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Research has shown that arts-based approaches facilitate literacy learning in children; however, few studies have focused on the integration of art and early writing in community-based Chinese heritage language classes, which have been marginalized from the formal educational discourse in the United States. By drawing on the theoretical perspectives on social semiotics, this paper explored how young Chinese heritage learners engage in "writing" Chinese characters using fallen leaves. The data sources included field notes of observations, video recordings of the class, and the artifacts made by the children. Multimodal analysis revealed that the teacher invited the students to write together and created a social context for children to compose writing artwork. Children engaged with their composition through a variety of modes. This study has implications for research, practice, and policy. [ABSTRACT FROM AUTHOR]

Background: In the US, over 50% of suicide deaths are by firearm injury. Studies have found that limiting access to firearms, including storing them temporarily outside of the home or locking and unloading them securely at home, helps prevent suicide. Family members and other loved ones are in a unique position to encourage secure firearm storage. This paper describes the development of a workshop to empower loved ones of individuals at risk for suicide to discuss secure firearm storage in New York State. Methods: Using a multistakeholder engagement framework, we partnered with New York State county-level suicide prevention coalitions, local firearms experts, and other stakeholders to develop a 90-min workshop addressing secure firearm storage for suicide prevention. Pilot workshops were co-facilitated by a suicide prevention coalition member and a local firearms expert. Feedback gathered via surveys from workshop attendees and interviews with workshop co-facilitators were used to revise workshop content and inform dissemination. Following pilot workshops, a 1-day training event was held for potential future facilitators, and survey data were collected to assess trainee experiences and interest in facilitating future workshops. Data analysis included rapid qualitative analysis of interviews and statistical analysis of survey responses about acceptability of workshop. Results: Four pilot workshops included a total of 23 attendees. Pilot workshop attendees endorsed willingness and confidence to discuss secure firearm storage with a family member or loved one. The training event included 42 attendees, of which 26 indicated interest in facilitating a workshop within the next year. Co-facilitators agreed on several key themes, including the importance of having a "trusted messenger" deliver the firearms portion of the workshop, keeping the conversation focused on firearm safety for suicide prevention, and developing interventions that reflect firearm owning community's culture. Conclusions: Consistent with a public health approach to suicide prevention, this study leveraged a multistakeholder engagement framework to develop a community-based workshop empowering loved ones of individuals at risk for suicide to discuss secure firearm storage. The workshop will be disseminated across New York State. We noted positive and collaborative relationships across stakeholder groups, and willingness to facilitate the workshop among both suicide prevention and firearm stakeholders. [ABSTRACT FROM AUTHOR]

Based on a qualitative study, this paper explores how United States public health professionals view and think about the existing U.S. healthcare system, while also allowing these study participants to imagine new ways of structuring and practicing public health. Using semi-structured qualitative interviews, I show how public health professionals engage with the concept of "the social" and their personal experiences with public health to question the status quo. By giving public health professionals space in which to imagine changes and different ways of practicing public health, I demonstrate the effectiveness of imagination as a capacity that public health professionals possess to take the lead in creating the changes they hope for. [ABSTRACT FROM AUTHOR]

With the growing prevalence of chronic conditions driving 85% of all healthcare costs, digital health offers a promising opportunity to reverse disease and improve health at-scale. The healthcare industry's predominant approach to behavior change is performance-based with a focus on goals and tracking. This has not reversed the epidemic of chronic diseases and also can harm chronically ill and vulnerable patients via perceived failure-induced loss of motivation. Still nascent, the digital health industry is uniquely positioned to adopt and scale new and better behavior change approaches. In this paper, we present the theoretical foundation and initial findings of a neuroscience-based behavior change approach—what we call the Iterative Mindset MethodTM. We discuss its promise, as a potentially more effective, neuroscience-based approach to changing health behaviors long-term, particularly in vulnerable populations. We conclude with avenues for future research. [ABSTRACT FROM AUTHOR]

The article cites information on the special issue of "Journal of Family and Economic Issues" for 2010. The research will focus on the significant impact of economic crisis and demographic trends on the family owned businesses in the U.S. It will highlight the different factors of downsizing businesses, and welcome quantitative and qualitative research from readers. It suggests topics including managerial strategies for family owned businesses, resource management and trends in family owned business.

