were integrated in a mixed methods analysis. The integrated results suggest that this intervention may improve adolescents' management of the difficulties of living with co-existing ADHD and a medical disorder, and that self-insight and nurse support are prerequisites for developing self-management strategies. However, the results showed that the intervention did not impact parental support. Further research is needed to evaluate the impact of the intervention on a larger scale.
Collapse
Affiliation(s)
- Helle Enggaard
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Nursing & Research Program for Children and Youth at Risk and Inequalities in Life Opportunities, University College Northern Denmark, Aalborg, Denmark
| | - Britt Laugesen
- Danish Centre of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | - Michael Derwin Fetters
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marlene Briciet Lauritsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Vibeke Zoffmann
- The Research Unit for Women's and Children's Health, University Hospital Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
33
|
Chua KP, DeJonckheere M, Reeves SL, Tribble AC, Prosser LA. Factors Associated With School Attendance Plans and Support for COVID-19 Risk Mitigation Measures Among Parents and Guardians. Acad Pediatr 2021; 21:684-693. [PMID: 33249257 PMCID: PMC8106633 DOI: 10.1016/j.acap.2020.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine which factors are associated with plans for in-person school attendance during the 2020-2021 school year and with support for 15 school-based COVID-19 risk mitigation measures among parents and guardians. METHODS In June 2020, we conducted an online survey of parents and guardians of public school children in Illinois, Michigan, and Ohio. In a child-level analysis, we used linear regression to assess which demographic factors, health-related concerns, and parent/guardian views were associated with plans for in-person school attendance. In a respondent-level analysis, we used linear regression to assess factors associated with the number of risk mitigation measures supported. RESULTS Among 2202 children in the child-level analysis, in-person school attendance was planned for 71.0%. Such plans were less likely among children of Black respondents (-14.1 percentage points, 95% confidence interval [CI]: -25.7, -2.6) and Asian respondents (-16.8, 95% CI: -31.3, -2.2), and among children with perceived high-risk health conditions (-9.7, 95% CI: -15.8, -3.6). Among 1,126 respondents in the respondent-level analysis, the mean number of measures supported was 8.0 (SD 4.4). Several factors were associated with support, but the magnitude of associations was generally modest. CONCLUSIONS During the COVID-19 pandemic, families of children with health conditions or who are of Black or Asian race/ethnicity may be less likely to opt for in-person learning. For these families, addressing barriers to remote education is critical. As schools plan for the 2020-2021 school year and beyond, they should respond to the desire among parents and guardians to implement substantial numbers of risk mitigation measures.
Collapse
Affiliation(s)
- Kao-Ping Chua
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School (KPC, SLR, LAP), Ann Arbor, Mich; Department of Health Management and Policy, University of Michigan School of Public Health (KPC, LAP), Ann Arbor, Mich.
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Sarah L. Reeves
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Alison C. Tribble
- Department of Pediatrics, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI
| | - Lisa A. Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| |
Collapse
|
34
|
Yost O, DeJonckheere M, Stonebraker S, Ling G, Buis L, Pop-Busui R, Kim N, Mizokami-Stout K, Richardson C. Continuous Glucose Monitoring With Low-Carbohydrate Diet Coaching in Adults With Prediabetes: Mixed Methods Pilot Study. JMIR Diabetes 2020; 5:e21551. [PMID: 33325831 PMCID: PMC7773517 DOI: 10.2196/21551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is preventable; however, few patients with prediabetes participate in prevention programs. The use of user-friendly continuous glucose monitors (CGMs) with low-carbohydrate diet coaching is a novel strategy to prevent T2DM. OBJECTIVE This study aims to determine the patient satisfaction and feasibility of an intervention combining CGM use and low-carbohydrate diet coaching in patients with prediabetes to drive dietary behavior change. METHODS We conducted a mixed methods, single-arm pilot and feasibility study at a suburban family medicine clinic. A total of 15 adults with prediabetes with hemoglobin A1c (HbA1c) levels between 5.7% and 6.4% and a BMI >30 kg/m2 were recruited to participate. The intervention and assessments took place during 3 in-person study visits and 2 qualitative phone interviews (3 weeks and 6 months after the intervention). During visit 1, participants were asked to wear a CGM and complete a food intake and craving log for 10 days. During visit 2, the food intake and craving log along with the CGM results of the participants were reviewed and the participants received low-carbohydrate diet coaching, including learning about carbohydrates and personalized feedback. A second CGM sensor, with the ability to