Search

Accelerated resolution therapy (ART) is a psychotherapy for the treatment of prolonged grief disorder (PGD) defined as severe, enduring longing for the lost person. Currently, ART lacks examination of intrapersonal processes, like expectancy, as behavioural mechanisms for action. Therefore, the purpose of this paper was to present the findings on participants' treatment expectations of ART for PGD and then discuss potential hypotheses for future testing. This study was a primary qualitative descriptive analysis of prospectively collected interview data (collected 2017–2019) accrued as part of a randomised, wait‐list controlled clinical trial in bereaved hospice family caregivers in the United States. The sample included 29 former informal caregivers who were at least 1‐year post death of their care recipient. They were primarily female, older (67.4 ± 7.1 years), and a little over half (n = 18) had been married to their care recipient. Thematic analysis resulted in three distinct themes with six sub‐themes: The role of knowledge in expectations (sub‐themes uncertainty, prior knowledge); The role of personality in expectations (sub‐themes openness, positive affect); and Expecting a process (sub‐themes cognitive processes, affective processes) which described the interaction of person and process in shaping expectations of our intervention. An across theme analysis of the specificity of the participants' expectations uncovered that knowledge and personality inform expectations of ART and that individuals who verbalise a process for recovery tend to be very specific in their expectations. Three hypotheses for testing are put forward and implications for practice, research and policy discussed. [ABSTRACT FROM AUTHOR]

The health and well-being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US-focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at-risk sub-groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health. [ABSTRACT FROM AUTHOR]

The vulnerability of deafblind people is considered axiomatic; they are seen not only as a vulnerable group but also as one of the most vulnerable. This paper aims to synthesise existing knowledge to determine what is known about such vulnerability. A comprehensive literature search was undertaken between April 2013 and May 2014. The review method was informed by systematic review principles. An approach based on a 'hierarchy of evidence' would have reduced the amount of literature reviewed significantly, to the point where synthesis would not be possible. Included material was appraised and an interpretative rather than aggregative approach to synthesis adopted. Drawing on principles of critical interpretive synthesis, rather than being a determiner of whether material should be included or excluded, a critique of the literature is offered within the synthesis. Twenty-eight references were identified for inclusion, originating from the UK, USA, Australia, Continental Europe and the Nordic Countries. No empirical studies specifically examining the experience of vulnerability of deafblind people were found. However, deafblind people describe feelings of vulnerability in studies exploring their experiences more generally, and in personal accounts of living with the impairment. Literature produced by practitioners and specialist organisations also explores the topic. Deafblind people are identified as a population 'at risk' of various adverse outcomes, particularly when compared to the non-deafblind majority, and deafblind people describe being and feeling vulnerable in various situations. The literature largely relates to negative outcomes and includes significantly less exploration of positive risk taking, coping capacity and resilience. Deafblind people do not appear to describe themselves as being vulnerable as a permanent state, suggesting a need for greater exploration of the experience among all sections of this heterogeneous population, with consideration of the concepts of resilience and coping capacity. [ABSTRACT FROM AUTHOR]

Abstract: The results of a study examining differences between U.S. adolescent and adult abortion fund service recipients are presented in this paper. Using existing case data from 2010 to 2015 from the National Network of Abortion Funds (N = 3,288), a secondary data analysis was conducted to determine whether or not the experiences of adolescent (n = 481) and adult abortion patients (n = 2,807) who received financial assistance to help pay for an abortion differed. Fisher's exact tests examined differences in dichotomous variables, and regression examined differences in procedural costs, patient resources and expected travel distances to obtain an abortion. Results show that a greater proportion of adolescents in this data set identified as African American, and that adolescents were more likely to report seeking an abortion due to lack of contraception, and rape, while adult patients were more likely to be seeking an abortion due to contraceptive failure and partner violence. Results are discussed using a trauma‐informed framework. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores racial disparities and risk factors of adverse pregnancy outcomes in Black and White pregnant women in the US. The study uses a cross‐sectional approach to explore Black and White disparities using data from the 2012 National Survey on Drug Use and Health (NSDUH), which collects interview data from approximately 70,000 randomly selected participants. We included several self‐reported conditions that we categorised as individual and social stressors (e.g. measures of institutionalised racism, individual health behaviours, access to quality care and social context factors). We used descriptive statistics, univariate and multivariate analyses in risk factors of adverse pregnancy outcomes between Black and White women. Black women who were pregnant had a lower socioeconomic status and experienced more measures of institutionalised racism compared to White women who were pregnant. More white women who were pregnant were married, had higher levels of educational attainment, higher income levels, and greater employment opportunities. White pregnant women also had higher levels of private health insurance and less dependency on government programmes for access to healthcare. Results from the regressions indicated that Black pregnant women were less likely to be married (OR = 0.01), less likely to have higher income levels (OR = 0.31) and less likely to be employed (OR = 0.52). However, Black pregnant women were more likely to be younger (OR = 1.82). For the health‐eroding behaviours, Black pregnant women were less likely to smoke (OR = 0.53) and use alcohol (0.52). After assessing the SES Household‐level stressors (access to healthcare), Black pregnant women were more likely to have Medicaid/CHIP (OR = 3.21) and health coverage through government assistant programmes (OR = 3.80); however, less likely to have private health insurance (OR = 0.38). There are differences in risk factors of adverse pregnancy outcomes between White and Black pregnant women based on measures of individual level/social stressors, institutionalised racism, health behaviours and access to care. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]

This systematic review synthesises evidence on the perceptions and experiences of adult victims of domestic violence when accessing healthcare services. The review was concerned with disclosure of domestic violence by adult victims when accessing health services, the responses of healthcare professionals to these victims, victims’ perceived barriers to support, and the appropriateness of support and referrals. These aims required the review to focus on studies using in-depth qualitative methods to explore victims’ perceptions and experiences. A comprehensive systematic search of 12 databases was carried out in June/July 2005. Application of the review protocol and inclusion criteria resulted in 10 studies (conducted in the UK, USA and Australia) being considered eligible for the review. Data were extracted from these studies and a quality assessment completed. Thematic analysis was carried out to enable the identification of recurrent themes within the included studies. Findings indicate that victims of domestic violence experience difficulties when accessing healthcare services. Victims perceive that these difficulties can be attributed to inappropriate responses by healthcare professionals, discomfort with the healthcare environment, perceived barriers to disclosing domestic violence, and a lack of confidence in the outcomes of disclosure to a health professional. The methodological quality of included studies was variable, but no papers were rejected based on quality issues. These results can contribute to and inform a comprehensive assessment of the experiences of adult victims of domestic violence when accessing healthcare services. The health service is in a unique position to contribute towards the assessment and identification of domestic violence and to provide access to appropriate support. The messages of this study are important for policy-makers and practitioners. [ABSTRACT FROM AUTHOR]

