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Introduction: Hypertension affects 5–10% of pregnancies in the United States. Chronic hypertension during pregnancy can have a significant impact on maternal and neonatal outcomes, especially in rural populations. Pregnancies complicated by hypertension are currently managed through frequent clinic visits or extended hospital stays. Cellular-enabled remote patient monitoring devices provide an alternative treatment method for women in rural areas. Research Aim: This study aimed to measure the feasibility of and patient satisfaction with using an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center. Methods: In a mixed methods pilot study, twelve women with chronic hypertension during pregnancy were given cellular-enabled BodyTrace™ blood pressure cuffs and weight scales. Participants' blood pressures were continuously monitored by a nurse call center. Participants completed a survey and a brief semi-structured interview after two weeks. Results: Participants scored low on stress and anxiety with mean scores of 5.45 (SD = 3.56) and 8.09 (SD 3.62), respectively. Participants scored high on behavioral intention, system usability, and perceived benefits with mean scores of 8.73 (SD = 2.53), 75.91 (SD = 23.70), and 19.64 (SD = 5.92), respectively. Participants perceived benefits to using the device, including increased monitoring by health professionals, increased self-awareness, decreased number of clinic visits, and convenience of use. Perceived disadvantages included higher readings when compared to clinical readings. Discussion: Cellular-enabled remote patient monitoring devices for blood pressure are a valuable tool for managing treatment of pregnancies complicated by hypertension. [ABSTRACT FROM AUTHOR]

Nearly all people in prison have experienced trauma, and many meet the criteria for posttraumatic stress disorder (PTSD). Untreated PTSD increases the risk of substance use problems after release, contributing to a well‐documented cycle of trauma, addiction, and incarceration. However, evidence‐based, trauma‐focused therapy for PTSD is rarely offered in prisons, and there is little research that can guide implementation efforts. In preparation for an effectiveness–implementation hybrid II pilot trial examining group‐delivered cognitive processing therapy (CPT) in prisons, we conducted a formative evaluation using interviews structured according to the consolidated framework for implementation research (i.e., CFIR). Participants were correction center leadership, treatment staff, health care staff, and security staff (n = 22) and incarcerated persons (n = 14; 57.1% female). We found that CPT was highly compatible with residents' needs and the centers' available resources, culture, existing programs, and current workflow. CPT was also acceptable to all stakeholders. Potential barriers were the lower relative priority for CPT compared with programs that are reinforced at the system level, limited staff time to deliver CPT, limited staff knowledge about PTSD, and center features that could distract from CPT groups and/or training or be countertherapeutic. Taken together, CPT is a promising trauma‐focused therapy for corrections, but these findings underscore the importance of identifying and matching potential barriers to effective implementation strategies a priori and work in the policy arena to promote sustainability. [ABSTRACT FROM AUTHOR]

Background: Transgender and gender nonbinary (trans/NB) individuals face many barriers to accessing health care in the United States due to systemic and clinician discrimination. Such experiences can lead to avoidance or delays in seeking care. These issues are relevant for emergency department (ED) clinicians and staff because trans/NB patients may use the ED in times of crisis.Objectives: The purpose of this study was to qualitatively explore experiences of trans/NB individuals accessing health care in the ED and provide recommendations for improvements.Methods: This study involved semi-structured qualitative interviews with nine trans/NB individuals living in Arkansas about their experiences when visiting local EDs.Results: Interviews revealed four main themes: 1) system and structural issues; 2) interactions with clinicians/staff influence care received; 3) perceptions of clinician knowledge and education about trans/NB health; and 4) impact on future health and health care access. Participants recommended education for current and future ED clinicians and staff to improve knowledge of best practices for trans/NB health care. Recommendations were also made to improve ED policy for inclusive and affirming intake processes, intake forms, and electronic health record (EHR) documentation, including documentation and use of patients' chosen name and pronouns.Conclusion: The negative experiences and discrimination reported by trans/NB patients in ED visits underscores the importance of improving ED clinician knowledge of gender-affirming care practices, ED intake policies and practices, and EHR documentation in EDs. [ABSTRACT FROM AUTHOR]