scan and record glucose trends, was placed, and the participants logged their food intake and cravings as they attempted to reduce their total carbohydrate intake (<100 g/day). During visit 3, the participants reviewed their CGM and log data. The primary outcome was satisfaction with the use of CGM and low-carbohydrate diet. The secondary outcomes included feasibility, weight, and HbA1c change, and percentage of time spent in hyperglycemia. Changes in attitudes and risk perception of developing diabetes were also assessed. RESULTS The overall satisfaction rate of our intervention was 93%. The intervention induced a weight reduction of 1.4 lb (P=.02) and a reduction of HbA1c levels by 0.71% (P<.001) since enrollment. Although not significantly, the percentage of time above glucose goal and average daily glucose levels decreased slightly during the study period. Qualitative interview themes indicated no major barriers to CGM use; the acceptance of a low-carbohydrate diet; and that CGMs helped to visualize the impact of carbohydrates on the body, driving dietary changes. CONCLUSIONS The use of CGMs and low-carbohydrate diet coaching to drive dietary changes in patients with prediabetes is feasible and acceptable to patients. This novel method merits further exploration, as the preliminary data indicate that combining CGM use with low-carbohydrate diet coaching drives dietary changes, which may ultimately prevent T2DM.
Collapse
Affiliation(s)
- Olivia Yost
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Spring Stonebraker
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace Ling
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Noa Kim
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kara Mizokami-Stout
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
35
|
Jones DE, Lindquist-Grantz R, DeJonckheere M. A Review of Mixed Methods Community-Based Participatory Research Applications in Mental Health. ACTA ACUST UNITED AC 2020. [DOI: 10.5590/jsbhs.2020.14.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The aim of the paper was to methodologically review the intersection of mixed methods research (MMR) and community-based participatory research (CBPR) in the field of mental health research. We classify this intersecting approach as MMCBPR. The methodological review of empirical literature was conducted between October 2017 and March 2020 of full-text articles in Scopus, Pubmed, ProQuest Central, Web of Science, and EBSCOhost search engine databases in the English language. Twenty-nine studies meeting the inclusion criteria were included in the final analysis. We found some evidence of MMCBPR but it was limited by factors such as a lack of explicit rationales for the use of MMR and CBPR, limited evidence of long-term commitment to a community, and an ad hoc approach to the application of MMR and CBPR. These findings informed the development of practical recommendations for psychologists, mental health professionals, and researchers in the application of MMCBPR. In particular, our MMCBPR recommendations aim to advance the social justice agenda in counseling psychology, increase the rigor of MMCBPR approaches in mental health studies, and inform how advanced mixed methods applications can be used to address the complexities associated with mental health and well-being.
Collapse
|
36
|
DeJonckheere M, Zhao A, Lane J, Plegue MA, Ranalli L, Wagner E, Riley M. Results of a National Text Message Poll of Youth: Perspectives on Primary Care. J Adolesc Health 2020; 67:814-820. [PMID: 32620346 DOI: 10.1016/j.jadohealth.2020.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a significant interest in improving adolescent access to primary care, yet limited attempts to incorporate youth feedback within these efforts. The purpose of this study was to describe the experiences related to primary care among a large national sample of adolescents to improve patient-centered care. METHODS Youth were sent open-ended text message prompts via an ongoing study of 14- to 24-year-olds in the U.S. Text responses were analyzed using qualitative thematic analysis, including descriptive coding, consensus building, and theme development. Secondary quantitative analyses were conducted to determine differences by demographics. RESULTS Of 1,123 eligible participants, 789 (70.2%) responded to at least one prompt. Four themes were developed: (1) youth recognized the importance of primary care, but barriers exist that limited their utilization; (2) youth felt that improving convenience would increase the use of primary care; (3) youth were unsure how to transition between primary care settings; and (4) feeling respected was essential to youth having positive experiences in a primary care health care setting. Older youth and those identifying as female, nonbinary, or transgender were more likely to report previous bad experiences with primary care. CONCLUSIONS Our findings describe barriers and possible solutions to primary care among youth. Because attitudes toward health and health care are established during adolescence, a transformation is needed to create more patient-centered care that aligns with young people's values and experiences. Thus, primary care providers have the opportunity to positively impact the health of young people today and the adults of the future.