Home-based family support programs provide early intervention to support families with young children. Home visiting models typically serve pregnant and parenting women with risk factors known to influence the caregiver-child relationship including history of trauma, low academic achievement, low income, limited support networks, maternal depression, and maternal substance use. Few, if any, home visiting models, however, were developed specifically to support families affected by maternal substance use. The Team for Infants Exposed to Substance use (TIES) Program is a home-based family support program exclusively serving families affected by maternal substance use. The model design and intensive services allow TIES participants to achieve significant positive outcomes in the program's six goal areas: maternal substance use, parenting skills, child mental and physical health, maternal mental and physical health, family income, and family housing. Goal scores are assessed jointly by participants and staff throughout the program using a validated scale. Program staff hypothesize that goal attainment in these areas may be influenced by the therapeutic relationship developed between home visitors and participants. This relationship is assessed using the Working Alliance Inventory (WAI), a validated assessment of therapeutic alliance administered to both participants and staff. An analysis of 127 program participants shows that when controlling for home visitor WAI scores in multilevel models (MLMs), goal attainment scores improved from intake to discharge across all goal areas except for housing stability. These results stress the importance of the therapeutic relationship in maximizing TIES participants' growth and success. [ABSTRACT FROM AUTHOR]

Refugee newcomers resettled in the United States face numerous challenges impacting their mental health and overall well-being. Despite extensive research on clinical interventions, multimodal interventions with peer-based group models in resettlement contexts remain scarce. Adopting a realist evaluation approach, this study aims to conduct a comprehensive implementation evaluation of a complex community-based mental health and psychosocial support (CB-MHPSS) group intervention, examining its mechanisms and processes while considering the interplay among context, implementing agents, and community settings. Qualitative and quantitative data on the implementation process were collected from 11 refugee agencies, involving trained resettlement staffers (n = 32) and refugee community facilitators (n = 31) who implemented the 31 CB-MHPSS psychosocial groups in 2021. The analysis included fidelity reports, process reflections, and follow-up survey responses, utilizing a structured template based on the CB-MHPSS Theory of Change (ToC) and Medical Research Council (MRC) guidance. Results of an in-depth exploration of complex relations between context and implementation processes reveal the vital role that adaptability to socio-ecological circumstances during the global coronavirus pandemic played in achieving successful implementation of psychosocial group interventions. Striking a balance between fidelity and refinement of intervention of the intervention curriculum emerged as crucial factors for aligning facilitation goals with newcomer needs. This approach maintained the integrity and appropriateness of the intervention, requiring implementers to utilize local knowledge of community resources and their understanding of lived experience of forced migrants and their within the community. Furthermore, exploring intervention barriers and facilitators revealed merits aligned with program change theories and areas for adjustment, while cataloged guidelines addressed community needs, showcasing competence beyond standard checkboxes. Strategic dissemination guidance provided by the central office in a supportive and nonintrusive manner facilitated uptake in a participatory and context-specific manner. This study emphasizes the importance of leveraging community partnerships and local knowledge to result in sustained improvements in the mental health and well-being of refugees. [ABSTRACT FROM AUTHOR]

The provision of human services associated with HIV and AIDS has been a controversial issue in Western countries, given the degree of stigma attached to AIDS, and the high level of public concern about the possibility of contracting HIV. Previous research on attitudes to controversial human services has identified some key characteristics associated with negative attitudes and resistant ‘not-in-my-backyard’ behaviour. Attitudes towards HIV- and AIDS-related services may be affected by other factors as well; in particular, they may be related to self-identified sexual orientation, given the role of HIV and AIDS in the emergence of a strong gay political identity. However, little research has yet been conducted to explore how knowledge and attitudes towards these services in particular localities are associated with a range of characteristics of local residents, including sensitive information such as sexual orientation and household HIV status, and how these might contribute to the creation of more accepting environments. This paper provides an analysis of a 1994 city-wide survey conducted in West Hollywood, California. This small city has a large and politically-organized gay and lesbian population, as well as significant numbers of residents in other, diverse social groupings, and has experienced high levels of HIV infection and AIDS relative to the surrounding Los Angeles County. Although issues of HIV and AIDS service provision have been well publicized in the city, residents may be expected to hold rather different sets of knowledge about and attitudes to these services, depending on their personal characteristics. Analysis of the survey data reveals that a large proportion of residents of West Hollywood rated HIV and AIDS services as very important, but there were interesting differences among groups. Most notably, variation in knowledge of services and attitudes to services (rating of importance) was particularly associated with age and l... [ABSTRACT FROM AUTHOR]

Many cities across the United States are experiencing homelessness at crisis levels, including rises in the number of unhoused emerging adults (18–25). Emerging adults experiencing homelessness may be at higher risk of experiencing negative outcomes, given that being unhoused increases risk for a variety of behaviors. To better understand the current living circumstances of emerging adults with a history of homelessness, as well as their perceptions about associations between housing stability and quality of life (QOL), we conducted 30 semistructured in-depth interviews with individuals recruited from drop-in centers for youth experiencing homelessness. At the time of recruitment, n = 19 were stably housed and n = 11 were unstably housed. Two coders analyzed these data inductively and deductively, using preidentified domains and open coding. Coding reliability was assessed. Three main themes emerged, each with subthemes: (1) housing quality (neighborhood safety, convenience, and housing unit characteristics); (2) QOL before stable housing (physical and mental wellbeing, social wellbeing, and other determinants of QOL, such as encounters with law enforcement); and (3) changes in QOL after stable housing (same subthemes as for prehousing stability QOL). Findings indicated a pattern of perceived relationships between housing stability, housing quality, built and social environments, and QOL in the context of emerging adults who experienced or continued to experience homelessness. However, results were mixed with regard to the perceived effects of housing stability on alcohol and other drug use. Taken together, results indicate several areas of challenge but also highlight opportunities to facilitate improvements in QOL among vulnerable emerging adults who experience homelessness. [ABSTRACT FROM AUTHOR]

