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With notable and growing exceptions, there is a dearth of research on mechanisms by which youth in foster care build resilience and achieve positive outcomes. We report on data from an interview study with young adults exiting or recently exited foster care in Maryland (N=15) designed to understand what facilitates their engagement with courts. Our findings indicate that despite challenges of ?being in foster care?, youth found ways to pursue their goals and make their voices heard through developing stable relationships with supportive adults (including judges, caseworkers, or lawyers) and demanding that child welfare professionals ?speak to me not at me.? Youth indicated that their needs, capabilities, and goals changed as they matured and as their circumstances changed. Such changes helped them find their voices but also created tensions within their child welfare system interactions. This led us to develop the theory of adaptive responsivity, according to which child welfare stakeholders should respond appropriately to developmental and circumstantial changes to help child-welfare involved youth face difficult circumstances and thrive. Such responses include providing developmentally and situationally appropriate information and decision-making power to youth in their own cases as well as opportunities to weigh in on systems change. [ABSTRACT FROM AUTHOR]

Objective: Statin treatment compliance and achieving target levels differ between populations. This study aimed to determine the status of achieving the lipid targets and evaluate patients' compliance to statin treatment in type 2 diabetic patients with dyslipidemia. Method: This cross-sectional study included type 2 diabetes mellitus (T2DM) patients with dyslipidemia who applied for treatment at our polyclinics. Statin compliance was evaluated using the Modified Morisky Adherence Scale (MMAS-8) through a face-to-face interview. Cardiovascular (CV) risk was calculated according to the 2019 ESC (European Society of Cardiology) criteria by evaluating the patients' individual risk factors. LDL targets were determined according to risk categories with the same criteria. Results: A total of 504 patients (F/M: 274/230) were included. The serum LDL levels were 102.6 ± 39.2 mg/dL. Of the patients, 56.1% were under statin treatment. CV risk was very high in 73.6% of patients. LDL levels were significantly lower in users than in non-users (91.2 ± 26.0, 117.3 ± 38.4, p < 0.0001). The rate of reaching the LDL target was 14.8% in statin users. Treatment compliance was low for 40.6% of statin users. Discontinuation of statin treatment due to side effects was 15.7% (n = 14). N = 49 patients willingly discontinued statin treatment. They reported that 40.8% considered the treatment unnecessary. Conclusion: It was observed that 56.1% of type 2 diabetic patients were on statin therapy. A small percentage of them 14.8% (n = 42) reached the LDL target. Statin non-compliance and a lack of awareness of the statin treatment are the main reasons for high LDL levels in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

Background: Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using modern medical technology (sociotechnical system) in a cost-effective manner. Ensuring perioperative patient safety is of particular importance. At the same time, the efficient use of the central operating room is essential for the economic success of a hospital. Preoperative preparation is a complex process with many substeps that are often difficult to manage. Historically, the focus has been on retrospective learning from errors and incidents. More recent approaches take a systemic view. A central idea is to consider the mostly positive course of treatment and the adjustments to daily work that are currently required by the people involved (Safety-II). By taking greater account of how the many components of the system interact, processes can be better understood and specific measures derived. This strengthens the system's ability to adapt to changes and disturbances, thus ensuring that goals are achieved. The functional resonance analysis method (FRAM) is an internationally recognized method for modelling work as done compared to work as imagined. This paper presents the application of FRAM to preoperative preparation in a major regional hospital. Objective: Is FRAM suitable for improving process understanding in preoperative preparation? Material and methods: An interdisciplinary project team identified relevant functions of preoperative preparation through document analysis and walkthroughs. Based on this, more than 30 guided interviews were conducted with functionaries. The results were presented graphically and specific information, such as safety-related statements or reasons for the variability of functions, were also presented textually. In the next phase, statements were evaluated and compared with the target model and the job descriptions. Results: The FRAM revealed the process as a complex network of relationships. During the modelling process, a varying degree of centrality and variability of certain functions became apparent. From the observations, the project team selected those with high relevance for patient safety and for the efficiency of the overall process in order to prioritize starting points for deriving measures to increase resilience. These starting points relate either to single functions, such as surgical site marking or to multiple functions that are variable in their execution, such as delays due to nonsynchronized duty times. Conclusion: The FRAM conducted provides valuable new insights into the functioning of complex sociotechnical systems that go far beyond classical linear methods. The awareness of operational processes gained and the resulting dynamic view of interactions within the system enable specific measures to be derived that promote resilient behavior and reduce critical variability, thus contributing to increased patient safety and efficiency. [ABSTRACT FROM AUTHOR]

Religion and spirituality are powerful social forces in contemporary South Africa. Traditional Health Practitioners (THPs) are commonly consulted for both spiritual and medical ailments as a first line of care. Many studies have assessed African traditional health seeking behaviors but few have examined beliefs, practices, and behaviors of THPs themselves. This study sought to explore spiritual worldviews among South African THPs. Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data were managed using NVivo 12 software and thematically analyzed. The majority of THPs interviewed indicated that initiation as a THP was almost always preceded by a sickness accompanied by dreams/visions that represented an "ancestral calling" to become a healer. Most THPs also trained as both sangomas—who healed according to traditional beliefs—and prophets—who healed according to Christian beliefs. This reflects a syncretic relationship between traditional African beliefs and Christianity. However, not all churches are accepting of traditional beliefs and subsequently these THPs are members only at non-Pentecostal AIC churches who blend both African and Christian practices. Similar to these forms of religious pluralism melding Christianity and traditional beliefs, many THPs also often practice medical pluralism, mixing Western treatments with traditional practices/medicines. THPs are able to adapt elements of Western and African beliefs into healing practices that span multiple religious and medical fields. Thus, collaborative and decentralized healthcare services may be highly acceptable among such a pluralistic community. [ABSTRACT FROM AUTHOR]