Collapse
Affiliation(s)
| | - Aisling Zhao
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jenni Lane
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lauren Ranalli
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Ellen Wagner
- Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| | - Margaret Riley
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Adolescent Health Initiative, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
37
|
Zazove P, Plegue MA, McKee MM, DeJonckheere M, Kileny PR, Schleicher LS, Green LA, Sen A, Rapai ME, Mulhem E. Effective Hearing Loss Screening in Primary Care: The Early Auditory Referral-Primary Care Study. Ann Fam Med 2020; 18:520-527. [PMID: 33168680 PMCID: PMC7708285 DOI: 10.1370/afm.2590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes. METHODS A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged ≥55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits. RESULTS The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n=1,484) had HHI scores suggestive of hearing loss; those patients had higher referral rates, 28% vs 9.2% (P <.001). Of 1,660 patients referred for hearing testing, 717 had audiology data available for analysis: 669 (93.3%) were rated appropriately referred and 421 (58.7%) were considered hearing aid candidates. Overall, 71.5% of patients contacted felt their referral was appropriate. CONCLUSION An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae.
Collapse
Affiliation(s)
- Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Paul R Kileny
- Otorhinolaryngology Department, University of Michigan, Ann Arbor, Michigan
| | | | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ananda Sen
- Department of Family Medicine and Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mary E Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elie Mulhem
- Department of Family Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| |
Collapse
|
38
|
Wu JP, Van Sparrentak M, Waselewski M, DeJonckheere M, Remen R, Chang T. Youth opinions about Title X funding and policy in the United States: A mixed methods text message survey. Contraception 2020; 103:92-96. [PMID: 33075333 DOI: 10.1016/j.contraception.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aim to assess youth awareness of and opinions about Title X policy changes in 2019. STUDY DESIGN We analyzed data from four open-ended questions and demographic items collected through MyVoice, a national text message survey of youth aged 14-24. We calculated descriptive statistics to summarize awareness of and opinions about Title X. We integrated the quantitative findings with qualitative themes to achieve deeper understanding of the beliefs that inform youth opinions. RESULTS Seven hundred and fifty youth responded to the text message survey (58.0% response rate). The majority (74.9%) was unaware of recent Title X changes. Most (79.3%) were unsupportive of these changes, and a sizable portion (40%) worried these changes could impact them. Opposition to Title X changes was based upon five themes: (1) youth need to be aware of their health options, including abortion; (2) the policy will undermine reproductive rights; (3) the policy is unfair; (4) the policy is unconstitutional; (5) the policy will threaten public health and health services, including affordable and safe abortion. Those who supported Title X changes (13.8%) described moral objections to abortion and beliefs that the government should not be responsible for abortion care. CONCLUSIONS Most youth in this sample were unsupportive of Title X changes. Limited youth awareness of Title X changes suggests that better youth outreach is needed regarding sexual and reproductive health (SRH) policies. IMPLICATIONS Although youth represent 40% of clients who receive SRH services through Title X, more efforts are needed to inform and engage them in salient policy changes that may directly affect their SRH health and health care access.