Community violence, particularly gun violence, is a leading cause of morbidity and mortality in young people in the United States. Because persons experiencing violence‐related injuries are likely to receive medical care through emergency departments, hospitals are increasingly seen as primary locations for violence intervention services. Currently, there is little research on how best to implement hospital‐based violence intervention programs (HVIPs) across large hospital systems. This study explored the factors influencing the implementation of a multi‐site HVIP using qualitative interviews with a purposive sample of 20 multidisciplinary stakeholders. Thematic analysis was used to generate several themes that included: (1) reframing gun violence as a public health issue; (2) developing networks of community–hospital–university partners; (3) demonstrating effectiveness and community benefit; and (4) establishing patient engagement pathways. Effective implementation and sustainment of HVIPs requires robust and sustained multidisciplinary partnerships within and across hospital systems and the establishment of HVIPs as a standard of care. [ABSTRACT FROM AUTHOR]

In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; Mage = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = −0.014, 95% confidence interval: −0.041, −0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities. [ABSTRACT FROM AUTHOR]

Veterans in rural areas of the United States face barriers to accessing healthcare and other services, which are intensified for those experiencing housing instability. Recent legislative acts have the potential to address obstacles faced by rural patients in the U.S. This study explores how infrastructure—including features related to the physical and digital environment—impacts the ability of rural Veterans experiencing housing instability to access healthcare and related services from the perspective of homeless service providers within the Veterans Health Administration (VHA). We conducted semi‐structured telephone interviews (n = 22) with providers in high/low performing and/or resourced communities across the U.S. in May and June 2021 and analysed transcripts using template analysis. Themes described by providers highlight how infrastructure limitations in rural areas can exacerbate health disparities for Veterans experiencing housing instability, the impact of COVID‐19 on service access, and recommendations to enhance service delivery. Providers suggested that VHA reconfigure where and how staff work, identify additional resources for transportation and/or alternative transportation models, and increase Veterans' access to technology and broadband Internet. Federal infrastructure investments should address challenges faced by Veterans experiencing housing instability in rural areas and the concerns of providers connecting them with care. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) and food security are two leading public health issues that disproportionately impact women in the United States. Despite this connection, the relationship between IPV and food security has been relatively unexplored. While food security is a known factor in increased well‐being, it is not often explicitly included in care for survivors. As part of a larger study on survivors of domestic violence who are receiving services from a domestic violence and sexual assault agency in the Southern United States, we analysed participant responses (n = 26) to various scales (i.e. depression, anxiety, PTSD, disability, well‐being, hope, food security) to determine the relationships between mental health and food‐related variables. Importantly, findings from our study show that survivors experience low food security at higher rates (53.8%) than the U.S. national average (11.5%). Additionally, the proportion of survivors in our sample who are receiving some form of food aid and remain food insecure is high (26.9%), leading to questions about the adequacy of food aid. Finally, our results underpin the relationship between food security and mental health for survivors, as low food security is positively correlated with depression, PTSD, disability, trouble concentrating, lack of hope and decreased well‐being. These findings have implications for how we evaluate food security and the role it plays in well‐being for survivors. [ABSTRACT FROM AUTHOR]

Pregnant and parenting women living with HIV (WLWH) face high levels of psychological stress and mental illness but lack tailored and acceptable psychosocial treatments. The research team sought to inform the adaptation of a mindfulness intervention for pregnant and parenting WLWH through focus groups exploring psychosocial treatment needs and mindfulness intervention preferences. The research team conducted focus groups with pregnant and parenting WLWH (n = 16) and case managers (n = 6) recruited from a community‐based enhanced case management program. The research team utilised an iterative inductive approach to coding of the transcripts from these focus groups. Five themes emerged: stressors, signs of stress, coping, lack of access and acceptability of care, and motivation and trust in care engagement. These focus groups revealed a desire for a group intervention that could decrease isolation while protecting against involuntary disclosure of HIV status. Participants expressed openness to mindfulness skills for coping with stress. The focus group participants' preference for a non‐stigmatising group intervention supports the potential of a mindfulness‐based group intervention to reduce stress and improve the mental health of pregnant and parenting women living with HIV. [ABSTRACT FROM AUTHOR]

Collaboration between social workers (SW) and community health workers (CHW) plays an essential role in addressing health inequities in the United States (US). However, little is known about the current state of CHW/SW collaboration. The objectives of this review were to identify (a) the nature, goals and setting of CHWs and SW collaboration; (b) the patient outcomes utilised to measure intervention efficacy. The literature search was conducted in December 2020 using six databases. The inclusion criteria were (1) interventions that included CHWs and SWs; (2) US‐based; (3) published between 2000–2020; (4) peer‐reviewed journal articles; (5) examining health or mental health outcomes. Search results identified 281 articles, and 15 were included in the final analysis. Settings that utilised SW/CHW collaboration included outpatient clinics (n = 10); community organisations (n = 4) or hospital (n = 1). CHW and SW interventions focused on disease prevention (n = 8), chronic care (n = 4) and mental health (n = 3). Health outcomes were the most evaluated (n = 13), and significant improvement of at least one health outcome was reported in those studies. Mental health outcomes (n = 3) were also significantly improved, while social determinants of health (n = 2) were least common and descriptive only. This is the first review of SW and CHW collaboration. Clarity regarding SW and CHW roles and scopes of practice are needed to understand better SW/CHW collaboration and its impacts on community health outcomes and improve the process of collaboration. SW and CHW collaboration may increase clients' access to preventive care, mental health and address health inequities. [ABSTRACT FROM AUTHOR]

Spoken language interpreters play a critical role in bridging the linguistic and cultural gap between refugee newcomers and service providers in resettlement countries. Little is known about the positions interpreters assume in their work with refugee newcomers and the meaning‐making processes attached. Our study used constructivist grounded theory techniques and Situational Analysis to analyse interview transcripts and identify positions taken. We conducted in‐depth qualitative interviews with 12 professional interpreters working in the southeastern United States. Findings suggest interpreters break the mould of the dominant training paradigm—the black box interpretation model—to support the realities of their clients' needs. We conceptualised five prominent positions interpreters take—the conduit, the clarifier, the co‐clinician, the comforter, and the volunteer. Practice recommendations include incorporating identified positions into professional interpreter training and supervision agendas. [ABSTRACT FROM AUTHOR]