Using a mixed-method approach, this present study examined the roles of calling and the relation between life goals and spiritual values among early childhood professionals in New Zealand. Among the 102 participants who completed the surveys, 24 participated in the follow-up individual interviews. In line with previous research, results showed that the five spiritual values—conformity, universalism, tradition, benevolence, and security—positively correlated with at least three intrinsic life goals, but showed a negative correlation with at least three of the four extrinsic goals. In addition, all non-spiritual values—self-direction, stimulation, hedonism, achievement, and power—correlated negatively with at least three of the intrinsic life goals. A similar pattern was found between the correlation between all non-spiritual values and extrinsic life goals. Interview data showed that participants who self-identified as having experienced a call to work with young children actively engaged with their calling. They also affirmed that their calling was experienced at a deeply personal and emotional level. Participants also recognized the important impact of life goals, personal and spiritual values on their work. This paper concludes with implications for future research and practice. [ABSTRACT FROM AUTHOR]

OnTrackNY provides early intervention services to young people with early psychosis throughout New York State. This report describes the impact of the COVID-19 pandemic on community participation of OnTrackNY program participants and their families. Thirteen participants and nine family members participated in five focus groups and three individual semi-structured interviews. Data were analyzed using a summary template and matrix analysis approach. Major themes highlight the negative impacts of the pandemic with reports of decreased socializing or using online means to connect, unemployment, challenges with online learning and a decrease in civic engagement. Positive impacts include more time to deepen connections with family and valued friendships and engage in activities that promote wellness and goal attainment. Implications for coordinated specialty care programs include adapting services to promote mainstream community integration and creating new strategies for community involvement of young people within a new context brought forth by the pandemic. [ABSTRACT FROM AUTHOR]

Background: Cerebral palsy (CP) is one of the most common childhood disabilities, impacting many areas of a child's life. Increasingly, quality of life (QOL) measures are used to capture holistic wellbeing of children with CP. However most validated QOL measures for children are based on adult perspective only, with limited focus on child perspective. Conceptual differences between children's and adults' definitions of QOL may reflect different underlying QOL models which contribute to measurement score divergence. This qualitative study investigated the conceptual meaning of QOL for children with CP, comparing child and parent perspectives. Eighteen families completed 8 child interviews and 18 parent interviews. Children (11 boys, 7 girls) represented the spectrum of motor functioning, with comorbidities including epilepsy, intellectual disability, and communication impairments. Child and parent interviews were analysed separately using constructivist grounded theory methods and then findings were integrated to examine similarities and differences. Results: All participants sought child inclusion in social activities, education, and recreation, requiring negotiation, adaptations, and advocacy. Five conceptual categories emerged from child interviews: socialising, play, negotiating limitations, self-identity, and developing agency. This reflected an individual model of QOL supporting child development goals. Parent interview findings revealed concepts related to child-specific QOL (day-to-day functioning and enabling child goals), as well as parent and family functioning concepts aligned to models of "family QOL", embracing impacts of family relationships and the interdependence of QOL among family members. Conclusions: This study identified similarities and differences in child and parent perceptions of QOL for the child with CP. Children provided insights into the importance of play and peer support, and their developing self-identity and sense of agency. Self-directed free play, especially, was identified by children but not parents as a central everyday activity promoting wellbeing and social inclusion. Parents discussed family functioning and aspects outside of child sight, such as managing time and financial resources. Relying on parents' perspective alone to model child QOL misses valuable information that children contribute. Equally, child report alone misses parent experiences that directly influence child QOL. There is value in incorporating family QOL into parent reports while developing a conceptually separate child self-report QOL instrument. [ABSTRACT FROM AUTHOR]

The importance of parents in the transmission of educational aspirations to children is well-established. However, little is known about the quality of parent-child communication about educational aspirations and how this communication relates to children's educational aspirations in socioeconomically disadvantaged families in rural China. In this study, we sought to gain insight into parent-child communication around educational aspirations from the perspective of Chinese rural adolescents. Twenty-three grade-9 students were recruited from middle schools in Songzi, a poor rural county in central China. Participants comprised 12 boys and 11 girls aged 14 to 16 years (M = 14.65 years, SD = 0.59). Students completed one-to-one qualitative interviews about parent-child communication and their educational aspirations in June 2020. Thematic analysis revealed that adolescents' educational aspirations were strongly influenced by their parents' beliefs and aspirations for them, with fulfilling parental aspirations and achieving economic success being important influences on rural adolescents' educational aspirations. However, parent-child communication quality was undermined when parents had an authoritarian communication style and when parents were absent due to rural-urban migration, in which case adolescents reported stress and perceived lack of support in achieving their goals. In addition, mothers were viewed as playing a more vital role in communication than fathers. The implications of the findings for school and community-based interventions promoting rural parents' ability to communicate effectively with their children about academic concerns are discussed. Highlights: This is the first qualitative study to explore parent-child communication around educational aspirations in Chinese rural families. Adolescents identified fulfilling parental aspirations and achieving economic success as the main influences on their aspirations. An authoritarian parenting style and/or parental absence were related to poor quality parent-child communication. Most rural adolescents reported being stressed and lacking support in achieving their educational goals. Caregivers with an authoritarian style need support to improve their communication skills to positively motivate rural youth. [ABSTRACT FROM AUTHOR]