Rural areas are becoming more and more concerned about their aging population and perceived loss of youth. Analysts see the older members of communities as a burden, and focus their development strategies on attracting and retaining the young. In doing so, they may be missing the value that elders' civic engagement can provide to rural community development. This qualitative study, based on interviews with 40 elders in mostly rural areas of Wisconsin, in the United States, shows the benefits that their civic engagement brings to rural areas. They have biographical availability, political and economic freedom, and life-long experience to offer. They do face some challenges, including occasional health issues, lack of technological agility, and change-resistant peers. The paper concludes by considering how communities can better access and honour elder civic engagement, including understanding elders' motivations and skills for civic engagement. [ABSTRACT FROM AUTHOR]

Research has repeatedly shown the positive effects of early diagnosis and intervention in improving the quality of life and symptom trajectory of individuals with autism spectrum disorder (ASD). Immigrant and racial/ethnic minority children are diagnosed with ASD at significantly older ages, and have access to interventions later than their White peers. Recent efforts to address diagnostic disparities have focused on universal ASD screening in pediatric primary care. However, little is known about immigrant families' experiences with ASD screening and with navigating subsequent referrals after receiving a positive ASD screen. In the current study, we explored cultural influences on: mothers' perceptions of child development and disability, communication with pediatric healthcare providers, and perceived benefits of Early Intervention services. We interviewed 26 mothers (14 US-born and 12 immigrant—representing twelve different nationalities) of children who screened positively for ASD in primary care but did not receive an ASD diagnosis after a formal evaluation (i.e., false positive ASD screen). Mothers completed semi-structured qualitative interviews that explored their perceptions of child development, experiences with the ASD screening and developmental evaluation process, and experiences with developmental services. Data were stratified by U.S. nativity and analyzed using applied thematic analysis. Immigrant mothers described different ways of monitoring child development than US-born mothers, and described a mismatch between their own views and the child development frameworks used in the U.S. Due to this mismatch, immigrant parents may be less likely to raise concerns to their pediatricians, and therefore may particularly benefit from routine screening. This paper uses data from a supplemental study to a larger clinical trial. The clinical trial registration number is NCT02359084. Highlights: Immigrant families view child development as a process that unfolds uniquely for each child, therefore, monitoring development through milestones can be a new idea for culturally diverse families. Immigrant children with elevated risk for ASD may be at higher risk for later identification of developmental delays if they are not screened at their well-child visits. Culturally and linguistically accessible explanations of child development and disabilities can help immigrant families throughout the ASD screening process. Immigrant families emphasize benefiting from family navigation and logistical support during the developmental evaluation process. [ABSTRACT FROM AUTHOR]

The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South. [ABSTRACT FROM AUTHOR]

Introduction: The National Maternal and Child Health Workforce Development Center provides training, coaching, and consultation to Title V programs. The flagship experience is the Cohort program, a 6-8-month leadership development program where Title V programs convene a multisector team to address a pre-selected state/jurisdictional challenge related to health systems transformation. The overall objective of this paper is to demonstrate the impact of skills developed via the Cohort program on state/jurisdictional capacities to address complex challenges. Methods: Qualitative, post-Cohort evaluation data were analyzed using inductive and deductive coding and the "Sort and Sift, Think and Shift" method. Themes and supporting text were summarized using episode profiles for each team and subsequently organized using the EvaluLEAD methodology for identifying and documenting impact. Results: Teams brought an array of challenges related to health systems transformation and 94% of teams reported achieving progress on their challenge six-months after the Cohort program. Teams described how the Cohort program improved workforce skills in strategic thinking, systems thinking, adaptive leadership, and communication. Teams also reported the Cohort program contributed to stronger partnerships, improved sustainability of their project, produced mindset shifts, and increased confidence. The Cohort program has also led to improved population health outcomes. Discussion: Through working with the Center, Title V leaders and their teams achieved episodic, developmental, and transformative results through application of Center tools and skills to complex challenges. Investment in the MCH workforce through skill development is critical for achieving transformative results and solving "wicked" public health problems. [ABSTRACT FROM AUTHOR]