The Covid‐19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community‐based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health. [ABSTRACT FROM AUTHOR]

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state‐recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community‐based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life‐course interviews with participants of a state‐recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state‐recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs. [ABSTRACT FROM AUTHOR]

Using a qualitative phenomenological design, the objective of this study was to explore in‐depth how US‐born Latinos provide social support to their immigrant counterparts during a time of heightened anti‐immigrant rhetoric. A sample of 22 US‐born Latino adult was recruited in 2019 for qualitative interviews, following a period of intense immigration raids. Eligible participants were adults who reported experiencing an immigration‐related stressor and screened positive for a mental health concern or substance misuse. Open‐ended questions focused on topics of immigration and health. Using a thematic analysis approach, interview transcripts were coded to identify common themes within the domains of social support: instrumental; informational; emotional; and appraisal. We found that US‐born Latinos provide diverse forms of social support to immigrants with the intention of protecting them from immigration enforcement encounters (e.g. deportation), thereby safeguarding the livelihoods of their communities. US‐born Latinos are integral pillars of support and resiliency for immigrant communities, and the domains identified within this study suggest important implications for immigrant health. [ABSTRACT FROM AUTHOR]

Food insecurity and loneliness are shockingly large and growing problems in the older population in the U.S. and globally. Thus, the study's primary aim was to investigate the prevalence as well as the association between these two social determinants of health in the marginalised and often underserved population of older residents of urban subsidised housing (also referred to as social housing or affordable housing). Of particular interest was whether a greater sense of loneliness increases the risk of older residents being food insecure. The study uses survey data gathered through in‐person interviews conducted onsite in English or Spanish with 216 of the 300 older adults (72% response rate) living in a subsidised housing community in a central neighbourhood of a U.S. northeastern city. Amongst the 216 participants, 50% identified as Black and 45% identified as Latino. In addition to food insecurity and loneliness, the survey assessed participants' health, food access challenges, and sociodemographic characteristics. Results revealed a 34% food insecurity prevalence rate amongst the participants which is higher than the estimate of slightly less than 10% of the U.S. older population being food insecure. The participants' 34% loneliness rate was also higher than the 19%–29% prevalence range in U.S. older population studies. Bivariate analyses highlighted the interrelatedness or intertwining of food insecurity, loneliness, poor health and food access challenges whilst a series of logistic regressions further explored the significant association of loneliness with food insecurity. Loneliness increased the odds ratio of food insecurity in the binary (unadjusted) regression (p < 0.001, OR = 3.1) and the multivariate (adjusted) regression that included all covariates (p < 0.05, OR = 2.4). Overall, the findings underscore the need for greater awareness of loneliness as a public health threat as well as future research exploring how loneliness may intensify the health consequences of food insecurity in later life. [ABSTRACT FROM AUTHOR]

Despite steady increases in homelessness in the U.S., only recently has research on transportation needs and use for persons experiencing homelessness (PEH) been the focus of research endeavours. Moreover, limited research has identified how the geographic relocation of homeless community services and resources impacts the transportation needs of PEH and how this process affects access to health and social services. To fill this gap in the literature, using a community‐engaged research approach, we conducted a qualitative research study in which 24 professionals working in planning, transportation, local government, and the homelessness services sector were engaged in in‐depth, semi‐structured interviews. We examined participant perspectives on how PEH transportation needs and use changed after three new emergency shelters replaced a centralised one, and how access to health and social services was impacted. Data were organised into three overarching categories: (1) Changes in transportation need and use following decentralisation; (2) Impact of transportation changes on PEH access to services; and (3) Recommendations for improving transportation access. Findings suggest the need to offer PEH transportation on demand, provide education on transportation and system navigation, and increase transportation‐related funding for homeless service providers and PEH to ensure transportation costs are not a barrier to healthcare and social services. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the healthcare needs and experiences of women of refugee background in Chicago—home to one of the largest and most diverse refugee populations in the United States. We used a phenomenological study design with a desire‐centered rather than damage‐centered approach to conduct a series of focus group discussions with 24 women of refugee background in their native languages in Chicago, Illinois between December 2018 and February 2019. Convenience sampling was used to recruit women of refugee background at least 18 years of age living in the Chicago metropolitan area who attended educational women's health workshops at local refugee community centers. An inductive approach to the analysis was used to code transcripts and generate themes. Our study identified four major healthcare priorities for women of refugee background in a major metropolitan area: (1) central and centralised healthcare, (2) continuity of care, (3) trauma‐informed care and (4) community engagement and partnerships. The healthcare priorities identified by the participants in this study should inform existing and future healthcare models and clinics providing care for women of refugee background in urban and sub‐urban contexts across the United States. [ABSTRACT FROM AUTHOR]

Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality. [ABSTRACT FROM AUTHOR]

Access to housing is an important manifestation of structural racism and discrimination, and birth outcomes show wide health disparities, but few studies have examined eviction and birth outcomes. This multilevel study merged data from the Eviction Lab on 2015 eviction judgements and records with the National Center for Health Statistics natality dataset. The analytic sample included 2,950,965 births across 5924 counties in 45 states. Outcomes of interest were low birthweight (<2500 g; LBW) and preterm birth (<37 weeks gestation; PTB). We fit generalised estimating equations to account for clustering within county and a logistic distribution to estimate the odds ratio of LBW or PTB associated with the county‐level eviction rate, with control for individual‐ and county‐level characteristics. Results were calculated separately for non‐Hispanic white, non‐Hispanic black and Hispanic mothers. After adjustment for covariates, living in the counties in the highest quartile of eviction was associated with a 12–13% increased odds of LBW. The magnitude of association with PTB was not as large. Non‐Hispanic black women were more likely to live in counties in the highest quartile of eviction rate (43%, vs. 23% for white women and 23% for Hispanic women) or filing rate (44%, vs. 23% for white and 18% for Hispanic). The association between eviction rate and LBW/PTB was strongest for black women, while there was essentially no association among Hispanic women. Housing instability may be a key social determinant of poor birth outcomes and should be considered in state and local maternal and child health policy and programming. [ABSTRACT FROM AUTHOR]