Collapse
Affiliation(s)
- Justine P Wu
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, MI, United States.
| | | | - Marika Waselewski
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, MI, United States
| | - Razel Remen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, MI, United States
| |
Collapse
|
39
|
Harbaugh CM, Vu JV, DeJonckheere M, Kim N, Nichols LP, Chang T. Youth Perspectives of Prescription Pain Medication in the Opioid Crisis. J Pediatr 2020; 221:159-164. [PMID: 32143929 DOI: 10.1016/j.jpeds.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To characterize current youth perspectives of prescription pain medication. STUDY DESIGN In total, 1047 youths aged 14-24 years were recruited by targeted social media advertisements to match national demographic benchmarks. Youths were queried by open-ended text message prompts about exposure and access to prescription pain medication, perceived safety of prescribed and nonprescribed medication, and associations with the word "opioid." Responses were analyzed inductively for emerging themes and frequencies. RESULTS Among 745 respondents (71.2% response rate), 439 identified as female (59.3%), 561 as white (75.8%), and mean age was 18.3 ± 3.2 years. Previous exposure to prescription pain medication was reported by 377 respondents (52.0%), most commonly related to dentistry (32.8%), surgery (19.2%), and injury (12.0%). Nonmedical sources of access to prescription pain medication were identified by 256 respondents (36.9%) and medical sources other than their doctor by an additional 111 respondents (16.0%). Three additional themes emerged from youth responses: (1) prescribed medication was thought to be safer than nonprescribed medication, based on trust in doctors; (2) risks of addiction and overdose were thought to be greater for nonprescribed medication; (3) respondents had a widely ranging understanding of the word "opioid," from historical to current events, medical to illicit substances, and personal to public associations. CONCLUSIONS Although youths are aware of the opioid crisis, they perceive less risk of prescription pain medication prescribed by a doctor, than from other sources. Policies should target education to youth in clinical and nonclinical settings, highlighting the risks of addiction and overdose with all opioids.
Collapse
Affiliation(s)
| | - Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Noa Kim
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| |
Collapse
|
40
|
Joiner KL, DeJonckheere M, Whittemore R, Grey M. Perceptions and experiences of living with type 1 diabetes among Latino adolescents and parents with limited English proficiency. Res Nurs Health 2020; 43:263-273. [PMID: 32281136 DOI: 10.1002/nur.22019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/07/2022]
Abstract
We explored perceptions and experiences of living with type 1 diabetes mellitus (T1DM) among U.S. Latino adolescents (age 12-19 years) with T1DM and parents with limited English proficiency. We used a qualitative descriptive approach with semi-structured interviews of adolescents together with their parents. Interview data were reviewed, coded, and combined into themes about participant experiences with T1DM. Twenty-four adolescents (mean age: 15.4 years) and 23 parents participated. Analysis resulted in three themes: (a) Understanding and adapting to T1DM (i.e., initial fear and misunderstandings of T1DM; adolescents' reflections on living with a chronic health condition); (b) Coming to terms with social and environmental influences on T1DM self-management (i.e., T1DM as disruptive to school and social activities; dealing with stigma and judgments related to diabetes); and, (c) Integrating T1DM self-management expectations with components of Latino cultures (i.e., orientation toward family well-being; parent concerns about cultural preferences that influence food choices, positive influence of spirituality and religiousness; parental views of their current health care in comparison to that available in their place of birth). Adolescents and their parents reported experiences that are universal to adolescents with T1DM in addition to challenges that are unique to Latinos. Efforts aimed at improving T1DM self-management during adolescence with this population need to be tailored to meet the unique social and cultural contexts and delivered in a culturally and linguistically congruent manner.