Most emergency medical clinicians are not trained to conduct forensic sexual assault exams yet are often the first to care for survivors of recent sexual assault. Before the implementation of live sexual assault nurse examiner (SANE) consultation provided via telemedicine (“teleSANE”) in one state, results of an online survey of emergency nurses (N = 116) found only 13% felt extremely confident providing quality forensic sexual assault examinations. Two-thirds of emergency nurses felt using teleSANE during sexual assault care would support their clinical decision-making skills. Findings suggest that teleSANE may be a promising strategy to improve access to specialized sexual assault care. [ABSTRACT FROM AUTHOR]

Although incarcerated women are a highly victimized population, therapy for sexual violence victimization (SVV) sequela is not routinely offered in prison. SHARE is a group therapy for SVV survivors that was successfully implemented and sustained in a women's correction center. Here, we aimed to identify implementation factors and strategies that led to SHARE's success and describe incarcerated women's perspectives on the program. We conducted a retrospective process evaluation using interviews structured according to EPIS, a well‐established implementation science framework. Participants (N = 22) were incarcerated women, members of the SHARE treatment team, and members of the correction center's leadership, therapeutic team, and volunteer program. Factors that facilitated SHARE implementation varied by EPIS phase and organization. Positive inter‐organizational and interpersonal relationships were key across phases, as were the synergies between both the strengths and needs of each organization involved in implementation. Incarcerated women reported a strong need for SHARE and did not report any concerns about receiving trauma therapy in a carceral setting. Therapy for SVV sequelae, including exposure‐based therapy, is possible to implement and sustain in carceral settings. Community–academic partnerships may be a particularly feasible way to expand access to SVV therapy for incarcerated women. Highlights: Described implementing a group therapy for survivors of sexual violence within a women's prison.Evaluated contextual factors and strategies that led to successful sustainment of the group.Includes views of incarcerated women, members of the treatment team, and prison leadership.Found personal and organizational partnerships were key to effecting and sustaining the program.Incarcerated women noted a need for trauma therapy and felt prison was a suitable setting for it. [ABSTRACT FROM AUTHOR]

Introduction:Telehealth is becoming integral to health care delivery, which may create a higher need for better internet. This is the first study to examine whether users are willing to spend more on their internet if they are (1) more experienced in using telehealth, (2) more optimistic about telehealth benefits, and (3) less concerned about the difficulty of using telehealth. Methods:We surveyed 5,200 Americans about their willingness to pay (WTP) for internet speed and quality on the one hand, and their (1) prior use of telehealth, (2) opinion about the benefits of telehealth, and (3) opinion about the difficulties of using telehealth. We stratified the sample using the three aspects above and conducted a conjoint analysis to estimate the WTP for internet speed and quality within each stratum. Results:Compared with respondents who had never used telehealth, respondents who had used five to six different types of telehealth services were willing to spend 50.4% more on their internet plans. Users who most firmly believed in the benefits of telehealth were willing to spend 59.2% more than the most pessimistic users. Users who had the lowest concerns about the difficulty of using telehealth were willing to spend 114% more than users with the most perceived difficulty. Discussion:We found strong ties between the WTP for internet and prior telehealth use and perceptions of telehealth benefits and barriers. Thus, internet expenditures may be influenced by users' anticipation of using telehealth. Future studies may investigate the causality of the relationship. [ABSTRACT FROM AUTHOR]

Perceived sexual and gender minority (SGM) youth experience more bullying in schools than their heteronormative peers. The social ecological model offers a framework for exploring the phenomenon of homophobic bullying. This study aimed to describe experiences of victimized youth. Using critical qualitative inquiry, youth (N = 16) of ages 15 to 20 who self-identified as having been bullied for being perceived to be SGM and who resided in a Midwestern state in the United States were interviewed in-person or online. Thematic analysis revealed that gender nonconformity was a common factor in being bullied. Subthemes are as follows: the sociocultural context shapes school climate; victimized youth felt a perception of being seen as deviant; and, victimized youth react to victimization differently. Findings indicate that bullying for gender nonconformity is a sociocultural issue. Improving the school climate for gender nonconforming youth is still needed. Implementing supportive programs and protective policies at the broader socioecological levels can help. [ABSTRACT FROM AUTHOR]

