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Purpose: In this paper, we present an exploratory, qualitative strand of a multiphase program evaluation of the Canadian-based SNAP® Youth Justice (SNAP YJ) model for males involved with the youth criminal justice system. SNAP YJ's therapeutic approach is founded on the evidence-based SNAP (Stop Now And Plan) model which focuses on strategies to enhance emotion regulation, self-control, and problem-solving for latency-aged children and their families. Integrating best practices from the literature, the SNAP YJ intervention uses technology (digital modules) to convey the manualized strategies and program sessions, engaging youth in an interactive manner. This systemic, cognitive behavioral intervention is designed to reduce further contact with the law and/or gang affiliation. The objectives of this study are to understand youth experiences of programing, enrich and contextualize preliminary outcome findings, and further develop programing through the inclusion of the youth perspective and feedback. Methods: A thematic analysis of 15 interviews with program participants from diverse backgrounds was conducted. Results: The results revealed a continuum of learning related to self-understanding and awareness of feelings; thinking and consequences; and prosocial skills and behavior. Discussion: Refinements to the program to target increased program effectiveness as a result of youth experiences are discussed. [ABSTRACT FROM AUTHOR]

Prenatal depression affects approximately 10% to 15% of women. Guidelines recommend supporting women to make informed treatment decisions; however, minimal evidence exists regarding this decision-making process. This study aimed to develop a constructivist grounded theory of prenatal antidepressant treatment decision-making. Semi-structured interviews were conducted with purposively sampled women from the community or specialty clinics (N = 31). Iterative data collection and analysis, theoretical sampling, and member checking supported model sufficiency. In the Creating Comfort in Choice theory that we developed, participants were highly conscious of societal stigma toward mental illness and prenatal medication use, so fear, anxiety, and guilt dominated decision-making. Participants navigated dynamically among three clusters of decision-making activities: seeking information, making sense of information, and self-soothing. "Seeking information" included internal and external processes. In "making sense of information," participants appraised available evidence. In "self-soothing," participants engaged in coping strategies to try to alleviate painful emotions. The Creating Comfort in Choice theory can support patient-oriented decision-making regarding prenatal mental healthcare. [ABSTRACT FROM AUTHOR]

Although the historical impact of racial segregation and ongoing health and economic inequities between older Black and White adults is well documented, little is known about the relationships among race, individual- and neighborhood-resources, and formal volunteering in later life. This study explores this intersection. Individual-level data from 268 respondents aged 55+ were collected in the St. Louis metropolitan area through paper-based mail surveys. Objective neighborhood data were obtained at the zip code level from secondary sources and matched with respondents. Using exploratory factor analysis, we constructed a 14-item environmental scale with 3 neighborhood dimensions (economic, social, and built environment). Older Black adults had lower levels of education; had fewer financial assets; lived in neighborhoods with less economic resources and lower built environment scores; and fewer formally volunteered when compared to older White adults. Individual resources (financial assets, health) and neighborhood resources (social and built environment) were positively associated with formal volunteering among older Black adults. Only individual resources (age, marital status, financial assets, health) were associated with formal volunteering among older White adults. A coherent set of policies that bolsters individual and environmental capacities may increase the rate of volunteerism among older black adults. [ABSTRACT FROM AUTHOR]

This interpretive research study explores U.S. adults' lived experiences during the beginning months of the COVID-19 global pandemic. Participants (N= 44), recruited from a convenience sample of U.S. adults, engaged in in-depth semi-structured interviews or focus groups. Through an iterative analysis of participants' experiences and the theoretical model of communal coping (TMCC), the authors identified three convergent stressors (i.e., isolation, uncertainty, conflict) and several coping strategies related to participants' stressor appraisal (i.e., individual or joint) and action orientation (i.e., individual or joint). Based on these findings, this study offers the novel theoretical concept of Discursive coping and proposes a model for how this perspective might be integrated with current theorizing about individual and communal coping. Implications for communal coping and discursive theory are discussed as well as practical recommendations for public health messaging. [ABSTRACT FROM AUTHOR]