Extensive studies have explored the factors affecting caregiving stress, but how oral health of care recipients (CRs) associates with caregiving stress and the mechanism behind it are not well‐known. Guided by Stress Process Theory, this study addressed such research gaps. Caregiver services dataset came from the 13th National Survey of Older Americans Act Participants in the United States (N = 1289). Caregiving stress included physical, emotional, and financial stress. The oral health of CRs was self‐rated by a single item. The functional ability of CRs was assessed by activities of daily living (ADLs) and instrumental activities of daily living (IADLs). PROCESS 3.4 for SPSS 26.0 was used to conduct the mediation analyses. Results from the study showed that caregivers reported slightly high levels of physical (M = 3.06, SD = 1.33, Range = 1–5), emotional (M = 3.43, SD = 1.28, Range = 1–5), and financial (M = 2.83, SD = 1.43, Range = 1–5) stress. The results from hierarchical linear regression revealed that poor oral health of CRs was significantly associated with higher levels of physical (B = 0.11, p < 0.001), emotional (B = 0.09, p < 0.01), and financial (B = 0.12, p < 0.001) stress, respectively. The functional ability of CRs mediated such relationships between the oral health of CRs and the caregiving stress of their family caregivers. Findings from this study enrich our theoretical and practical understanding of caregiving stress in aged care and offer programs and policy implications of oral and physical healthcare for community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Social work has been a part of the essential workforce historically and throughout the COVID‐19 pandemic, yet lack recognition. This work explores the experiences and invisibility of social workers within the pandemic response. Data are drawn from a large cross‐sectional survey of US‐based social worker from June to August of 2020. A summative content analysis of responses to the question 'What do you wish people knew about social work during the COVID‐19 pandemic' was undertaken. Participants (n = 515) were majority white (72.1%) and female (90.8%). Seven coding categories were subsequently collapsed into three domains: (1) meeting basic needs, (2) well‐being (emotional distress and dual role) and (3) professional invisibility (workplace equals, physical safety, professional invisibility and organisational invisibility). Meeting social needs requires broad‐based policies that strengthen the health and social safety net. Social workers have and will continue to play a critical role in the response, and recovery from COVID‐19. Organisational and governmental policies must expand to increase the visibility and responsiveness to the needs of social care providers. [ABSTRACT FROM AUTHOR]

Nearly 1 in every 14 youth have had a parent incarcerated at some point. In any given year, over 9 million adults from jail and 700,000 adults from prison return to their families and communities. However, few studies have explored the family experiences during re‐entry or have provided suggestions on how to best support children during this time. The goal of this qualitative study was to describe family experiences and provide their considerations on how to better support children during the period of parent's re‐entry. Qualitative data was gathered from 26 participants using semi‐structured, in‐depth phone interviews from March to August 2020. The sample included 10 youth (12–18 years) who have had a parent incarcerated, 10 custodial caregivers of youth who have had incarcerated parents, and 6 parents released from incarceration. Qualitative content analysis and open‐coding procedures were used to determine themes across raters. Experiences centred on the challenges of assimilating to new family roles upon the parent returning home and to the community. Families also shared the difficulty in navigating parole restrictions and managing fears surrounding the recidivism of the parent. Three primary themes were deduced as relationship‐building obstacles, unaligned family expectations and parole‐related family burdens. Results from this study revealed suggestions that may address youth, caregiver and returning parent's needs during the re‐entry phase. Family counselling and peer support groups may improve the process of mending or forming relationships. Access to re‐entry programs, mental health services, and parental education may better align family expectations. Transparent wrap‐around social services and decreasing legal challenges may reduce the parole‐related burdens on the family. [ABSTRACT FROM AUTHOR]

Social isolation has been associated with poor mental health outcomes, particularly for older immigrants who do not have a protective social environment. The purpose of this study was to investigate the relationship of social isolation (living alone, marginal family ties and marginal friend ties) with mental distress and to examine the moderating role of social cohesion (family cohesion and community cohesion). We hypothesised that social isolation and social cohesion would be directly associated with mental distress and that social cohesion would buffer the influence of social isolation on mental distress. Data were drawn from the Study of Older Korean Americans (SOKA), which included 2150 older Korean Americans aged 60 or over in multiple areas, collected during 2017–2018. A series of hierarchical regression models of mental distress examined the direct and interactive role of social isolation and social cohesion. Approximately one‐third of the sample lived alone, 20% had marginal family ties and 27% had marginal friend ties. All three indicators of social isolation had a significant direct effect on mental health; however, living alone lost its statistical significance with the inclusion of social cohesion variables. Both indicators of family and community cohesion were significantly associated with lower levels of mental distress. In addition, family cohesion buffered the negative effects of marginal ties to family and friends on mental distress. The significant role of a positive social environment must be considered when addressing the needs of older immigrants who are socially isolated. [ABSTRACT FROM AUTHOR]

Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment‐based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well‐being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full‐text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well‐being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co‐designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness. [ABSTRACT FROM AUTHOR]

Sexual minority people in the United States are less likely to have access to health services when compared to their heterosexual counterparts. Less is known about the within‐group sociodemographic memberships among sexual minority people regarding access to health services. Using data from a nationally representative sample, a series of univariate and bivariate analyses were used to determine associations between sociodemographic group membership and access to health services. Results suggest there are significant differences in access to health services within the sexual minority population. Differences in access to health services when considering sex‐at‐birth, sexual identity, age, race/ethnicity, urbanicity, education level and income status were found. These findings offer insight into the role sociodemographic group membership has on the equity of access to health services. Specifically, results indicated that disproportionate access to health services among sexual minority people were more pronounced among those with group membership who experience social marginalisation. This was particularly true for sexual minority people who were bisexual, younger, Black and Latinx, lower‐income earners and sexual minority people with less education attainment. Results from this study may be used to inform policies and practices aimed at improving access to health services including, but not limited to, the expansion of the Affordable Care Act and continued development of Federally Qualified Health Centers, while acknowledging the role of within‐group differences among sexual minority people. [ABSTRACT FROM AUTHOR]

