Healthcare Providers’ Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases

Johns Hopkins School of Nursing

Purpose: The purpose of this study was to identify healthcare providers’ experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases. Design and methods: A qualitative, descriptive design was used with 13 pediatric healthcare providers. Findings: Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support. Conclusions: Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers. Practice implications: The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.

Publication
Journal of Pediatric Nursing
Publication Year
2020

Probation Officers’ and Supervisors’ Perspectives on Critical Resources for Implementing Specialty Mental Health Probation

University of North Carolina at Chapel Hill

This paper presents the results of a qualitative study designed to explore and identify the resources that probation officers need to implement specialized mental health probation caseloads, a promising practice that enhances mental health treatment engagement and reduces recidivism among people with mental illnesses. Our research team conducted a directed content analysis guided by the Practical, Robust Implementation and Sustainability Model (PRISM) to analyze qualitative interviews with 16 specialty mental health probation officers and their supervising chiefs. Results indicated five components and resources related to multiple PRISM constructs: (1) meaningfully reduced caseload sizes (intervention design), (2) officers’ ability to build rapport and individualize probation (organizational staff characteristics), (3) specialized training that is offered regularly (implementation and sustainability infrastructure), (4) regular case staffing and consultation (implementation and sustainability infrastructure), and (5) communication and collaboration with community-based providers (external environment). Agencies implementing specialized mental health probation approaches should pay particular attention to selecting officers and chiefs and establishing the infrastructure to implement and sustain specialty mental health probation.

Publication
Administration and Policy in Mental Health and Mental Health Services Research
Publication Year
2020

Does gender-bending help or hinder friending? The roles of gender and gender similarity in friendship dissolution

Department of Psychological Sciences

We explored how gender and gender similarity affects friendship dissolution following the transition to middle school. We predicted that both gender and gender similarity (measured by perceived similarity to own-gender and other-gender peers) explain dissolution trends and that less own-gender similarity or more other-gender similarity predicts more friendship dissolution. We considered gender and gender similarity at both the individual and dyad level (reflecting the discrepancy between friends). Participants were 198 students in Grade 6 (42% Latinx, 21% Caucasian, 10% Native American, 8% African American, 2% Asian American, and 17% mixed backgrounds; 77% qualified for free/reduced meals) in reciprocated same- or mixed-gender friendships followed from fall to spring of the academic year. Multilevel multimember logistic regression models, nesting friendships within each participating individual, demonstrated that girl–girl friendships were less likely to dissolve than boy–boy friendships, and mixed-gender friendships did not dissolve more than same-gender friendships. Feeling similar to one’s own gender predicted less dissolution, but feeling similar to the other gender did not increase friendship dissolution. There was no support for the hypothesis that feeling similar to both genders (i.e., androgyny) protected against friendship dissolution, nor was there any support for the hypothesis that dyad-level differences in gender similarity would predict dissolution. The discussion focuses on the importance of conducting individual and dyad-level analyses as well as including gender similarity constructs when studying gender differences in friendships and their trajectories over time.

Publication
Developmental Psychology
Publication Year
2020

Developing Interprofessional Competence: Results of Embedding TeamSTEPPS® in All Semesters of an Accelerated and Traditional BSN Program

City University of New York School of Public Health

This study assessed the effectiveness of a curriculum designed to teach interprofessional communication and teamwork skills to traditional and accelerated baccalaureate nursing students. The curriculum was designed to incorporate TeamSTEPPS® concepts using incremental learning experiences and a variety of instructional techniques throughout all clinical program semesters; more than 200 students representing four cohorts were enrolled in the study. Three tools were used to evaluate program effectiveness. Both accelerated and traditional groups demonstrated varying degrees of improvement on all tools. The curriculum design positively influenced students’ communication and teamwork skills, advancing their interprofessional competency.