Background: Goal Attainment Scaling (GAS) is an outcome measure that reflects the perspectives and experiences of patients, consistent with patient-centred care approaches and with the aims of patient-reported outcome measures (PROMs). GAS has been used in a variety of clinical settings, including in geriatric care, but research on its feasibility in primary care practice has been limited. The time required to complete GAS is a barrier to its use by busy primary care clinicians. In this study, we explored the feasibility of lay interviewers completing GAS with older primary care patients. Methods: Older adults were recruited from participants of a larger study in five primary care clinics in Alberta and Ontario, Canada. GAS guides were developed based on semi-structured telephone interviews completed by a non-clinician lay interviewer; goals were reviewed in a follow-up interview after six months. Results: Goal-setting interviews were conducted with 41 participants. GAS follow-up guides could be developed for 40 patients (mean of two goals/patient); follow-up interviews were completed with 29 patients. Mobility-focused goals were the most common goal areas identified. Conclusions: Study results suggest that it is feasible for lay interviewers to conduct GAS over the telephone with older primary care patients. This study yielded an inventory of patient goal areas that could be used as a starting point for future goal-setting interviews in primary care. Recommendations are made for use of GAS and for future research in the primary care context. [ABSTRACT FROM AUTHOR]

Purpose: State Title V programs collaborate with diverse partners to improve maternal and child health. Since 2014, the National Maternal and Child Health Workforce Development Center has trained Title V leaders in facilitating system change. This article describes aspects of initial collaborative readiness differentiating state and jurisdiction teams that later reported meeting their goals to greater or lesser degrees. Description: We used quantitative data from initial team leader reports to characterize readiness to collaborate with external partners, and their responses twelve months later to a prompt about how fully they had accomplished their goals. In addition, we coded excerpts from team leader accounts six and twelve months into their work with the Center, and retrospective coach perspectives, to identify collaborative readiness patterns. Assessment: Teams whose leaders reported higher goal accomplishment twelve months after beginning work with the Center had initially reported higher levels of collaboration with key partners. Our analyses suggest that such teams were also better able to use their cohort experience with the Center to improve collaboration, including information sharing with external stakeholders. Challenges working with Medicaid were reported both by teams with more and less goal accomplishment. Conclusions: Title V teams with lower levels of initial collaborative readiness may benefit from additional support in skill development, connections to key partners, and convening power. Given the crucial and increasing role of Medicaid in maternal and child health systems, more attention may be warranted to supporting all Title V programs in partnering with this funder. Significance: What is already known on this subject?: Prior research has identified the ability to convene diverse stakeholders as key to achieving partnership synergies, and in turn improved community outcomes. What this study adds: State and territorial Title V programs may achieve greater synergies with external partners by initially assessing and strategically enhancing collaborative readiness. Training and technical assistance providers might enhance partnership synergies through focused assistance to states with lower initial levels of external collaboration. Title V leaders may improve outcomes by leveraging their strongest collaborations to foster relationships with additional stakeholders. Title V programs in general could benefit from support cultivating relationships with Medicaid. [ABSTRACT FROM AUTHOR]

Background: The impact of physical activity interventions for Latina women can be enhanced by identifying and implementing strategies to achieve long-term physical activity maintenance. Physical activity promotion research has mainly focused on physical activity initiation and we know little regarding individual, interpersonal, or environmental factors that influence maintenance of physical activity. This study aimed to qualitatively explore and understand factors associated with maintenance and non-maintenance of physical activity among Latinas. Methods: Semi-structured individual interviews were conducted with 21 Latinas who increased their physical activity as a result of an intervention, and who completed a 3-month maintenance period without contact from research staff. Data were analyzed using thematic analysis. Results: Important facilitators of physical activity maintenance described by participants included having made physical activity a habit; the ability to proactively overcome obstacles to engaging in physical activity, and satisfaction with outcomes obtained from engaging in physical activity. Additional facilitators mentioned by both maintainers and non-maintainers included having motivation, social support, and opportunities to be active. Both maintainers and non-maintainers reported high self-efficacy for PA maintenance in the future. Conclusions: Guiding intervention participants to form habits and to set realistic expectations could help them to independently continue engaging in physical activity upon completion of physical activity interventions. Teaching them skills to proactively overcome obstacles may also be important for physical activity maintenance. [ABSTRACT FROM AUTHOR]

Background: Assess the feasibility of using goal attainment scaling (GAS) in care planning for older adults with complex needs. GAS is an individualized approach to goal setting and follow up using a quantified scale. To date, little is known about the feasibility of GAS among this population. Methods: We conducted a qualitative study with a sample of 28 older adults and 23 providers from diverse settings to evaluate the value and challenges of this approach. We conducted semi-structured interviews and iteratively coded and analyzed interview transcripts for themes related to value, challenges, and implementation. Results: Most older adults and providers reported that the GAS approach added value to the care encounter. GAS supported collaboration and patient accountability for their goals, though it could be demotivating to some patients. Some older adults and providers noted that GAS could be confusing and that it was uncomfortable to talk about negative outcomes (i.e., the − 2 and − 1 boxes of the scale). Factors that facilitated implementation included using visual copies of the GAS forms, having an established patient-provider relationship, practicing the approach, and having previous goal-related clinical training. Conclusions: GAS was feasible to implement across diverse settings, and, despite challenges, both older adults and providers reported that it added value to care planning encounters with the potential to improve delivery of person-centered care. Further efforts to demonstrate the applicability and benefit of this method for older adults are warranted, particularly to address implementation of the approach. [ABSTRACT FROM AUTHOR]