As behavioural health occupations have diversified, more specialists such as social workers and counsellors are involved in providing substance use disorder treatment services. This study examined the association between changes in the number of different types of behavioural health professionals and changes in drug and opioid overdose deaths in the United States. Using publicly available state‐level data from 2008 to 2017, we constructed multivariate linear regression models with state‐ and year fixed‐effects to examine the effect of changes in the number of different types of behavioural health professionals (i.e. psychiatrists, psychologists, social workers and counsellors) on changes in drug and opioid overdose deaths at the state level, controlling for state population characteristics and other state‐level factors. After controlling for confounding factors, a 1% increase in the number of social workers and counsellors at the state level was significantly associated with a 0.215% reduction in drug overdose deaths per 100,000 state population and with a 0.358% reduction in opioid overdose deaths per 100,000 state population. We did not find statistically significant associations between changes in drug overdose death rates and increases in the number of psychiatrists or psychologists alone. Our findings suggest efforts to facilitate a prepared and skilled workforce, such as expanding the capacity of social workers and counsellors, to maximise access to substance use disorder treatment services. [ABSTRACT FROM AUTHOR]

Although volunteering has been shown to benefit cognitive health, there is a paucity of evidence on informal volunteering and subjective measures of cognitive impairment. Also, little is known about whether such relationships vary by race/ethnicity. This study aimed to examine the associations of both formal and informal volunteering with older adults' objective and subjective cognition and explore the moderating role of race/ethnicity in such associations. Using data from the Health and Retirement Study in the United States (2010–2016), 9941 older adults (51+) who were cognitively unimpaired in 2010 and alive through 2016 were included. Ordered logistic regression models were performed to assess the relationships among volunteering, cognitive impairment and race/ethnicity. Findings showed that more years of formal and informal volunteering significantly reduced the odds of objective cognitive impairment; neither volunteering type was significant for subjective cognitive impairment. The relationship between informal volunteering and objective cognition varied by race/ethnicity. Compared to non‐Hispanic Whites, non‐Hispanic Black older adults who engaged in more years of informal volunteering had a significantly higher odds of cognitive impairment over time. The current study is one of the first to look at the associations between informal volunteering and cognition. The inclusion of subjective cognitive impairment, paired with objective measures of cognition, also adds value to the knowledge body. Our findings indicate any type of volunteering is a viable approach to prevent cognitive impairment for older populations. However, more research is needed to better understand why racial/ethnic minority, particularly non‐Hispanic Black older adults, do not benefit from informal volunteering. [ABSTRACT FROM AUTHOR]

Every year tens of thousands of older Canadians travel to the southern United States (US) to live there seasonally during the winter months to enjoy a warmer climate—a practice known as international retirement migration. Several factors facilitate participation in this transnational mobility, including having the financial resources needed to live abroad. For those managing chronic or acute health conditions, traveling with a caregiver (typically a spouse) is another important facilitator. In this qualitative analysis, we explore the transnational systems of support that Canadian international retirement migrant spousal caregivers draw upon to enable them to provide care while in the US. We report on the findings of ten semi‐structured dyad interviews (n = 20 participants) conducted with Canadian international retirement migrants living seasonally in Yuma, Arizona. The dyads consisted of spouses, one of whom had defined care needs and the other of whom provided informal care. Through thematic analysis of these interviews, we identified three types of transnational support systems that spousal caregivers draw on: relational, community‐based and practical. While aspects of these support systems have been documented in other informal care‐giving studies, this analysis demonstrates their copresence in the transnational care‐giving context associated with international retirement migration. Overall, this analysis highlights the benefits of close social relations enjoyed by international retirement migrants providing informal care to mitigate the lack of access to their established support networks at home. [ABSTRACT FROM AUTHOR]

Health and well‐being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim‐driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well‐being. To address the gap of risk‐informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system's care coordination program through refined patient selection and customised engagement in intensive care coordination. A non‐randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N = 216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t‐tests were incorporated to evaluate statistical significance of the intervention group. Impact on well‐being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well‐being [feeling anxious (t = 4.051; p < 0.000)] and reduced SDOH barriers [food access (t = 4.662; p < 0.000); housing (t = 2.203; p = 0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well‐being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well‐being. [ABSTRACT FROM AUTHOR]

In 2020, healthcare workers faced the COVID‐19 pandemic amidst other salient sociopolitical stressors. This study, therefore, set out to examine associations between personal, work‐related and contextual factors and three outcomes – stress, burnout and turnover intention – at a critical juncture in the pandemic. In December 2020, we recruited a broad array of healthcare workers (n = 985) in a public safety net healthcare system serving socially and economically marginalised communities in the Southwest region of the United States using a cross‐sectional online survey. The results indicated that more health problems were associated with higher stress and burnout symptoms. While seeking emotional support and using drugs or alcohol to cope were associated with higher stress, a positive social outlook was associated with lower stress. Lower quality of work‐life was associated with higher burnout symptoms and turnover intention. Negative effects of the pandemic on wellbeing and higher number of COVID‐19‐related concerns were associated with higher stress and burnout symptoms. Contrary to the original hypotheses, self‐care was not associated with any of the three outcomes, and effects of the political climate and issues of racism on wellbeing were not associated with stress, burnout or turnover intention. However, identifying as a Person of Colour was associated with higher stress, as well as lower burnout. The findings on worker health, social outlook, quality of work‐life and race/ethnicity, in particular, suggest a critical need for healthcare systems to address the wellbeing of workers through equitable organisational policy and practice. [ABSTRACT FROM AUTHOR]