Publication
Nursing Education Perspectives:
Publication Year
2020

Air pollution and green consumption of consumers in China’s urban areas: a norm activation perspective

University of Iowa

This study aims to explore how consumers’ psychological factors affect their pro-environment purchasing behavior in a smog-ridden city. Based on the Protective Action Decision Model and Heuristic–Systematic Model, this study proposed a model to investigate consumers’ decision-making process in purchasing green anti-smog products. It also provided new empirical evidence for the role of personal norms on consumers’ green consumption behavior by examining the differences between two groups of consumers (i.e., green and non-green) through a multi-group path analysis. The predictions were tested using a questionnaire survey of 1,124 participants living in the Beijing–Tianjin–Hebei region of China. Results indicated that product knowledge, smog knowledge, risk perception, and systematic processing positively affected consumers’ purchase intention. In addition, the significant differences of consumers with various personal norms in purchase decision-making were found in the current study. In the green group, product knowledge positively affected consumers’ risk perceptions and systematic processing intentions. Information seeking increased their purchase intentions. However, these relationships were not significant in the non-green group. This study contributes to the existing literature by linking consumers’ protective behaviors with green consumption and providing a comprehensive model for predicting consumers’ purchase decisions.

Publication
Human and Ecological Risk Assessment: An International Journal
Publication Year
2020

Does mindfulness practice promote psychological functioning or is it the other way around? A daily diary study

University of Utah

Mindfulness-based interventions are commonly used to reduce psychological symptoms and enhance positive qualities of human functioning. However, the influence of mindfulness practice dosage remains poorly understood, limiting dissemination and implementation efforts. The current study examined the association between practice dosage and several constructs related to psychological functioning (positive and negative affect, state mindfulness) over the course of a standardized mindfulness-based intervention (Mindfulness-Oriented Recovery Enhancement). Twenty-five participants completed daily diary assessments for 12 weeks. Two-part gamma regression models examined the dichotomous (did practice occur?) and continuous (how much practice?) components of practice minutes. Practice time and outcomes showed same-day relationships in the expected directions. Lagged models, however, showed no evidence that current day practice time predicts subsequent day outcomes. In contrast, higher current day negative affect predicted less subsequent day practice time, and higher current day mindfulness predicted more subsequent day practice time. In a post hoc analysis, practice time moderated the link between day-to-day affect, strengthening the link for positive affect and weakening the link for negative affect. Collectively, these findings suggest that the causal direction linking practice time and outcome may flow from outcome to practice time, rather than the reverse—with potential recursive relationships between these factors. Further examination of lagged relationships between practice time and outcome as well as random assignment of participants to varying practice dosages (e.g., in within-person microrandomized trials) may help clarify the influence of this central treatment ingredient within mindfulness-based interventions.

Publication
Psychotherapy
Publication Year
2020

Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado

Geisinger Commonwealth School of Medicine

There have been dynamic changes in prescription opioid use in the US but the state level policy factors contributing to these are incompletely understood. We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. Prescription data reported to the Drug Enforcement Administration for nine opioids used for pain (e.g., fentanyl, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone) and two primarily for opioid use disorder (OUD, methadone and buprenorphine) from 2007 to 2017 were evaluated. Analysis of the interval pre (2007–2012) versus post (2013–2017) marijuana legalization revealed statistically significant decreases for Colorado (P < 0.05) and Maryland (P < 0.01), but not Utah, for pain medications. There was a larger reduction from 2012 to 2017 in Colorado (–31.5%) than the other states (–14.2% to –23.5%). Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states. The most prevalent opioids by morphine equivalents were oxycodone and methadone. Due to rapid and pronounced changes in prescription opioid distribution over the past decade, additional study with more states is needed to determine whether cannabis policy was associated with reductions in opioids used for chronic pain.

Publication
International Journal of Environmental Research and Public Health
Publication Year
2020

Beautiful stranger: Voices from the front lines of community practice in Israel

Bryn Mawr College

Over the past few decades, economic, political and cultural forces have altered the development of social policies and affected the life circumstances of oppressed communities in many countries. In response, calls for greater understanding and awareness of macro practice skills and interventions have been increasing within many of the social care professions. These calls have been particularly strong within the social work profession. A major field in macro social work is community practice, which aims to help people organise, plan and act for change. To date, there has been a dearth of studies examining social workers’ involvement in community practice at the ground level. Drawing on in‐depth interviews with 26 community social workers in public social services in Israel, this qualitative study examines community social workers’ everyday experiences of community practice and the meanings they attribute to it. Findings highlight three main themes: (a) the elusive and unbounded nature of community practice; (b) the tense relations that community social workers maintain with various actors within the profession; and (c) the complex relations they maintain with the communities in which they work. We discuss these findings in light of Georg Simmel’s concept of ‘the stranger’. Implications to community practice are outlined.