In times of shrinking resources and fragmented societies, partnership is a value-driven social structure that should be theorized in order to be considered for implementation, effectively and sustainably. Recognizing the scarce theoretical perspectives on partnership, this article addresses the lack of an integrated universal model. It delineates the theoretical field through extensive literature review, reaffirming the critical gap in knowledge. Original qualitative research utilized an international case-study of a social partnership, and a historic investigation since its inception three decades ago. A Grounded Theory Methodology guided the systemic analysis of the empirical data, culminating in a proposed universal partnership model. The study finds mutuality to be the heart of a partnership and a differentiating criterion from other social structures. Three pillars that are grounded in mutuality sustain a partnership, and include a common ground, connection, and commitment. Further research is needed to test the proposed model on other diverse partnerships. [ABSTRACT FROM AUTHOR]

Measuring hope reliably and accurately remains an important research objective, not least in less prosperous settings where 'holding on to hope' may be critically important in the struggle against adverse life conditions. The State Hope Scale was designed for use in the US. Despite reported application in diverse cultures and using translations the scale has not been extensively validated outside US populations. This study contributes to a larger project exploring the measurement of hope and provides a critique of Snyder's scale as used in a Tanzanian female population of 1021 urban microfinance participants. We evaluate the scale's validity through assessment of the empirical distribution of scores, item response profiles, internal consistency and discriminatory ability. Participants mostly scored very high and many reached very near the maximum attainable score. Hardly any endorsed the negative half of the response scale. Several problems are discussed including poor discrimination and strong evidence of acquiescence response bias. We also found little association of the scale scores with hypothesised correlates of hope. Future improvements on the measurement of hope are recommended, especially in studies outside the narrow Western context in which the scale was devised. [ABSTRACT FROM AUTHOR]

Background: Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated. Objective: The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice. Method: A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making. Findings: An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core. Conclusion: Study findings advance our understanding of ethical decision-making in day-to-day clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to understand the factors that determine whether an adult who is eligible for cochlear implantation (CI) choose to take up or not take up the implant. Design: We conducted a qualitative in-depth interview study, informed by grounded theory methods of constant comparison to build a theory to describe why and how people decide to opt for CI or not. Study sample: Our samples were patients from an audiology service in England. Results: Our results describe the key factors in weighing up risks and benefits. These are influenced by living context and support, information and social identity. We identify the key features that impact decision making for adults eligible for cochlear implants. The importance of the patient lifeworld view is discussed. Conclusions: This qualitative study provides the first in depth examination of how and why patients do and do not take up the offer of cochlear implants. It highlights the complex and iterative nature of this decision making and the individualised risks that trade off benefits of implantation. [ABSTRACT FROM AUTHOR]

Background and Objectives: There is still no clear portrayal of women's empowerment in managing menopause. The present study was conducted to design a model for the empowerment of Iranian women in managing menopause. Materials and Methods: This qualitative study was conducted using the grounded theory on 40-60-year-old women who were first selected through purposive sampling and then by theoretical sampling from November 2013 to July 2016. Data were collected using 33 in-depth, semi-structured, individual interviews with 30 participants. Data were analyzed using the Strauss and Corbin(2008) approach and organized in MAXQDA-10. Results: The analysis of the data led to the emergence of "active coping with menopause" as the core variable with four themes. The two themes "threat to feminine identity" and "latent opportunity" explained the context of the study, and "redefining the feminine identity" and "self-retrieval" explained its process. Conclusion: In our social context, the phenomenon of menopause is a coin with two sides and its experience leans more on the threat to feminine identity and less on latent opportunity. The model of postmenopausal women's empowerment for managing menopause might offer health policy-makers a realistic and divergent understanding of the challenges of empowering women by explaining key concepts. [ABSTRACT FROM AUTHOR]