Israel is one of the few countries worldwide with a national policy and defined standards of palliative care (PC); its culture is highly diverse and more traditionally oriented in comparison with Western countries. This study describes the current state of PC in Israel through examination of: (1) its current status, self-image and structural factors; (2) its relation to cultural and political characteristics; and (3) the chances, goals and obstacles of advancing PC in Israel. Face-to-face interviews were conducted at all five public medical faculties in Israel from November 2017 to February 2018. The following findings are reported: (1) definition of palliative care, (2) multidisciplinary approach, (3) special role of nurses, (4) personal perceptions of death, (5) understanding the role of medicine, (6) specialty palliative medicine, (7) religious, spiritual and cultural aspects, (8) political and economic aspects, (9) obstacles and weaknesses, and (10) prospects and goals of palliative care. Participants perceive PC as an integrative healthcare service that should be available to all patients, including children and their families, at any stage of illness. They internalize that PC principles apply regardless of ethnic, cultural, and religious background. Utilizing nurses' leadership, enhancing multidisciplinary teamwork, and person-centered approach, supports better PC to more people. [ABSTRACT FROM AUTHOR]

Background: As life expectancy of people with Down syndrome (DS) increases, so does the risk of Alzheimer's disease (AD). Identifying symptoms and tracking disease progression is especially challenging whenever levels of function vary before the onset of dementia. Goal Attainment Scaling (GAS), an individualized patient-reported outcome, can aid in monitoring disease progression and treatment effectiveness in adults with DS. Here, with clinical input, a validated dementia symptom menu was revised to facilitate GAS in adults living with Down Syndrome-associated Alzheimer's disease (DS-AD). Methods: Four clinicians with expertise in DS-AD and ten caregivers of adults living with DS-AD participated in semi-structured interviews to review the menu. Each participant reviewed 9–15 goal areas to assess their clarity and comprehensiveness. Responses were systematically and independently coded by two researchers as 'clear', 'modify', 'remove' or 'new'. Caregivers were encouraged to suggest additional items and recommend changes to clarify items. Results: Median caregiver age was 65 years (range 54–77). Most were female (9/10) with ≥15 years of education (10/10). Adults with DS-AD had a median age of 58 years (range 52–61) and either a formal diagnosis (6/10) or clinical suspicion (4/10) of dementia. The initial symptom menu consisted of 67 symptoms each with 2–12 descriptors (589 total). The clinicians' adaptation yielded 58 symptoms each with 4–17 descriptors (580 total). Of these 580 descriptors, caregivers identified 37 (6%) as unclear; these were reworded, and one goal area (4 descriptors) was removed. A further 47 descriptors and one goal area were added to include caregiver-identified concepts. The final menu contained 58 goal areas, each with 7–17 descriptors (623 total). Conclusions: A comprehensive symptom menu for adults living with DS-AD was developed to facilitate GAS. Incorporating expert clinician opinion and input from caregivers of adults with DS-AD identified meaningful items that incorporate patient/caregiver perspectives. [ABSTRACT FROM AUTHOR]

Background: The SENATOR trial intervention included the provision of computer-generated medication recommendations to physician prescribers caring for hospitalised older adults (≥ 65 years), with the aim of reducing in-hospital adverse drug reactions. Interim data analysis during the trial revealed that the prescriber implementation rates of the computer-generated STOPP/START recommendations were lower than expected across all six trial sites. Aim: The aim of this qualitative study was to identify the factors affecting prescriber implementation of the medication recommendations in the SENATOR trial. Methods: Semi-structured interviews were conducted with trial researchers and physician prescribers who were provided with SENATOR recommendations. Content analysis was used to identify the most relevant domains from the Theoretical Domains Framework (TDF) that affected recommendation uptake. Results: Ten trial researchers and fourteen prescribers were interviewed across the six trial sites. Eight TDF domains were found to be most relevant in affecting prescriber implementation: 'environmental context and resources', 'goals', 'intentions', 'knowledge', 'beliefs about consequences', 'memory, attention and decision processes', 'social/professional role and identity', and 'social influences'. Interviewees felt that there was often a disconnect between the time prescribers were reviewing the patient and the point at which the recommendations were provided. However, when recommendations were reviewed, prescriber inertia was highly pervasive, with a particular reluctance to make pharmacotherapy changes outside their own specialty. Implementation was facilitated by recommendations reaching a 'decision-maker', but this was often not possible as the software could not evaluate the entire clinical context of patients, and thus frequently produced recommendations of low clinical relevance. Conclusion: This study has demonstrated that the clinical relevance of the SENATOR prescribing recommendations was a significant factor affecting their implementation. Whilst software refinement will be necessary to improve the quality of recommendations, future interventions will need to be multifaceted to overcome the complex prescriber specialty culture within the acute hospital environment. [ABSTRACT FROM AUTHOR]