Publication
Health & Social Care in the Community
Publication Year
2020

A Sociometric Approach to Understanding Concordance in Substance Use Perceptions Among Youth Experiencing Homelessness

University of Denver

Objective: Most studies examining peer influence on drug-use among youth experiencing homelessness (YEH) have relied on perceptions of peer use rather than measuring peers’ self-reported use, an approach that can inflate esti- mates of peer substance use behavior. Sociometric network data provide an op- timal mechanism to compare perceptual data to actual self-reports from peers. Method: Using an event-based approach, we recruited a sample of YEH (N 5 241), ages13–25years,between October 2011 and February 2012 from 2 drop-in cen- ters—1 in Hollywood, CA, and 1 in Santa Monica, CA. We used multilevel multiple membership modeling to investigate participant-level, network-level, and relationship- level factors associated with the accuracy of respondent perceptions. Results: The accuracy of respondent perceptions of peer substance use was high (70%–90% de- pending on the substance). The individual- and network-level factors associated with accuracy or inaccuracy varied by substance. Conclusions: Interventions designed to reduce the risk of substance use among YEH may benefit from using a social norms approach that emphasizes changing norms at a community/group level rather than at an individual level.

Publication
Journal of the Society for Social Work and Research
Publication Year
2020

Social Work Scholarship on Forced Migration: A Scoping Review

University of Washington

This scoping review identifies and analyses historical to present–day contributions of social work scholarship on forced migration, with the aim of reviewing trends and identifying priority areas for the discipline moving forward. This review examined 331 articles related to forced migration published in 40 social work journals over four decades (1978 to 2019). Findings illustrate notable trends in temporal, methodological, topical and geographical dimensions and how those vary by first authors’ locations, research sites and study populations. Temporally, the number of articles has been increasing, quadrupling between 2001–2010 and 2011–2019, with 20 social work journals doubling their number of articles. Methodologically, the large majority of articles were qualitative and/or conceptual. Topically, the most common were practice, intervention, health and mental health, while the least common topics included human rights, social justice, poverty, religion, violence, history and theory. Geographically, social work scholarship was mainly focused on refugees in the Global North and third-country resettlement contexts, and authored by scholars in the Global North. Findings thus reveal critical gaps in topics and geographical biases, raising questions related to issues of ethics, power and the production of knowledge about forced migration in the social work academy.

Publication
The British Journal of Social Work
Publication Year
2020

Gender Differences in the Marital Plans and Union Transitions of First Cohabitations

Cornell University

In an era of changing relationship norms, plans for marriage are an increasingly complex yet important indicator of the link between cohabitation and marriage. Despite qualitative evidence on this complexity, little is known about the nuances of marital plans and gender differences at the population level. This study introduces the concept of “informal” marital plans—cohabitations beginning with some intentions to marry that had yet to be formalized. Drawing on data of heterosexual cohabitors in their first coresidential union from the National Survey of Family Growth (2011–2015, n  = 5545), I examine the sociodemographic correlates of marital plans as well as their consequences for men’s and women’s union transitions. The results show significant gender differences in reports of marital plans at the time of moving in together, with women more likely to report engagement and men more likely to report informal marital plans. Although having any marital intentions is positively associated with transitioning to marriage for both genders, engagement is a significantly stronger predictor of marriage than informal marital plans. Pronounced gender differences are found with respect to the dissolution of first cohabitations, as both informal and formal marital plans are more protective against dissolution for men than for women. Distinguishing informal marital plans from engagement provides meaningful new insights into the role of cohabitation in modern American union formation.

Publication
Population Research and Policy Review
Publication Year
2020

Walking on Eggshells, An Update on the Stigmatizing of Teen Mothers

Saint Louis University

Teen mothers are stigmatized for violating age norms for parenting and for being members of devalued racial or socioeconomic groups. Stereotypes of young mothers perpetuate stigma by teen pregnancy prevention campaigns, television shows, sex education programs, professionals, and the general public. How teen mothers became a stigmatized group; updates on research about their experience of stigma; and resources for reducing stigma are presented. Because stigma is pervasive and has damaging effects, nurses are urged to reduce stigma and discrimination by assuring that health settings are safe and welcoming, and that pregnant and parenting teens are treated with respect and dignity. Doing so is consistent with our professional commitment to promote social justice and mitigate the social inequities that contribute to health disparities for all parents, irrespective of age, gender, ethnicity, immigration status, or income.