The International Rescue Committee's Life Skills Tailored Package for Early Marriage focuses on engaged, married, and divorced Syrian refugee girls aged 13–18 living in Lebanon. This paper details findings from a qualitative program evaluation. In-depth interviews (IDIs) and focus group discussions (FGDs) explored participants' viewpoints about program components. IDIs engaged program staff and adolescent girls. FGDs included adolescent girls, husbands/fathers, and mothers/mothers-in-law. Data were audio-recorded, transcribed, and assessed using inductive content analysis. Three themes emerged: (1) engaging influencers with discretion facilitated girls' participation, (2) reaching out to vulnerable girls required foresight and flexibility, and (3) participation fostered development of personal resources and adaptive capacities among adolescent girls, who described improvements in self-confidence for decision-making/time management, reproductive health knowledge, emotional regulation/understanding of healthy relationships, and self-protection. Efforts to improve psychosocial and reproductive health of refugee adolescent girls experiencing child marriage should integrate lessons learned through this program. [ABSTRACT FROM AUTHOR]

Though barriers to HIV pre-exposure prophylaxis (PrEP) uptake among gay, bisexual, and other men who have sex with men (MSM) have received substantial research attention, less is known about what factors may be affecting PrEP uptake among male sex workers (MSWs), a population at high risk of HIV. This paper presents qualitative findings regarding why a subsample of MSM engaged in exchange sex (receiving money, drugs, shelter, or other goods in exchange for sex) with partners they met on dating/hookup websites and apps had never used PrEP. Analysis revealed several barriers to PrEP uptake including lack of awareness and knowledge about PrEP, scientific and medical concerns, issues related to individual risk perception and beliefs/preferences about risk management, practical and logistical barriers, and provider-level barriers. Nuances to these barriers are discussed, particularly as they relate to the specific type of sex work participants were engaged in. Implications for interventions are also discussed. [ABSTRACT FROM AUTHOR]

In the Eastern Snake Plain of Idaho, increasing rates of groundwater extraction for irrigation have corresponded with the adoption of more efficient irrigation technologies; higher use and lower incidental recharge have led to increasing groundwater scarcity. This paper assesses farmer vulnerability to a water resource policy that responds to that scarcity by reducing availability of groundwater for irrigation by 4–20%. Using results from a household survey of impacted farmers, we examine vulnerability in two stages, contributing to theorization of farmer vulnerability in a changing climate as well as producing important regional policy insights. The first stage, multimodel selection and inference, analyzes the primary predictors of two forms of vulnerability to groundwater scarcity among this population of farmers. The second stage, a segmentation analysis, highlights policy-relevant variation in adaptive capacity and in vulnerability predictors across the population. Individual-level results indicate that key indicators of vulnerability include several dimensions of adaptive capacity and sensitivity. At the population level, we find that reductions in sensitivity may play an important role in reducing farmer vulnerability. Accelerating global environmental change will require agriculture in arid and semi-arid regions to adapt to shifts in water availability. As water resources shift, institutional contexts and policy landscapes will shift in parallel, as seen with the reduction in groundwater availability in our case study. These institutional shifts may change the face of adaptation and farmer vulnerability in unexpected ways. Our results indicate that such institutional shifts could lean on efforts to enhance farmer adaptive capacity or reduce farmer sensitivity as mechanisms for reducing farmer vulnerability to adaptation policy changes. [ABSTRACT FROM AUTHOR]