This study drew on appraisal theory to examine how fear appeal messages and individual coping styles combined to drive users' intention to click (ITC) health risk messages on social media. A 2 × 2 × 2 mixed-design experiment was conducted, with threat and efficacy as between subject factors and message as the within subject factor. The results suggested that: (1) threat and efficacy message influenced ITC via the mediating effect of perceived threat, and perceived efficacy; (2) fear arousal was positively related to intention to click; (3) blunting style used by the participant suppressed fear arousal's ability to mobilize ITC; and (4) monitoring style had a positive main effect on ITC. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Tanzania has made strides to end gender discrimination and sexual exploitation, yet, studies have found that these practices continue. One distinct form of exploitation is transactional sex. Girls agree to sex – often with older men known as "sugar-daddies" – in exchange for basic needs like breakfast or soap, something that other researchers have written about it with concern. Herein, I provide an overview of the published research and then discuss my research on this issue, based on interviews with women and participant observation with girls in a remote part of Tanzania. My intention was to discover if and how girls are taken advantage of, discriminated against, or solicited for sex in and around schools. Transactional sex, a practice sometimes encouraged by family members, emerged as a pertinent theme. Ultimately, I focus on strategies for prevention using Bronfenbrenner's ecological model to consider interventions at multiple levels of these girls' lives. [ABSTRACT FROM AUTHOR]

Self-directed care (SDC) is a service delivery model in which individuals diagnosed with a severe and persistent mental illness (SPMI) direct their behavioral healthcare by managing an individual budget and purchasing the goods and services they deem most helpful in meeting their needs and supporting their recovery. Participants may purchase conventional mental health services as well as alternative goods (e.g., books, clothing) and services (e.g., fitness classes) to support their recovery. Several quantitative studies have examined the types of purchases commonly made by SDC participants. This qualitative study builds on this research by reporting findings from interviews with 18 SDC participants on the factors that influence their purchasing decisions, the benefits derived from SDC purchases, and perceived barriers experienced in making desired purchases. Findings reveal the extent to which money matters in mental health recovery and suggest that individualized budgeting and purchasing contribute to SDC participants' mental wellness and stability, enhance their control over service choices, and, most notably, provide some material relief in ongoing struggles with chronic poverty. Findings also highlight the importance of flexible spending guidelines and streamlined approval processes; overly proscriptive policies may undermine participants' self-determination. Additional implications for SDC practice, policy, and research are discussed. [ABSTRACT FROM AUTHOR]

The objectives of this study were (1) to describe home health care (HHC) nurses’ perception of and care processes related to geriatric depression and frailty, and (2) to identify barriers to care delivery for older persons with these two conditions. Ten semi-structured interviews were conducted with HHC nurses, and 16 HHC nursing visits to 16 older patients (≥65 years) were observed. Mixed method analysis showed that HHC nurses did not routinely assess for frailty and depression. Major barriers to care delivery included insufficient training, documentation burden, limited reimbursement, and high caseload. Addressing these barriers would facilitate HHC nursing care for frail, depressed elders. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this case report is to explore the active engagement model as a tool to illuminate the ethical reflections of student physical therapists in the context of service learning in a developing country.Methods: The study participants were a convenience sample of six students. The study design is a case report using a phenomenological perspective. Data were collected from students’ narrative writing and semi-structured interviews. The steps of the active engagement model provided the structural framework for student responses. The analysis process included open coding, selective coding, and member checking.Results: Results showed the emergence of two main themes: 1) gathering rich detail and 2) developing independent moral identity. Students’ descriptions of their relationships were detailed and included explanations about the complexities of the sociocultural context. Independent and deliberate agency was evident by the students’ preparedness to be collaborative, to raise ethical questions, to identify ethically important aspects of their practice and to describe their professional roles. The students noted that the use of the model increased their engagement in the ethical decision-making process and their recognition of ethical questions.Conclusions: This case report illustrates attributes of the active engagement model which have implications for teaching ethical reflection: scaffolding for ethical reflection, use of narrative for reflection, reflection in action, and illumination of relevant themes. Each of these attributes leads to the development of meaningful ethical reflection. The attributes of this model shown by this case report have potential applications to teaching ethical reflection. [ABSTRACT FROM PUBLISHER]