Publication
The American Journal of Maternal/Child Nursing
Publication Year
2020

At the end of the journey Lyle Lewis Lloyd (August 10 1934–February 12 2020)

Indiana University

Lyle was a pioneer of the field of augmentative and alternative communication (AAC). He was one of the initiators of ISAAC and the journal Augmentative and Alternative Communication in the 1980s. His own engagement in nonspeech communication emerged in the 1970s. Lyle published articles, several together with Macalyn Fristoe, and organized courses about what later became known as AAC before ISAAC and the AAC journal were established. He remained strong within this field until the end of his career, and his work is frequently cited. He has guided, and supported several generations of researchers and practitioners working in the field of AAC.

Publication
Augmentative and Alternative Communication
Publication Year
2020

The initial development and validation of the Racial Socialization Competency Scale: Quality and quantity

University of North Carolina at Chapel Hill

The present study investigated the reliability and validity of the Racial Socialization Competency Scale (RaSCS). As posited by the Racial Encounter Coping Appraisal and Socialization Theory (RECAST), the RaSCS consists of 3 factors representing 3 novel dimensions of racial socialization competency present in families (e.g., stress, skills, and confidence). Responses to the RaSCS were collected from 361 self-identified Black and African American parents and primary caretakers across the United States. After factor analysis, three scales and 27 items were maintained. Evidence was consistently found for 2 subscales within the stress dimension, namely “Call to Action” and “General” racial socialization stressors. Dimensions were also related to their respectively hypothesized constructs, including overall stress, racial socialization frequency, and self-efficacy. Future directions and recommendations on the measure’s use, particularly in the context of interventions, are also discussed.

Publication
Cultural Diversity & Ethnic Minority Psychology
Publication Year
2020

Body Appreciation and Health Care Avoidance: A Brief Report

The University of Kansas

Research suggests that body image is related to health behaviors and health care use, but possible mechanisms for this relationship remain unclear. The current study examined the presence of a relationship between body appreciation and avoiding the doctor to avoid being weighed, using a diverse sample of women (N = 499). Controlling for body size and determinants of health care utilization, logistic regression results suggested that women with higher body appreciation were less likely to avoid health care to avoid being weighed (odds ratio = 0.38, p < .001). In addition, differences in avoiding the doctor to avoid being weighed were found for the covariates (that is, age, race, body mass index, and socioeconomic status). These results inform knowledge regarding barriers to health care use and the relationship between body image and health care use. The article concludes with a discussion of the implications for future research, social work interventions, and social work education to promote women's health and well-being.

Publication
Health & Social Work
Publication Year
2020

Pathways From Intimate Partner Violence to Academic Disengagement Among Women University Students

Washington University in St. Louis

More knowledge is needed related to collegiate intimate partner violence (IPV) and the pathways between experiencing physical and psychological IPV and academic disengagement. Students in a University System in the southwest completed an online survey including measures of physical and psychological IPV, academic disengagement, sense of community, and safety on campus. Conditional process analyses were used to understand key pathways for 6,818 woman identified students. All models found a significant indirect path between physical and psychological IPV and academic disengagement via depression symptoms. Students’ sense of community on campus was associated with less academic disengagement regardless of physical violence. The impact of psychological IPV on disengagement was stronger for those with lower senses of community. Enhancing screening and education, providing effective mental health counseling, and increasing advocacy will help institutions better address IPV.

Publication
Violence and Victims
Publication Year
2020

Setting the Stage for Research Success: Creation of Standardized Physician-Scientist Training Program Guidelines to Facilitate Research During Clinical Training