Objectives: Community health worker (CHW) programs are a promising strategy to improve maternal and child health outcomes, particularly among low-resource women. Yet, little is known about which aspects of CHW-client relationships are most salient for promoting positive change. This paper examines features of the CHW-client relationship that perinatal women with chronic conditions reported as being beneficial for their experience of prenatal care and pregnancy. Methods: Focus groups and interviews were conducted with 18 CHWs and 39 clients from three Merck for Mothers-funded programs in the Eastern United States. Data were analyzed using a grounded theory-informed thematic approach. Results: CHWs built trust-based relationships through emotional attendance, authenticity, and prioritization of clients' needs. They provided instrumental, informational, and emotional support that clients reported facilitated greater engagement with the healthcare system, improved health behaviors, and reduced stress. CHWs and clients alike viewed their relationships as having long-lasting impacts, made possible by the trust-based bond between them. Discussion: Strong, trusting relationships with CHWs may be one avenue through which to improve maternal and infant health for vulnerable perinatal women. Community health care programs should promote trust-building as an explicit program goal. Trust-based CHW-client relationships may serve as an exemplar for transforming traditional care relationships between providers and clients, leading to greater client engagement in care and improved health. [ABSTRACT FROM AUTHOR]

Background: Accurate symptom monitoring is vital when managing pediatric asthma, providing an opportunity to improve control and relieve associated burden. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) has been validated for asthma control assessment in children; however, there are concerns that response option images used in the C-ACT are not culturally universal and could be misinterpreted. This cross-sectional, qualitative study developed and evaluated alternative response option images using interviews with children with asthma aged 4–11 years (and their parents/caregivers) in the United States, Spain, Poland, and Argentina. Interviews were conducted in two stages (with expert input) to evaluate the appropriateness, understanding and qualitative equivalence of the alternative images (both on paper and electronically). This included comparing the new images with the original C-ACT response scale, to provide context for equivalence results. Results: Alternative response option images included scale A (simple faces), scale B (circles of decreasing size), and scale C (squares of decreasing quantity). In Stage 1, most children logically ranked images using scales A, B and C (66.7%, 79.0% and 70.6%, respectively). However, some children ranked the images in scales B (26.7%) and C (58.3%) in reverse order. Slightly more children could interpret the images within the context of their asthma in scale B (68.4%) than A (55.6%) and C (47.5%). Based on Stage 1 results, experts recommended scales A (with slight modifications) and B be investigated further. In Stage 2, similar proportions of children logically ranked the images used in modified scales A (69.7%) and B (75.7%). However, a majority of children ranked the images in scale B in the reverse order (60.0%). Slightly more children were able to interpret the images in the context of their asthma using scale B (57.6%) than modified scale A (48.5%). Children and parents/caregivers preferred modified scale A over scale B (78.8% and 90.9%, respectively). Compared with the original C-ACT, most children selected the same response option on items using both scales, supporting equivalency. Following review of Stage 2 results, all five experts agreed modified scale A was the optimal response scale. Conclusions: This study developed alternative response option images for use in the C-ACT and provides qualitative evidence of the equivalency of these response options to the originals. Plain English summary: Accurate monitoring of the symptoms associated with pediatric asthma is important when managing the condition. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) is a questionnaire widely used to measure asthma severity in young children (aged 4–11 years). Each question answered by the child in the C-ACT has four possible answer choices. To help children answer, each choice is presented alongside an image of a male child's face ranging from sad to happy. However, there are concerns that the images used are not culturally universal and could be misinterpreted—due to difficulties translating to electronic formats and a lack of differentiation between the images used. Through interviewing children with asthma, we aimed to address these concerns by developing and testing new images. Alternative image options developed included simpler faces, circles of decreasing size and squares of decreasing quantity. Children aged 4–11 years old were interviewed to test whether they understood the response scale using the new images and if they answered in the same way as with the original images. Interviews were conducted in two stages, with expert guidance at key stages. Results showed that children can interpret and understand the newly developed images and that they answer the questions the same as they would using the original images. These new images have the advantages of being culturally neutral and easier to implement on an electronic device. [ABSTRACT FROM AUTHOR]