Collapse
Affiliation(s)
- Kevin L Joiner
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | | | | | - Margaret Grey
- School of Nursing, Yale University, Orange, Connecticut
| |
Collapse
|
41
|
Affiliation(s)
- Lisa M Vaughn
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa DeJonckheere
- University of Michigan Medical School, Department of Family Medicine, Ann Arbor, Michigan
| |
Collapse
|
42
|
DeJonckheere M, Nichols LP, Vydiswaran VGV, Zhao X, Collins-Thompson K, Resnicow K, Chang T. Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy. JMIR Form Res 2019; 3:e11397. [PMID: 30932869 PMCID: PMC6462892 DOI: 10.2196/11397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/30/2018] [Accepted: 01/27/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth's perceptions of and knowledge about weight gain during pregnancy. OBJECTIVE The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. METHODS To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. RESULTS Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. CONCLUSIONS This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States.,School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Xinyan Zhao
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Kenneth Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
43
|
DeJonckheere M, Vaughn LM. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health 2019; 7:e000057. [PMID: 32148704 PMCID: PMC6910737 DOI: 10.1136/fmch-2018-000057] [Citation(s) in RCA: 354] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/04/2018] [Accepted: 01/23/2019] [Indexed: 12/05/2022] Open
Abstract
Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research. This method typically consists of a dialogue between researcher and participant, guided by a flexible interview protocol and supplemented by follow-up questions, probes and comments. The method allows the researcher to collect open-ended data, to explore participant thoughts, feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues. The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings. We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings. Overall, semistructured interviewing requires both a relational focus and practice in the skills of facilitation. Skills include: (1) determining the purpose and scope of the study; (2) identifying participants; (3) considering ethical issues; (4) planning logistical aspects; (5) developing the interview guide; (6) establishing trust and rapport; (7) conducting the interview; (8) memoing and reflection; (9) analysing the data; (10) demonstrating the trustworthiness of the research; and (11) presenting findings in a paper or report. Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings. Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality. Semistructured interviewing can be a powerful tool for family physicians, primary care providers and other health services researchers to use to understand the thoughts, beliefs and experiences of individuals. Despite the utility, semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches. In order to elucidate this method, we provide practical guidance for researchers, including novice researchers and those with few resources, to use semistructured interviewing as a data collection strategy. We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.
Collapse
Affiliation(s)
| | - Lisa M Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
44
|
Guetterman TC, Chang T, DeJonckheere M, Basu T, Scruggs E, Vydiswaran VGV. Augmenting Qualitative Text Analysis with Natural Language Processing: Methodological Study. J Med Internet Res 2018; 20:e231. [PMID: 29959110 PMCID: PMC6045788 DOI: 10.2196/jmir.9702] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background Qualitative research methods are increasingly being used across disciplines because of their ability to help investigators understand the perspectives of participants in their own words. However, qualitative analysis is a laborious and resource-intensive process. To achieve depth, researchers are limited to smaller sample sizes when analyzing text data. One potential method to address this concern is natural language processing (NLP). Qualitative text analysis involves researchers reading data, assigning code labels, and iteratively developing findings; NLP has the potential to automate part of this process. Unfortunately, little methodological research has been done to compare automatic coding using NLP techniques and qualitative coding, which is critical to establish the viability of NLP as a useful, rigorous analysis procedure. Objective The purpose of this study was to compare the utility of a traditional qualitative text analysis, an NLP analysis, and an augmented approach that combines qualitative and NLP methods. Methods We conducted a 2-arm cross-over experiment to compare qualitative and NLP approaches to analyze data generated through 2 text (short message service) message survey questions, one about prescription drugs and the other about police interactions, sent to youth aged 14-24 years. We randomly assigned a question to each of the 2 experienced qualitative analysis teams for independent coding and analysis before receiving NLP results. A third team separately conducted NLP analysis of the same 2 questions. We examined the results of our analyses to compare (1) the similarity of findings derived, (2) the quality of inferences generated, and (3) the time spent in analysis. Results The qualitative-only analysis for the drug question (n=58) yielded 4 major findings, whereas the NLP analysis yielded 3 findings that missed contextual elements. The qualitative and NLP-augmented analysis was the most comprehensive. For the police question (n=68), the qualitative-only analysis yielded 4 primary findings and the NLP-only analysis yielded 4 slightly different findings. Again, the augmented qualitative and NLP analysis was the most comprehensive and produced the highest quality inferences, increasing our depth of understanding (ie, details and frequencies). In terms of time, the NLP-only approach was quicker than the qualitative-only approach for the drug (120 vs 270 minutes) and police (40 vs 270 minutes) questions. An approach beginning with qualitative analysis followed by qualitative- or NLP-augmented analysis took longer time than that beginning with NLP for both drug (450 vs 240 minutes) and police (390 vs 220 minutes) questions. Conclusions NLP provides both a foundation to code qualitatively more quickly and a method to validate qualitative findings. NLP methods were able to identify major themes found with traditional qualitative analysis but were not useful in identifying nuances. Traditional qualitative text analysis added important details and context.