Objectives: The socialization goals of immigrant parents in the United States for their children reflect the childrearing priorities of both their culture of origin and the mainstream culture. These goals, which guide parenting, likely have shared and unique characteristics with other immigrant groups from the same geographical region of origin. The current study aimed to explore and compare the socialization goals of Chinese and Korean immigrant mothers in the United States; the role of child gender in mothers' socialization goals was also investigated. Methods: Ninety-six Chinese (Mage = 37.60) and 97 Korean immigrant mothers (Mage = 35.87) with preschool-age children living in the United States were interviewed regarding their socialization goals. The qualitative interview transcripts were coded by trained research assistants. Results: The interviews revealed seven socialization goals (Self-maximization, Lovingness, Personal Integrity, Proper Demeanor, Religious Values, Self-control, and No High Expectations) across both groups. Findings demonstrated that Chinese and Korean immigrant mothers were similar on their endorsement of five socialization goals. However, group differences were found for goals of Religious Values and No High Expectations, which further differed across child gender. Conclusions: These findings highlighted the common socialization priorities of Chinese and Korean immigrant mothers of young children in urban contexts, but also the need to examine sub-ethnic groups separately to understand their shared and unique parenting experiences. These findings have meaningful implications for clinicians and other professionals towards providing more effective services to Asian immigrant families in the U.S. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to explore how momentary parenting goals vary by discipline episode-related factors, including type of child noncompliance, mothers' attributions, maternal negative affect, episode duration, and disciplinary practices used. Methods: This is a study of 105 mothers and their 17- to 31-month-old toddlers. Most mothers were interviewed first at the university laboratory and then by phone as soon as possible thereafter. They reported details of four turn-by-turn discipline episodes with their toddlers and then described their momentary parenting goals, attributions, and negative affect for each episode. Results: Whether parenting goals were child- or parent-centered or were short- or long-term was rarely consistent across all four episodes and changed within 26% of the episodes. Changes in goals were more likely during long episodes, in response to whining or tantrums, when mothers were upset emotionally, and when they reported a combination of both dispositional and situational attributions during the episode. Mothers' dispositional attributions predicted child-centered and long-term goals. Those goals, in turn, predicted increased use of reasoning and less use of physical power assertion and giving in. Child-centered goals also predicted less use of bribes/rewards and ignoring. Maternal negative affect was unrelated to momentary goal types. Hitting and passive noncompliance were marginally associated with child-centered and long-term goals. Conclusions: The results in this exploratory study provide initial evidence about some antecedents and consequences of momentary parenting goals, which often change across and within discipline episodes with toddlers. [ABSTRACT FROM AUTHOR]

Introduction: Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030. Methods: This study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016. Results: In NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38; 95% confidence interval [CI] 1.20–9.55), followed by women who had no education (AOR 1.87; 95% CI 1.62–2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76; CI 95% 1.17–2.59), household air pollution (AOR 1.37; CI 95% 1.59–1.62), belonging to a poorest quintile (AOR 1.37; CI 95% 1.21–1.54), residing in a rural area (AOR 1.28; CI 95% 1.13–1.44), and having no toilet at home (AOR 1.21; CI 95% 1.06–1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067. Conclusions: Although neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families. [ABSTRACT FROM AUTHOR]

Research is critical for developing HIV and tuberculosis (TB) programming for U.S. African-born communities, and depends on successful recruitment of African-born people. From January 2014 to June 2016, we recruited African-born people for HIV and TB research in King County, Washington. We compared the characteristics of study participants and the underlying populations of interest, and assessed recruitment strategies. Target enrollment for the HIV study was 167 participants; 51 participants (31%) were enrolled. Target enrollment for the TB study was 218 participants; 38 (17%) were successfully recruited. Of 249 prior TB patients we attempted to contact by phone, we reached 72 (33%). Multiple recruitment strategies were employed with variable impact. Study participants differed from the underlying populations in terms of gender, country of origin and language. Inequities in research participation and in meaningful opportunities for such participation may exacerbate existing health disparities. [ABSTRACT FROM AUTHOR]

Background: Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement.Objective: In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths' participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n = 16).Method: A semi-structured focus group with service providers (n = 7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two).Results: Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program.Conclusions: This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs. [ABSTRACT FROM AUTHOR]

Accessing an autism diagnosis is a key milestone, both for an individual and their family. Using a qualitative methodology, the current study examined the views and experiences of ten autistic adults, ten parents of children on the autism spectrum, and ten professionals involved in autism diagnosis, all based in the United Kingdom (UK). Interviewing these 30 respondents about the diagnostic process and subsequent support options, the goal was to identify aspects of the diagnostic process that are working well, and areas in which improvements are needed. Using thematic analysis, three key themes were identified: the process of understanding and accepting autism; multiple barriers to satisfaction with the diagnostic process; and inadequate post-diagnostic support provision. [ABSTRACT FROM AUTHOR]

The main goal of the present study is to compare male offenders and non-offenders in terms of how they attribute meaning to life and set life goals. The samples were chosen from among offenders (n = 50) and non-offenders (n = 50) who were between ages 19-26. Mixed method was used in this study. The scale of setting life goals and interview form were used to collect data. To analysis of the data, the content analysis technique and t test and were used. Findings of the present study show that offenders tend to have troubles setting life goals when compared to non-offenders. Furthermore, the results of this study could be used in rehabilitating offenders and preventing those at risk of committing criminal acts from doing so. [ABSTRACT FROM AUTHOR]

Sleep-related infant deaths continue to be a major, largely preventable cause of infant mortality, especially in Georgia. The Georgia Department of Public Health (DPH), as part of a multi-pronged safe infant sleep campaign, implemented a hospital initiative to (1) provide accurate safe infant sleep information to hospital personnel; (2) support hospitals in implementing and modeling safe sleep practices; and (3) provide guidance on addressing caregiver safe sleep concerns. A process evaluation was conducted to determine progress toward four goals set out by DPH: (1) all birthing hospitals have a safe infant sleep policy; (2) all safe infant sleep policies reference the AAP 2011 recommendations; (3) all safe infant sleep policies specify the type and/or content of patient safe sleep education; and (4) all hospitals require regular staff training on safe sleep recommendations. Data were collected via structured interviews and document review of crib audit data and safe sleep policies. All 79 birthing hospitals in the state participated in the statewide campaign. Prior to the initiative, 44.3% of hospitals had a safe sleep policy in place; currently, 87.3% have a policy in place. The majority (91.4%) of hospitals have provided safe sleep training to their staff at this time. Important lessons include: (1) Engagement is vital to success; (2) A comprehensive implementation guide is critical; (3) Piloting the program provides opportunities for refinement; (4) Ongoing support addresses barriers; and (5) Senior leadership facilitates success. [ABSTRACT FROM AUTHOR]