The removal of regulatory and reimbursement barriers during the COVID‐19 pandemic in the United States presented opportunities to explore the potential of telehealth to improve access to and use of healthcare among underserved populations. Therefore, we examined factors associated with accessibility and utilisation of telehealth among older adults during the COVID‐19 pandemic. We analysed the nationally representative Medicare Current Beneficiary Survey COVID‐19 Supplement File of community‐dwelling Medicare beneficiaries aged ≥65 years (n = 5,189), administered from 5 October 2020, through 15 November 2020. Two survey‐weighted multivariable logistic regression models were used to assess the association between factors (i.e., socio‐demographics, co‐morbidities and digital access/literacy) and whether (1) beneficiaries' regular providers offered telehealth during the COVID‐19 pandemic, and (2) those being offered telehealth used it. Furthermore, subgroup analyses by residing area and income status were conducted. Of study beneficiaries, 83.6% reported their regular providers offered telehealth during COVID‐19. Disparities in accessibility of telehealth by sociodemographic status were observed [e.g., those living in a non‐metro area (versus metro) were 7.1% (marginal effect [ME] = −7.1%; p < 0.01) less likely to report accessibility of telehealth]. Beneficiaries who had no access to internet (ME = −8.2%; p < 0.001) and had not participated in video/voice calls/conferencing prior (versus participated) (ME = −6.6%; p < 0.001) were less likely to report having access to telehealth. Among those being offered telehealth services, 43.0% reported using telehealth services. Hispanic and Non‐Hispanic Black beneficiaries (e.g., Black versus White; ME = 11.3%; p < 0.01) and those with co‐morbidities (versus 0–1 condition) (e.g., 2–3 co‐morbidities, ME = 7.3%; p < 0.01) were more likely to report using telehealth services when offered. Similar results were observed in the subgroup analyses regarding disparities in accessibility and utilisation of telehealth. The accessibility and utilisation of telehealth have increased amidst the pandemic; however, disparities in accessibility of telehealth were observed. A telehealth triage protocol is needed to ensure underserved patients continue to receive appropriate care. [ABSTRACT FROM AUTHOR]

International students in the US occupy a precarious position at the intersection of immigration policy and global education mobility, one made more challenging by the disparate impact of COVID‐19 on college students' mental health. Few studies, however, have explored the pandemic's effects on mental well‐being among the international student population in the US. Our study aims to provide initial empirical evidence on the mental health status of these students, with a specific focus on discrimination, loneliness, anxiety, and depression. We propose a mediation framework and estimate the mediating effects of loneliness and anxiety in the relationships between discrimination and depression in a sample of US‐based international students (N = 103). We collected cross‐sectional data from July to August 2020, using a 50‐item online survey instrument with three open‐ended questions. Mediation analyses using PROCESS Macro were used to analyse quantitative data and thematic analysis was used to analyse qualitative data. Findings showed that higher levels of discrimination were significantly associated with higher levels of loneliness. Higher levels of loneliness were significantly associated with higher levels of anxiety, which in turn led to high levels of depressive symptoms. Our study contributes to understanding the needs and capacities of international students in the wake of COVID‐19 and simultaneously provides pragmatic program and policy implications for inclusive higher education environments and the overall health and well‐being of this crucial US student population. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 – 15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well‐child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non‐Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five‐session home visitation program using the Problem‐Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self‐efficacy. Based on these results, a short‐term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms. [ABSTRACT FROM AUTHOR]

Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high‐tech and high‐touch service delivery option. Families can receive evidence‐based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well‐documented engagement barriers to digital health/computer‐mediated interventions exist across treatment modalities and technology platforms. Semi‐structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice‐based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth‐based home visitation. Findings include evidence that providers should be able to move between telehealth and on‐ground service provision with relative ease. [ABSTRACT FROM AUTHOR]

The purpose of this research was to examine patient characteristics that may be associated with appointment no‐show rates, and to explore patients' perspectives of missed appointments at a community health centre that primarily serves low‐income individuals. This mixed‐method, cross‐sectional study is based upon data collected from a community health centre in Southeastern Tennessee in the United States that provided preventative medical, behavioural health and dental care. Authors utilised de‐identified electronic health record (EHR) information on no‐show occurrence and sociodemographic characteristics of all patients served by the clinic (n = 1,243), as well as completed mixed method patient interviews a sub‐sample of those receiving service from the clinic (n = 30). EHR data were pulled from clinic visits occurring during July–November 2017, and patient interviews were completed January–March 2018. Measures were developed by the authors and clinic administrators after a thorough review of existing literature. HER data demonstrated an association between higher no‐show rate and younger patients was identified and Black or African American patients had higher no‐show rate than White patients. However, no differences in no‐show rate existed between male and female participants or when examining patients' location. Based on interview data, patients were generally satisfied with their services or providers, but some indicated dissatisfaction. Patients typically missed appointments due to personal issues and societal barriers. Findings support the need for clinics to consider ways to support patients facing competing demands for their time or those facing more resource constraints. Recommendations for research include examining long‐term health outcomes of clients who are experiencing no‐shows. Changes in practice or procedures were also noted, such as providing transportation, elevating awareness and access to social services, ensuring that that social care workers are reaching out to clients with higher no‐shows and educating clients on the importance of preventative care. [ABSTRACT FROM AUTHOR]

Non‐transport to a hospital after emergency medical services (EMS) encounters for falls is common. However, incident factors associated with non‐transport have not been well studied, especially beyond older adults. The objectives of this study are to (1) describe trends in fall‐related EMS utilisation among adult patients from 2010 to 2018; (2) describe incident characteristics by age; and (3) identify incident factors associated with non‐transport following a fall. This retrospective observational study includes prehospital clinical records data on falls from a large ambulance service in Minnesota, USA. Multivariable logistic regression was used to assess the independent association between non‐transport and the following factors: sex, age, race, previous fall‐related EMS encounter, incident location and primary impression. Of 62,835 fall‐related encounters studied, 14.7% (9,245) did not result in transport by EMS. Fall calls were less common among younger people and the location and medical conditions primarily treated by an EMS provider during a 9‐1‐1 call differed greatly from those occurring among patients 65 and older. Factors most strongly associated with an increased risk of non‐transport in the multivariable model were a primary impression of 'No apparent illness/injury' (OR = 34.5, 95% CI = 30.7–38.7), falling in a public location (OR = 2.09, CI = 1.96–2.22) and having had a fall‐related EMS encounter during the prior year (OR = 1.15, CI = 1.1–1.2). Falls that occur in public locations, in patients with a previous fall, or result in no clinical detection of apparent illness or injury have a significantly increased odds of non‐transport. Non‐transport fall incidents in the United States require significant agency resources. Knowledge about the incident factors associated with non‐transport calls is informative for development of alternative models for prehospital care delivery and initiatives to better serve patients. [ABSTRACT FROM AUTHOR]