Collapse
Affiliation(s)
- Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tanmay Basu
- Ramakrishna Mission Vivekananda Educational and Research Institute, Belur Math, West Bengal, India
| | - Elizabeth Scruggs
- Department of Internal Medicine-Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, United States.,School of Information, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
45
|
McGowan ML, Prows CA, DeJonckheere M, Brinkman WB, Vaughn L, Myers MF. Adolescent and Parental Attitudes About Return of Genomic Research Results: Focus Group Findings Regarding Decisional Preferences. J Empir Res Hum Res Ethics 2018; 13:371-382. [PMID: 29806518 DOI: 10.1177/1556264618776613] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Opportunities to participate in genomic sequencing studies, as well as recommendations to screen for variants in 59 medically actionable genes anytime clinical genomic sequencing is performed, indicate adolescents will increasingly be involved in decisions about learning secondary findings from genome sequencing. However, how adolescents want to be involved in such decisions is unknown. We conducted five focus groups with adolescents (2) and parents (3) to learn their decisional preferences about return of genomic research results to adolescents. Discussions about decisional preferences centered around three themes: feelings about receiving genomic risk information, adolescent involvement and capacity to participate in decision-making, and recommendations for parental versus collaborative decision-making. We address the contested space between parental duties to act in their children's best interests when choosing which results to return and adolescents' desires to make autonomous decisions. A collaborative decision-making approach is recommended for obtaining consent from adolescents and their parents for genome sequencing research.
Collapse
Affiliation(s)
- Michelle L McGowan
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| | | | | | - William B Brinkman
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| | - Lisa Vaughn
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| | - Melanie F Myers
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| |
Collapse
|
46
|
DeJonckheere M, Robinson CH, Evans L, Lowery J, Youles B, Tremblay A, Kelley C, Sussman JB. Designing for Clinical Change: Creating an Intervention to Implement New Statin Guidelines in a Primary Care Clinic. JMIR Hum Factors 2018; 5:e19. [PMID: 29691206 PMCID: PMC5941089 DOI: 10.2196/humanfactors.9030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/31/2018] [Accepted: 02/16/2018] [Indexed: 11/17/2022] Open
Abstract
Background Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user centered and specifically chosen to address identified barriers. Objective The objectives of this study were to identify potential determinants of provider uptake of the new statin guidelines and to use that information to tailor a coordinated and streamlined local quality improvement intervention focused on prescribing appropriate statins. Methods We employed user-centered design principles to guide the development and testing of a multicomponent guideline implementation intervention to improve statin prescribing. This paper describes the intervention development process whereby semistructured qualitative interviews with providers were conducted to (1) illuminate the knowledge, attitudes, and behaviors of providers and (2) elicit feedback on intervention prototypes developed to align with and support the use of the VA/DoD guidelines. Our aim was to use this information to design a local quality improvement intervention focused on statin prescribing that was tailored to the needs of primary care providers at our facility. Cabana’s Clinical Practice Guidelines Framework for Improvement and Nielsen’s Usability Heuristics were used to guide the analysis of data obtained in the intervention development process. Results Semistructured qualitative interviews were conducted with 15 primary care Patient Aligned Care Team professionals (13 physicians and 2 clinical pharmacists) at a single VA medical center. Findings highlight that providers were generally comfortable with the paradigm shift to risk-based guidelines but less clear on the need for the VA/DoD guidelines in specific. Providers preferred a clinical decision support tool that helped them calculate patient risk and guide their care without limiting autonomy. They were less comfortable with risk communication and performance measurement systems that do not account for shared decision making. When possible, we incorporated their recommendations into the intervention. Conclusions By combining qualitative methods and user-centered design principles, we could inform the design of a multicomponent guideline implementation intervention to better address the needs and preferences of providers, including clear and direct language, logical decision prompts with an option to dismiss a clinical decision support tool, and logical ordering of feedback information. Additionally, this process allowed us to identify future design considerations for quality improvement interventions.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Claire H Robinson
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Lindsey Evans
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Julie Lowery
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Bradley Youles