Patient organizations (POs) represent patient collectives in health care policy. The inclusion of people with a ‘neuro-psychiatric’ condition poses a particular challenge for the organizational processes and political representation of such collectives. In recent years, new POs (POs of) have been established in the field of autism spectrum disorder and dementia that advocate a different agenda and have a different organizational structure than traditional POs (POs for). The divide between these two types of POs indicates a different standpoint with regard to who should be included on an organizational level, which voices are accepted and who should represent these voices on the political level. The inclusion and exclusion of voices needs to be normatively justified in order to be regarded legitimate representation of such a collective. With the help of Miranda Fricker's theory of epistemic injustice, we scrutinize whether and, if so, which types of epistemic injustices (wrongdoings to a person as a knower) can be found within POs' practices and the political field in which they operate, by analyzing 37 interviews with PO representatives, their members and policy makers. Our in-depth analysis indicates that persistent stereotypes hamper the inclusion of affected members both within POs and on the health political level. Being affected causes distrust in having the ‘capacity to know' in a two-fold way; it is assumed that those who can represent themselves are “not affected enough” to present valuable insights into the condition and those who have difficulties to express themselves due to their condition are excluded because of their affectedness. We conclude that our analysis of the epistemic practices of POs serves as a good starting point to address these shortcomings from a theoretical and practical perspective and offers a valuable starting point for bioethics to understand unjust structures in the health political context. [ABSTRACT FROM PUBLISHER]

Communication campaigns often include components that have been designed for a specific population, a strategy referred to as targeting. Targeted narratives are story-based components of a campaign that feature a character or situation relevant to the intended audience. Though commonplace, few studies have explicated the underlying mechanisms by which targeted narratives exert influence. In a message evaluation study, 316 women aged 40–75 (Mage = 51.19,SD = 8.11) were exposed to one of two targeted narratives and asked to complete measures of model admiration, narrative memorability, and intentions to receive a mammography. Targeting was based upon affiliation with the Mormon church. The results revealed that the relationship between the targeted narratives and screening intentions was especially strong for women from the target population who admired the depicted models and found the stories memorable. [ABSTRACT FROM PUBLISHER]

Objectives: To introduce a psychological model of behaviour; the COM-B model and describe how this has been used in combination with the behaviour change wheel (BCW) in developing an intervention which aims to promote regular, long-term use of hearing aids by adults with acquired hearing loss. Design: Qualitative structured interview study using the COM-B model to identify the determinants of behavioural planning on the part of audiologists; a potentially important factor in encouraging long-term hearing-aid use. Study sample: Ten audiologists drawn from a random sample of five English audiology departments. Results: The analysis suggests that behavioural planning might be more likely to occur if audiologists’ psychological capability, physical and social opportunity, and reflective and automatic motivation were addressed. This analysis forms the basis of an intervention design, using the BCW, to encourage behavioural planning by audiologists and subsequent hearing-aid use by people with hearing loss. Conclusions: The COM-B model and BCW can be applied successfully in the context of audiology to analyse the behaviour of both people with hearing loss and professionals working with them, supplying information that is being used in intervention design. The effectiveness of the intervention will be tested in a clinical trial. [ABSTRACT FROM AUTHOR]

The article analyzes home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement, and also mentions quality improvement challenges including lack of time and resources, staff apprehension, resistance from consumers and families.