Introduction Under the CHIPRA Quality Demonstration Grant Program, CMS awarded $100 million through 10 grants that 18 state Medicaid agencies implemented between 2010 and 2015. The program’s legislatively-mandated purpose was to evaluate promising ideas for improving the quality of children’s health care provided through Medicaid and CHIP. As part of the program’s multifaceted evaluation, this study examined the extent to which states sustained key program activities after the demonstration ended. Methods We identified 115 potentially sustainable elements within states’ CHIPRA demonstrations and analyzed data from grantee reports and key informant interviews to assess sustainment outcomes and key influential factors. We also assessed sustainment of the projects’ intellectual capital. Results 56% of potentially sustainable elements were sustained. Sustainment varied by topic area: Elements related to quality measure reporting and practice facilitation were more likely to be sustained than others, such as parent advisors. Broad contextual factors, the state’s Medicaid environment, implementation partners’ resources, and characteristics of the demonstration itself all shaped sustainment outcomes. Discussion Assessing sustainment of key elements of states’ CHIPRA quality demonstration projects provides insight into the fates of the “promising ideas” that the grant program was designed to examine. As a result of the federal government’s investment in this grant program, many demonstration states are in a strong position to extend and spread specific strategies for improving the quality of care for children in Medicaid and CHIP. Our findings provide insights for policymakers and providers working to improve the quality of health care for low income children. [ABSTRACT FROM AUTHOR]

This study investigated the achievement goals and motivations of California Community College CalWORKs students in an effort to better support student success and persistence. This study was guided by three research questions: (1) What type of achievement goals do CalWORKs students enter with? (2) What are their rationales for these types of achievement goals? (3) How malleable are these achievement goals? Interviews with 48 participants focused on better understanding the relationship between achievement goal type and motivation changes while in college. Findings indicate that CalWORKs students enter college with a range of goal types, but for many changes in goal type led to more intrinsic motivation and ultimately persistence toward graduation and career goals. Findings from this study also reveal that experiences highlighting students' ability to be competent as learners while balancing other roles helped catalyze change in achievement goal type and/or rationale. The results of this study emphasize that CalWORKs students' achievement goals are malleable, and particular college experiences can facilitate students' movement toward more academically focused goals. More specifically, placing more focus on additional student support programs that can foster peer networking, faculty interactions, and additional career exploration opportunities can lead to change in academic persistence. [ABSTRACT FROM AUTHOR]

It has been well identified and supported in the literature that values and life goals are associated with one's general well-being. However, there have been few studies on values and life goals among international students in New Zealand. This study addressed this lack of research by focusing on the life goals and personal values among international students in three tertiary institutes in New Zealand. Based on the literature review, the hypothesis of this study is that international students' intrinsic life goals are positively correlated with their spiritual values. In contrast, extrinsic goals did not have similar effects. The Aspirations Index, which was used to assess life goals, and the Schwartz' value survey, which measured the students' personal values, were both distributed to the participants. Follow-up interviews with 24 of the participants were also conducted. Findings revealed that spiritual values were positively correlated with intrinsic goals and that extrinsic goals did not have similar effects. As the research findings showed that spiritual values were positively correlated with intrinsic goals, helping international students to find meaning and purpose in life may promote their well-being, and the learning and growth of international students can be improved by incorporating spiritual values and cultural aspects in college education. The authors also argue that a holistic approach to college education for international students is needed. [ABSTRACT FROM AUTHOR]

An intervention has social validity to the extent that it is socially acceptable to participants and stakeholders. This pilot convergent mixed methods study evaluated parents' perceptions of the social validity of the Early Start Denver Model (ESDM), a naturalistic behavioral intervention for children with autism. It focused on whether the parents viewed (a) the ESDM goals as appropriate for their children, (b) the intervention procedures as acceptable and appropriate, and (c) whether changes in their children's behavior was practically significant. Parents of four children who participated in the ESDM completed the TARF-R questionnaire and participated in a semi-structured interview. Both data sets indicated that parents rated their experiences with the ESDM positively and rated it as socially-valid. The findings indicated that what was implemented in the intervention is complemented by how it was implemented and by whom. [ABSTRACT FROM AUTHOR]

Every parent-to-be has wishes for his or her child's future. These wishes might influence parent-child interactions and children's outcomes, yet little is known about the content of these wishes. The purpose of this mixed-methods investigation was to: (a) examine the different types of prenatal wishes that parents have for their first-born child using qualitative methods; and (b) explore whether parents' wishes vary as a function of their gender and/or the gender of the child they are expecting, using quantitative methods. Participant interviews ( n = 126 couples) from a longitudinal investigation that began in 1992 were used and qualitative analysis of mothers' transcripts revealed eight wish categories: (1) well-being; (2) personal relationships; (3) particular characteristics; (4) particular goals; (5) personal achievement and responsibility; (6) personal fulfillment; (7) protection; and (8) dependence on the parent. Quantitative analyses revealed that, on average, mothers reported more wishes regarding their future child's happiness ( p < .05) and emotional fulfillment ( p < .01), whereas fathers' wishes focused more on their future child's characteristics ( p < .01), goals ( p < .05), and achievement ( p < .10). However, mothers' and fathers' wishes did not differ according to whether they knew if their future child was a boy or a girl. Although the types of wishes that mothers versus fathers have for their children's future are generally influenced by the gender stereotypes in which they were raised, findings suggest that both mothers and fathers seem to avoid imposing these gender stereotypes on their future children. [ABSTRACT FROM AUTHOR]