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Adam Tremblay
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,General Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Caitlin Kelley
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jeremy B Sussman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
47
|
Abstract
The 2016 presidential election season and subsequent political events have had physical and emotional impacts on youth. We collected qualitative insights from 14 to 24 year olds across the US related to these events over time. Open-ended probes were sent via text message at three time points before and after the 2016 presidential election. The majority of youth reported emotional stress during all three time points, and female participants were significantly more likely to experience emotional responses. White participants were more likely to report negative symptoms than their peers both pre-election and at 4-months post-election. While preliminary, the results indicate that feelings of stress, anxiety, and fear have persisted in the months following the election, particularly for young women. Additional research is needed to examine the long-term effects of political events on the emotional and physical health of youth.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- 0000000086837370grid.214458.eDepartment of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104 USA
| | - Andre Fisher
- 0000000086837370grid.214458.eUniversity of Michigan, 500 S. State St, Ann Arbor, MI 48109 USA
| | - Tammy Chang
- 0000000086837370grid.214458.eDepartment of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104 USA ,0000000086837370grid.214458.eInstitute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109 USA
| |
Collapse
|
48
|
DeJonckheere M, Nichols LP, Moniz MH, Sonneville KR, Vydiswaran VGV, Zhao X, Guetterman TC, Chang T. MyVoice National Text Message Survey of Youth Aged 14 to 24 Years: Study Protocol. JMIR Res Protoc 2017; 6:e247. [PMID: 29229587 PMCID: PMC5742661 DOI: 10.2196/resprot.8502] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/10/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022] Open
Abstract
Background There has been little progress in adolescent health outcomes in recent decades. Researchers and youth-serving organizations struggle to accurately elicit youth voice and translate youth perspectives into health care policy. Objective Our aim is to describe the protocol of the MyVoice Project, a longitudinal mixed methods study designed to engage youth, particularly those not typically included in research. Text messaging surveys are collected, analyzed, and disseminated in real time to leverage youth perspectives to impact policy. Methods Youth aged 14 to 24 years are recruited to receive weekly text message surveys on a variety of policy and health topics. The research team, including academic researchers, methodologists, and youth, develop questions through an iterative writing and piloting process. Question topics are elicited from community organizations, researchers, and policy makers to inform salient policies. A youth-centered interactive platform has been developed that automatically sends confidential weekly surveys and incentives to participants. Parental consent is not required because the survey is of minimal risk to participants. Recruitment occurs online (eg, Facebook, Instagram, university health research website) and in person at community events. Weekly surveys collect both quantitative and qualitative data. Quantitative data are analyzed using descriptive statistics. Qualitative data are quickly analyzed using natural language processing and traditional qualitative methods. Mixed methods integration and analysis supports a more in-depth understanding of the research questions. Results We are currently recruiting and enrolling participants through in-person and online strategies. Question development, weekly data collection, data analysis, and dissemination are in progress. Conclusions MyVoice quickly ascertains the thoughts and opinions of youth in real time using a widespread, readily available technology—text messaging. Results are disseminated to researchers, policy makers, and youth-serving organizations through a variety of methods. Policy makers and organizations also share their priority areas with the research team to develop additional question sets to inform important policy decisions. Youth-serving organizations can use results to make decisions to promote youth well-being.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michelle H Moniz
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States.,School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Xinyan Zhao
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
49
|
Du T, Hill L, Ding L, Towbin A, DeJonckheere M, Bennett P, Hagerman N, Varughese A, Pratap J. Gastric emptying for liquids of different compositions in children. Br J Anaesth 2017; 119:948-955. [DOI: 10.1093/bja/aex340] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 02/04/2023] Open
|
50
|
Vaughn LM, DeJonckheere M, Pratap JN. Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care. J Child Health Care 2017; 21:14-24. [PMID: 27282548 DOI: 10.1177/1367493516645858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.
Collapse
Affiliation(s)
- Lisa M Vaughn
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | |
Collapse
|