Objective: Perception of need is a key factor that influences decisions to seek help and complete treatment for substance use and mental health problems. In the current study, we examine patterns of perceived treatment needs among women with co-occurring substance use disorders and posttraumatic stress disorder (PTSD) and explore how these patterns are associated with demographics, psychosocial variables, and treatment-related factors. Methods: Secondary data analysis of the Women and Trauma Study from the National Institute on Drug Abuse's Clinical Trial Network was conducted. The sample included 353 women with co-occurring substance use disorders and PTSD (full or subthreshold) receiving outpatient substance abuse treatment. Latent class analysis was used to examine patterns of perceived treatment need and multinomial logistic regression was used to identify characteristics associated with these patterns. Results: The sample included women between the ages of 18 and 65 (mean = 39.2, SD = 9.3) and was 46% White, 34% African American, and 21% other races/ethnicities. A three-class model representing unique perceptions of treatment needs demonstrated the best fit (Bayesian information criterion = 2101.43; entropy = 0.76; average posterior probabilities ≤ 0.82). Class one reported elevated needs in multiple areas (38%), class two reported low needs (23%), and class three reported substance use and psychological needs (40%). Living with a substance abuser, depression symptoms, recent substance use, and treatment coercion were significantly associated with membership in class 2 (OR =.28,.84,.22, and 2.32, respectively). Other race, being married, depression symptoms, recent substance use, and criminal justice involvement were associated with membership in class 3 (OR = 2.32, 2.32,.94,.42, and 1.69, respectively). Number of treatment sessions attended was not significantly associated with class membership. Conclusions: Results provide insight into how women with co-occurring PTSD and substance use disorders view their treatment needs. While some women reported high levels of self-identified need in other areas (e.g., physical health, employment/financial support, and family or social relationships), others did not identify as having any problems (including substance use or psychological problems). Level of severity and temporal aspects of problems may be significant factors that influence women's perceived need for treatment. This clinical trial is registered at www.clinicaltrials.gov as trial #NCT00078156. [ABSTRACT FROM AUTHOR]

Using an ecological model, the individual-, school-, and sociocultural-level characteristics that affect gay–straight alliance (GSA) advisors were examined in the current study. The formation of GSAs has been one way that schools have sought to improve the school climate for lesbian, gay, bisexual, and transgender (LGBT) youth. Limited information is available about the demographics and experiences of GSA advisors who lead these clubs. GSA advisors are on the front line of LGBT advocacy in schools. The purpose of this study is to add to the minimal literature on GSA advisors by describing the demographics and the experiences of the largest known sample of GSA advisors in the research literature. In the current study, 262 GSA advisors provided information through a 67-item survey about their demographic characteristics and their experiences advocating for LGBT youth in schools. The results suggested this sample of advisors was a demographically homogenous group. Exploratory factor analysis identified two dimensions (i.e., barriers, facilitators) by which the advisors appeared to define their experiences when advocating for LGBT youth. These two factors accounted for 47.98% of the variance in the advisors' experiences. Limitations and future research directions are discussed. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate whether parents’ level of expectations would change after manipulating their perceived barriers to visiting doctors without any expectations for antibiotic prescriptions and their perceived benefits of using antibiotics. A prospective experimental study was conducted using a data-collection instrument to manipulate perceived barriers and perceived benefits using four scenarios. Scenarios were developed with the help of pediatricians and by conducting an elicitation survey among parents. Each subject viewed four scenarios. Parents’ expectations to receive an antibiotic prescription associated with each scenario were measured on a scale of 0 (no expectation) to 100 (high expectation); a 100 mm visual-analog scale was used. Data were collected at public places (Houston, Texas, USA) from subjects who had at least one child (age ≤ 5 years) during the study. Descriptive and repeated measures mixed method analyses were performed using SAS v. 9.3 with a .05 significance level. Three hundred surveys were analyzed. The mean age of the sample was 30.3 ± 7 years. The mean general expectation score (before reading any scenario) to receive an antibiotic prescription for children was 53.6 ± 25.7. The repeated measure mixed methods analysis indicated that there was a 12-point reduction (p< .0001) in the expectation score after removing perceived barriers from the situational scenarios, a 16-point decrease (p< .0001) in expectation score was observed after removing perceived benefits, and an 18-point decrease (p< .0001) in expectation score was observed after removing both perceived barriers and perceived benefits. [ABSTRACT FROM PUBLISHER]

Divorce has long been described as one of the most stressful life experiences. A review of the literature identified numerous studies that have identified detrimental effects of parental divorce on children and adolescents and few that have emphasized possible optimal implications or effective coping with this event. The focus of this study subsequently fell on how young adults had coped with the divorce of their parents during their childhood or adolescent years. Semistructured retrospective interviews were conducted with 15 participants selected by means of snowball sampling in the completion of this study. Findings revealed a set of themes and subthemes relating to adults’ coping with parental divorce during childhood or adolescence as well as a set of factors that could potentially hinder such coping. Effective communication in relationships was highlighted as a particularly valuable coping method. It is hoped that these insights will enable those involved with assisting families during divorce to cope more effectively with this event. [ABSTRACT FROM PUBLISHER]