Millions of people in the United States provide unpaid care to family and friends with long‐term illnesses and disabilities. Research shows that informal caregiving can be beneficial for recipients of care, but taxing for those providing care. Studies have not explored associations between informal caregiving and the risk of experiencing different forms of material hardship. In this study, we use data from the Survey of Income and Program Participation (N = 31,633) to address this gap in the literature. The sample was drawn from a multistage‐stratified sample of the civilian, non‐institutionalised population of the United States. We analyse data that were collected in 2011 and find that providing informal care to others is associated with an increased risk of experiencing healthcare hardship, bill‐paying hardship and food insecurity. Moreover, we find that household financial resources mediate the association between caregiving and material hardship. As a result, while caregiving households face a higher risk of experiencing material hardships at all income levels, the disparity is largest at low incomes and smallest at high incomes. The findings highlight the need for a stronger safety net for informal caregivers. [ABSTRACT FROM AUTHOR]

Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health‐promoting behaviours of healthy eating and physical activity among community‐dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post‐injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health‐promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi‐structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis. Participants included informal caregivers of individuals with SCI living in the community (n = 24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and (8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health‐promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self‐identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health‐promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested. [ABSTRACT FROM AUTHOR]

Attrition from clinical interventions targeting underserved populations is a substantive challenge to achieving optimal health outcomes. Our nationally recognised enriched medical home intervention (EMHI) utilised community health worker home visitation to improve health outcomes of children by engaging the entire family and removing barriers to care‐seeking. Families were enrolled into the program between 2013 and 2016, and, as part of the evaluation of the program's success, we identified predictors of program completion by conducting a secondary analysis of 304 families participating in the EMHI evaluation research. Program completers finished participation in the EMHI with mutual agreement that the family can independently follow recommended care. Program non‐completers were either lost to follow‐up or dropped out before reaching this milestone. Data were collected using electronic medical records and validated self‐report surveys to assess constructs such as social support, mental health difficulties and neighbourhood characteristics. The EMHI participants were primarily families with infants <24 months old, Medicaid‐insured and Latino. In the multivariable logistic regression model, EMHI program factors as well as community factors independently predicted program continuation and retention. Specifically, families learning about newborn care or with preferred spoken language Spanish were more likely to complete the program. Participants reporting neighbourhood distrust had a greater likelihood of non‐completion than others. Results underscore the importance of cultural competency and community involvement in program design and dissemination. Our findings are applicable to other home‐based interventions with the goal of supporting underserved families in following recommended clinical care. [ABSTRACT FROM AUTHOR]

Collaboration across sectors is needed to improve community health, but little is known about collaborative activities among public health prevention programs. Using the Nurse‐Family Partnership® (NFP) home visiting program as context, this qualitative study aimed to describe effective collaboration among nurse home visitors, healthcare providers and community support services to serve families experiencing social and economic adversities. We used grounded theory to characterise collaboration with six purposively sampled NFP sites in the United States through in‐depth interviews. We interviewed 73 participants between 2017 and 2019: 50 NFP staff, 18 healthcare providers and 5 other service providers. Interviews were recorded, transcribed, validated and analysed in NVivo 11. Validation steps included inter‐coder consistency checks and expert review. Thematic memos were synthesised across sites. Most participants perceived collaboration to be important when serving families with complex needs, but substantial variation existed in the degree to which NFP nurses collaborate with providers dependent on provider type and community context. Factors that contributed to effective collaboration were relational in nature, including leadership commitment and provider champions, shared perceptions of trust, respect and value, and referral partnerships and outreach; organisational in terms of mission congruence between providers; and structural such as policy and system integration that facilitated data sharing and communication channels. These findings provide greater insights into effective cross‐sector collaboration and care coordination for families experiencing adversities. Collaboration across sectors to promote health among families experiencing adversities requires intentional efforts by all inter‐professional providers and continued commitment among all levels of leadership to coordinate services. [ABSTRACT FROM AUTHOR]

One in four American women will experience a miscarriage, stillbirth or neonatal death each time she becomes pregnant. These perinatal losses occur even more frequently in women who are immigrants from developing countries. Care of Muslim families after perinatal loss is based primarily on expert opinion as opposed to research evidence, as few, if any, studies exist on this topic. It is critically important to know what parent's preferences for care actually are, since care that is incongruent with the desires of the bereaved parents may intensify their grief. The purpose of this study was to examine the perceptions and attitudes of immigrant Arab Muslims regarding psychosocial bereavement practices common in the United States after perinatal loss and to pilot test an investigator‐developed instrument for collecting data regarding culturally relevant psychosocial bereavement practices of immigrant Arab Muslims after perinatal loss. The study employed a cross‐sectional survey design using an investigator‐developed instrument entitled the Arab Muslim Perceptions of Perinatal Loss Care (AMPPLC). The AMPPLC, available in both English and Arabic, was used to collect data on perinatal loss care from a convenience sample of 79 immigrant Arab Muslim adults (male n = 43 [54.4%]; female n = 36 [45.6%]). The study opened in June 2017 and closed in August 2019. The AMPPLC instrument demonstrated good reliability (α = 0.89) in measuring participants' responses. Responses by survey participants did not always agree with prior published literature on Muslim preferences after a loss. Optimal care for Arab Muslim immigrants involves offering all options that are typically part of Western bereavement care as well as options that may be more specifically associated with Islam. This information will enable healthcare providers to provide more culturally sensitive and compassionate care to Middle Eastern Muslim parents during this difficult and tragic experience. [ABSTRACT FROM AUTHOR]

Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past‐3‐month abscess characteristics, treatment utilization, and barriers to medical treatment among N = 494 community‐recruited PWID. We used descriptive statistics to determine the frequencies of self‐treatment and medical treatment for their most recent past‐3‐month abscess as well as barriers to seeking medical treatment. We then used bivariate and multivariate logistic regression to identify factors associated with having an abscess in the past 3 months. Overall, 67% of participating PWID ever had an abscess and 23% had one in the past 3 months. Only 29% got medical treatment for their most recent abscess whereas 79% self‐treated. Methods for self‐treatment included pressing the pus out (81%), applying a hot compress (79%), and applying hydrogen peroxide (67%). Most (91%) self‐treated abscesses healed without further intervention. Barriers to medical treatment included long wait times (56%), being afraid to go (49%), and not wanting to be identified as a PWID (46%). Factors associated independently with having an abscess in the past 3 months were injecting purposely into muscle tissue (adjusted odds ratio [AOR] = 2.64), having difficulty finding a vein (AOR = 2.08), and sharing injection preparation equipment (AOR = 1.74). Our findings emphasize the importance of expanding community‐based access to SSTI education and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking resources. [ABSTRACT FROM AUTHOR]