Purpose: Most health outcome measures for chronic diseases do not incorporate specific health goals of patients and caregivers. To elicit patient-centered goals for dementia care, we conducted a qualitative study using focus groups of people with early-stage dementia and dementia caregivers.Methods: We conducted 5 focus groups with 43 participants (7 with early-stage dementia and 36 caregivers); 15 participants were Spanish-speaking. Verbatim transcriptions were independently analyzed line-by-line by two coders using both deductive and inductive approaches. Coded texts were grouped into domains and developed into a goal inventory for dementia care.Results: Participants identified 41 goals for dementia care within five domains (medical care, physical quality of life, social and emotional quality of life, access to services and supports, and caregiver support). Caregiver goals included ensuring the safety of the person with dementia and managing caregiving stress. Participants with early-stage dementia identified engaging in meaningful activity (e.g., work, family functions) and not being a burden on family near the end of life as important goals. Participants articulated the need to readdress goals as the disease progressed and reported challenges in goal-setting when goals differed between the person with dementia and the caregiver (e.g., patient safety vs. living independently at home). While goals were similar among English- and Spanish-speaking participants, Spanish-speaking participants emphasized the need to improve community education about dementia.Conclusions: Patient- and caregiver-identified goals for care are different than commonly measured health outcomes for dementia. Future work should incorporate patient-centered goals into clinical settings and assess their usefulness for dementia care. [ABSTRACT FROM AUTHOR]

HPV vaccine series completion rates among adolescent Hispanic females and males (~39 and 21 %, respectively) are far below the Healthy People 80 % coverage goal. Completion of the 3-dose vaccine series is critical to reducing the incidence of HPV-associated cancers. This formative study applies social marketing theory to assess the needs and preferences of Hispanic mothers in order to guide the development of interventions to increase HPV vaccine completion. We conducted 51 in-depth interviews with Hispanic mothers of adolescents to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place and promotion). Results suggest that a desire complete the vaccine series, vaccine reminders and preventing illnesses and protecting their children against illnesses and HPV all influence vaccination (product). The majority of Completed mothers did not experience barriers that prevented vaccine series completion and Initiated mothers perceived a lack of health insurance and the cost of the vaccine as potential barriers. Informational barriers were prevalent across both market segments (price). Clinics are important locations for deciding to complete the vaccine series (place). They are the preferred sources to obtain information about the HPV vaccine thus making them ideal locations to deliver intervention messages, followed by television, the child's school and brochures (promotion). Increasing HPV vaccine coverage among Hispanic adolescents will reduce the rates of HPV-associated cancers and the cervical cancer health disparity among Hispanic women. This research can inform the development of an intervention to increase HPV vaccine series completion in this population. [ABSTRACT FROM AUTHOR]

The article presents a study that proposes that the effect of self-discrepancy of pain outcomes is accounted for by psychological inflexibility, which involves the psychological processes that guide behaviors in the pursuit of goals and values. Topics include the results confirming that psychological inflexibility partly accounts for the variance observed between self-discrepancy and pain outcomes. Also mentioned is the study providing insight into the mechanism on patients' pain adjustment.

The article presents the authors' study which investigates the perspectives of therapy students regarding the concept of cotherapy. Topics discussed include an overview of the focus group discusssion used by the authors to acquire the relevant data for the study, the use of the open coding method in the analysis of the acquired data, and a comprehensive analysis of the results.

Background: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time. Purpose: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention. Methods: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles. Results: A core category 'Engagement phases in the process of a diet intervention' concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: 'Honeymoon phase', 'Everyday life phase', 'It's up to you phase' and 'Crossroads phase'. The early part of the intervention period was called 'Honeymoon phase' and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the 'Everyday life phase' and 'It's up to you phase', contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called 'Crossroads phase'. Conclusion: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention. [ABSTRACT FROM AUTHOR]

This qualitative study explored a newly introduced model of shared decision making (CommonGround) and how psychiatric medications were experienced by clients, prescribers, case managers and peer support staff. Of the twelve client subjects, six were highly engaged in shared decision-making and six were not. Five notable differences were found between the two groups including the presence of a goal, use of personal medicine, and the behavior of case managers and prescribers. Implications for a shared decision making model in psychiatry are discussed. [ABSTRACT FROM AUTHOR]

Crisis episodes have been most commonly associated with midlife, and correspondingly research on crisis after midlife is marked by its absence. Here, we report findings from a retrospective interview-based study of 21 adults about crises occurring between the ages of 60 and 69, in the first attempt to explore the holistic structure, process and experiential contents of later-life crisis. Basing our analysis on existing models of late-adult development, four key areas of later-life crisis were explored as follows: (1) life events and relationships, (2) self and identity, (3) motivation and goals and (4) cognition and affect. We were able to define a provisional common holistic process to later-life crisis episodes, shared by all participants, which included multiple loss-inducing stressful life events that provide a cumulative challenge to coping resources, a struggle with ego integrity, increased mortality awareness and the re-scaling of goals, activities and roles in ways that pertain to re-engagement, continuity or disengagement. Findings are discussed in relation to theories of adult development in later life, while strategies are proposed for future research on this understudied area. [ABSTRACT FROM AUTHOR]