This study explored the needs of children with developmental coordination disorder (DCD) from an ecosystemic viewpoint as part of a theory-driven program evaluation process. A multiple case study needs assessment was conducted. Participants included ten children with DCD, their parents ( n = 12), teachers ( n = 9), and service providers ( n = 6). Data collection involved semi-structured interviews, validated questionnaires, and a review of the children's records. The results support the relevance of using an ecosystemic model to assess the needs of children with DCD in their life and social contexts. More specifically, the results highlight the need to provide additional services at school, such as occupational therapy and special education, as well as information and training regarding DCD for parents and teachers. The results also point to the relevant variables to consider in an intervention program based on theory-driven evaluations. This study shows how employing an ecosystemic frame of reference provides a better understanding of the needs of children with DCD. Future research should document the ecosystemic profiles and evolution of the needs of children with DCD with a larger sample from diverse socioeconomic backgrounds using a longitudinal study design. [ABSTRACT FROM AUTHOR]

In India, while female sex workers (FSWs) are one of the groups most susceptible to HIV/AIDS transmission, research and interventions typically sidestep FSWs’ stories. The authors use interviews with 20 FSWs to reflect a more recent trend of research that encourages FSWs to tell their stories. Based on the findings that suggest both individual and structural factors influencing women's involvement in sex work, the authors suggest a theoretical framework for designing more comprehensive and culturally grounded intervention strategies targeting this population. [ABSTRACT FROM AUTHOR]

The objective of this research was to explore the context of abortion stigma in Ghana and Zambia through qualitative research, and develop a quantitative instrument to measure stigmatizing attitudes and beliefs about abortion. Ultimately, we aimed to develop a scale to measure abortion stigma at the individual and community level that can also be used in the evaluation of stigma reduction interventions. Focus group discussions were conducted in both countries to provide information around attitudes and beliefs about abortion. A 57-item instrument was created from these data, pre-tested, and then administered to 531 individuals (n = 250 in Ghana and n = 281 in Zambia). Exploratory factor analyses were conducted on 33 of the original 57 items to identify a statistically and conceptually relevant scale. Items with factor loadings >0.39 were retained. All analyses were completed using Stata IC/11.2. Exploratory factor analysis resulted in a three-factor solution that explained 53% of the variance in an 18-item instrument. The three identified subscales are: (i) negative stereotypes (eight items), (ii) discrimination and exclusion (seven items), and (iii) potential contagion (three items). Coefficient alphas of 0.85, 0.80, and 0.80 for the three subscales, and 0.90 for the full 18-item instrument provide evidence of internal consistency reliability. Our Stigmatizing Attitudes, Beliefs, and Actions scale captures three important dimensions of abortion stigma: negative stereotypes about men and women who are associated with abortion, discrimination/exclusion of women who have abortions, and fear of contagion as a result of coming in contact with a woman who has had an abortion. The development of this scale provides a validated tool for measuring stigmatizing attitudes and beliefs about abortion in Ghana and Zambia. Additionally, the scale has the potential to be applicable in other country settings. It represents an important contribution to the fields of reproductive health, abortion, and stigma. [ABSTRACT FROM AUTHOR]

Research suggests that African Americans are disproportionately likely to have their spiritual needs ignored in hospitals. To help address this disparity, the present study developed and tested a model for addressing the spiritual needs of hospitalized African Americans. Structural equation modeling was used with a sample of older African American inpatients (N= 2,217) consecutively discharged over a 12-month period from hospitals from four geographic regions. As hypothesized, addressing spiritual needs had a positive effect on overall satisfaction with service provision. The relationship between spiritual needs and satisfaction was fully mediated by five variables: nursing, the discharge process, physicians, visitors, and room quality. [ABSTRACT FROM PUBLISHER]