Despite a national decline in teenage pregnancy rates, Arkansas continues to have one of the highest rates in the USA. More teenagers in the state reported not using any method of contraception (20%) compared to the USA (13.8%). National-level research suggests that misinformation and lack of awareness about contraception is prevalent. This study examines awareness, knowledge and attitudes towards contraception among Arkansas teenagers and parents. Between July-November 2018, twelve focus groups – 6 with teenagers (n = 40) and 6 with parents (n = 28) – were conducted around the state. Parent participants were uncertain about their teenagers' access to and knowledge of contraception, had many concerns about their teenagers using contraception and spoke about teaching their kids about contraception in a future sense ('would' and 'should'). Although parents preferred abstinence for their teenagers, they preferred contraception use to teenage pregnancy. Teenage participants had limited knowledge/awareness of methods of contraception beyond condoms and birth control pills. They saw contraception as ineffective, were concerned about side effects and experienced difficulty accessing contraception. This study provides insight into current knowledge and attitudes towards contraception among teenagers and parents in Arkansas, as well as recommendations for designing educational campaigns centred around awareness, empowerment and inclusion. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus 2019 (COVID-19) pandemic not only exacerbated barriers to healthcare but has also highlighted the trend toward increased vaccine hesitancy. Our goal was to improve COVID-19 vaccine uptake through a student-led, emergency department-based (ED) vaccination program. Methods: This prospective, quality-improvement pilot program used medical and pharmacy student volunteers as COVID-19 vaccine screeners in a southern, urban, academic ED. Patients eligible for vaccination were offered either the Janssen-Johnson & Johnson or the Pfizer-BioNTech COVID-19 vaccine and were educated about vaccine concerns. Vaccine acceptance rates were recorded, as well as reasons for vaccine hesitancy, vaccine brand preferences, and demographics. The primary and secondary quantitative outcomes were overall vaccine acceptance and change in vaccine acceptance after student-provided education, respectively. We performed logistic regression to identify potential variables that correlated with vaccine acceptance. Guided by the Consolidated Framework for Implementation Research, focus group interviews with four key stakeholder groups explored implementation facilitators and barriers. Results: We screened 406 patients for COVID-19 vaccination eligibility and current vaccine status, the majority of whom were unvaccinated. Of unvaccinated or partially vaccinated patients, vaccine acceptance before education was 28.3% (81/286), and vaccine acceptance after education was 31.5% (90/286) (% difference, 3.1% [95% CI 0.3%-5.9%], P=0.03). The most common hesitancy factors cited were concerns about side effects and safety. Results from the regression analysis indicated that increasing age and Black race were associated with an increased odds of vaccine acceptance. Focus groups revealed implementation barriers, including patient resistance and workflow issues, and facilitators, including student involvement and public health promotion. Conclusion: Using medical and pharmacy student volunteers as COVID-19 vaccine screeners was successful, and brief education provided by the students led to a modest increase in vaccine acceptance, with overall acceptance of 31.5%. Numerous educational benefits are described. [ABSTRACT FROM AUTHOR]

Suicide by former United States military service members is of great public health concern, and one area, veterans' suicide attempts involving firearms, is understudied. One group that has a unique perspective on this are veterans with a psychiatric admission following a firearm-related suicide crisis, such as making a suicide plan or a suicide rehearsal with a firearm within the preceding 72 hours. This study seeks to address this gap in the literature by describing the characteristics and context of non-fatal suicide events involving firearms among veterans. This convergent parallel mixed-methods design study collected both quantitative and qualitative data from male veterans (N = 15) who were hospitalized due to a suicide attempt or serious ideation using a firearm. Veterans admitted to a Veterans Affairs Medical Center (VAMC) were interviewed and asked to complete a survey. Qualitative data on characteristics and context were analyzed using a thematic analysis. The fifteen male U.S. military veterans described their personal characteristics, such as their beliefs, family beliefs and structure, emotions, and employment status. Most participants were unemployed (n = 10; 67%), divorced (n = 7; 47%) or married (n = 5; 33%). Seven themes related to context emerged from qualitative interviews to include: combat trauma, non-combat trauma and negative life event(s), current and past suicide attempt(s), firearms, substance use, known deaths by suicide, and protective factors for suicide. Results suggest that engaging support networks and communities is essential when developing programs to promote identification of early warning signs and implementation of interventions or programs for reducing veteran suicide. [ABSTRACT FROM AUTHOR]