Two studies were conducted to examine the relationship between a proposed adaptive response to failure and subsequent flourishing. The cognitive/emotional level of the proposed adaptive response to failure, acceptance of negative emotions, is characterized by allowing negative emotions to surface without trying to control them. The behavioral level of response, goal reengagement, is characterized by reengaging with new, intrinsically meaningful goals. Study 1 ( N = 50) was based on a community sample (age range 32-90 years) and consisted of semi-structured interviews coded for participants' response to the biggest job-related failure ever experienced and current psychological flourishing. Study 2 ( N = 101), an online study based on a different community sample (age range 18-73 years), further tested the proposed adaptive response to failure by using questionnaires to assess participants' response to the biggest job-related failure ever experienced and current flourishing. Findings across both studies indicated that responding to failure by accepting negative emotions and reengaging with new, intrinsically meaningful goals was associated with greater subsequent flourishing, including more happiness and fewer depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose Despite the importance and cost of workers' compensation (WC)-based vocational rehabilitation (VR) programs, outcome evaluations are rare, in part due to the scarcity of suitable comparison groups. The aims of this study were to assess (1) the adequacy of a commonly recommended internal comparison group, i.e., workers who were eligible for but did not receive services, and (2) return-to-work (RTW) expectations as a potential source of bias. Methods In this prospective cohort study, we used WC claims data and worker-reported RTW expectations to compare workers who received vocational retraining services to eligible workers who did not receive such services. Workers were surveyed after retraining eligibility determination, prior to the initiation of retraining activities. VR progress and RTW wage outcomes were followed for 3 years. The magnitude of confounding contributed by RTW expectations and other covariates was quantified. Results Workers who were somewhat or very certain they would RTW had significantly better outcomes. RTW expectations played a strong confounding role, reducing the retraining plan effect estimate by about 23 %, while education and physical capacity each changed the effect estimate by <5 %. Conclusions RTW expectations predicted long-term RTW outcomes and can play a strong confounding role if unmeasured. We found that the internal comparison group approach, commonly recommended for VR program evaluation, is inappropriate for WC-based VR evaluations. Ultimately, there is no simple solution to the challenge of identifying a comparison group; however, measurement of RTW expectations, an easily-measured multi-dimensional construct, may be a useful addition to the VR evaluation toolbox. [ABSTRACT FROM AUTHOR]

This study evaluated a manualized intervention for sensory difficulties for children with autism, ages 4-8 years, using a randomized trial design. Diagnosis of autism was confirmed using gold standard measures. Results show that the children in the treatment group (n = 17) who received 30 sessions of the occupational therapy intervention scored significantly higher ( p = 0.003, d = 1.2) on Goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care ( p = 0.008 d = 0.9) and socialization ( p = 0.04, d = 0.7) than the Usual Care control group (n = 15). The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol, and provides support for the use of this intervention for children with autism. Findings are discussed in terms of their implications for practice and future research. [ABSTRACT FROM AUTHOR]

The prevalence of sleep disturbance among children with developmental disabilities is known to be considerably higher than the typical population. The current study examined the effectiveness of the Sleepwise intervention program (O'Connell and Vannan in Aust Occup Ther J 55:212-214, ): a parent-assisted group-based treatment for sleep disturbance which was recently adapted for older children and adolescents with DD. Twenty-six families with children aged 8-17 years participated. The study compared a treatment and a wait-list control group at baseline, post-treatment and 2 months post-treatment on measures of child and parent functioning. Results demonstrated that the Sleepwise approach was effective in reducing sleep disturbance and parent stress. Limitations and future research directions are discussed. [ABSTRACT FROM AUTHOR]

As evidence-based practice is becoming integrated into children's mental health services as a means of improving outcomes for children and youth with severe behavioral and emotional problems, therapeutic foster care (TFC; a specialized treatment approach for such youth) is one of few community-based programs considered to be evidence-based. 'Together Facing the Challenge' (TFTC) which was tested in a randomized trial of TFC has been identified as an evidence-based model. We describe the experiences reported by one of the agencies that participated in our study and how they have incorporated TFTC into their on-going practice. We highlight key implementation strategies, challenges faced, and lessons learned as the agency moved forward towards full implementation of TFTC. [ABSTRACT FROM AUTHOR]

The present study takes a motivational perspective that views youths' educational and career engagement as influential and potentially competing for the same motivational resources in the transition to adulthood. We investigated whether motivational engagement with educational and career goals in the year after high-school graduation was differentially associated with educational, career-related and subjective well-being outcomes 2 and 4 years after school graduation. Our longitudinal study of a multi-ethnic sample of Los Angeles high-school graduates followed participants 2 years ( N = 561; 61.5 % female) and 4 years ( N = 364; 59.8 % female) after high school graduation. The findings indicate that motivational engagement with educational goals after high school graduation predicted educational attainments and psychological well-being at follow-up 2 and 4 years after graduation, and occupational progress at 4 years after graduation. Work hours assessed shortly after high school graduation were associated with poorer educational outcomes both at 2 and 4 years after high school. Occupational goal engagement was not associated with better outcomes, but predicted less educational attainment 4 years after graduating. Thus, educational goal engagement predicted favorable outcomes, whereas career-related goal engagement for the most part was neutral with some select associations with negative educational outcomes. A strong motivational commitment to educational goals, but not to career goals, is an important component of a successful transition to adulthood. [ABSTRACT FROM AUTHOR]