University of North Carolina at Chapel Hill

OBJECTIVES/GOALS: To ameliorate the leaky pipeline of physician-scientists, we must address the factors that cause medical trainees to disengage from research. Here we describe the development of standardized Physician-Scientist Training Program guidelines that may be implemented across disciplines to address these challenges. METHODS/STUDY POPULATION: Maintenance of a robust pool of physician-scientists is critical to meet the rapidly growing need for novel therapeutics. A variety of factors contribute to the decline of this pool. Key among these are a lengthy training period that segregates research from clinical training, thus impeding research progress and milestones that allow for a successful research career. Through engagement of residency program directors and Vice Chairs of Research, we have created a series of guidelines that promote residency research tracks and enable better integration of research and clinical training time. Guidelines have been piloted in the Departments of Pediatrics, Medicine and Surgery in the context of 2 new R38-supported programs. RESULTS/ANTICIPATED RESULTS: Our physician-Scientist Training Program (PSTP) guidelines were developed by our central Office of Physician-Scientist Development (OPSD) after a successful pilot of an integrated research residency program in the Department of Pediatrics [Duke Pediatric Research Scholars (DPRS); Hurst, et al, 2019], which has included 36 resident and fellow scholars over 3 years. To date, eight clinical departments have adopted our PSTP guidelines as part of their R38-supported or pending programs. The OPSD has recently created a tracking database for scholar metrics, which will further promote PSTP development by enabling centralized reporting on scholar success to individual programs. DISCUSSION/SIGNIFICANCE OF IMPACT: PSTP guidelines enable effective implementation of new programs by sharing best practices and lessons learned, standardizing expectations, and defining metrics of success. By promoting proven strategies for integrated clinical and research training, PSTP guidelines may aid in retaining trainees pursuing research careers.

Publication
Journal of Clinical and Translational Science
Publication Year
2020

Prevalence of Intestinal Parasites in a Low-Income Texas Community

The University of Texas at Austin

Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth’s unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.

Publication
The American Journal of Tropical Medicine and Hygiene
Publication Year
2020

Use of Enhanced Data Visualization to Improve Patient Judgments about Hypertension Control

University of Missouri-Columbia

Objective. Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support—in the form of enhanced data visualization—could improve judgments about hypertension control. Methods. Participants (Internet sample of patients with hypertension) in 3 studies (N = 209) viewed graphs depicting blood pressure data for fictitious patients. For each graph, participants rated hypertension control, need for medication change, and perceived risk of heart attack and stroke. In study 3, participants also recalled the percentage of blood pressure measurements outside of the goal range. The graphs varied by systolic blood pressure mean and standard deviation, change in blood pressure values over time, and data visualization type. Results. In all 3 studies, data visualization type significantly affected judgments of hypertension control. In studies 1 and 2, perceived hypertension control was lower while perceived need for medication change and subjective perceptions of stroke and heart attack risk were higher for raw data displays compared with enhanced visualization that employed a smoothing function generated by the locally weighted smoothing algorithm. In general, perceptions of hypertension control were more closely aligned with clinical guidelines when data visualization included a smoothing function. However, conclusions were mixed when comparing tabular presentations of data to graphical presentations of data in study 3. Hypertension was perceived to be less well controlled when data were presented in a graph rather than a table, but recall was more accurate. Conclusion. Enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control. More research is needed to determine the contexts in which graphs are superior to data tables.

Publication
Medical Decision Making
Publication Year
2020

Investigating the Factors That Influence Self-Efficacy Among Home Care Workers Providing Dementia Care

University of Western Ontario

The self-efficacy beliefs of home care personal support workers (PSWs) play a crucial role in their professional competence and subsequent provision of quality care. Understanding the factors that influence self-efficacy of PSWs is critical to ensuring their job satisfaction and retention, and ultimately improving the quality of care provided to home care clients. Currently, there is a lack of literature exploring the factors influencing self-efficacy among home care PSWs who care for clients with dementia. Accordingly, the purpose of this study was to investigate the sources of self-efficacy for home care PSWs. Conventional content analysis of interviews with 15 home care PSWs yielded six categories of sources influencing self-efficacy: insufficient client information provided by employers, lack of supportive communication by employers, restriction of PSWs’ discretion and autonomy by employers, insufficient practical dementia-specific training, sufficient work experience with clients with dementia, and feedback from family caregivers. These findings call for a multi-pronged approach to enhance the self-efficacy of PSWs. In particular, these findings offer specific areas of improvement for employers on how to best support their PSWs. They also highlight the significant role of dementia-specific education and training for PSWs regardless of their experience in the field. Finally, the findings emphasize the importance of family caregivers in the home care context. Taken together, the study’s findings offer insights on how to best support PSWs and ensure stability in the dementia care workforce.

Publication
Innovation in Aging
Publication Year
2020