Longitudinal qualitative research can provide rich understanding of the life circumstances of vulnerable groups who experience health inequities, of whether, how and why these circumstances change, and of how these circumstances and processes of change impact health. But, this rich understanding is not automatic and requires systematic and thoughtful approaches to data collection and analysis. The purpose of this paper is to describe two longitudinal qualitative studies embedded in mixed-methods studies of social determinants of HIV in the United States and the Dominican Republic. We compare these two studies to critically reflect on specific techniques that facilitate longitudinal and iterative data collection, management, and analysis, in particular the use of participant-specific matrices and analytic summaries across the distinct phases of the research. We conclude that combining cross-sectional and longitudinal analysis that engages with both themes and processes of change can contribute to improved contextualization and understanding of social determinants of HIV. [ABSTRACT FROM AUTHOR]

Background: Robust and well-defined data collection is important when using electronic patient-reported outcome measures (ePROMs) in clinical studies. Questions have been raised as to whether older age may be a barrier to data collection due to patients' unfamiliarity with electronic devices. Older adults may also have underlying health conditions that affect their ability to fill out patient-reported outcome measures (PROMs) on electronic devices. The aim of this observational, qualitative research study was to evaluate the usability of electronic PROMs (ePROMs) on a tablet and smartphone in older participants with and without bullous pemphigoid (BP). Methods: Older people with and without BP were recruited in the US and France. They participated in 60-min in-person interviews, with moderators observing their completion of various tasks, including ePROMs, using a tablet and smartphone. Participants were scored on ease of task completion using a scale from 1 to 5. Results: A total of 12 participants were recruited (≥65 years old; six each with and without BP [all participants without BP were ≥75 years old]). Most participants (83%) could easily and confidently perform most assigned tasks on both the tablet and smartphone. Although select tasks required assistance, all participants were eventually able to complete all tasks. Overall, ePROM usability did not correlate with age, sex, country, or disease state. Feedback on the general usability of both electronic devices was largely positive, and most participants (n = 11; 92%) were willing to use them. Participants were generally pleased with the training modules offered on both devices, describing the training as sufficient, straightforward, and helpful. In total, 25 usability issues were identified, which fell into three categories: incomplete instructions, unclear language, and insufficient technical/visual design. Participants provided feedback on how to enhance device usability. Conclusions: The results suggest that older people can confidently use a tablet or smartphone for ePROM completion, particularly with appropriate training. ePROMs should be designed with the needs of the target patient population in mind. These results can be leveraged to improve clinical data recording, optimize device usability, and enhance the user experience for older people and those with functional or physical limitations. [ABSTRACT FROM AUTHOR]

Background: Bowel urgency, the sudden and immediate need to have a bowel movement, is common in patients with ulcerative colitis (UC) and Crohn's disease (CD). While its impact in UC is well established, less is known about its importance in CD. Further, what level of bowel urgency control patients with UC or CD would consider to be acceptable or in remission has not been established. This qualitative study aimed to understand perceptions of bowel urgency and remission in these patients. Methods: Semi-structured combined concept elicitation and cognitive interviews were conducted to explore how adults with moderate-to-severe UC or CD and current or recent bowel urgency think about the concept of bowel urgency and its remission. The Urgency Numeric Rating Scale (UNRS) was used to examine different levels of bowel urgency severity and to investigate what level of bowel urgency patients would consider as representing remission. Results: Forty adults (n = 19 UC, n = 21 CD) recruited from six US sites completed the study. Sociodemographic and clinical characteristics were similar in both groups. Both groups reported impacts of bowel urgency on physical, social, professional, and emotional aspects of their lives. Most participants (n = 15 UC, n = 18 CD) reported having experienced one or more incidents of urgency-related fecal incontinence. Most participants considered remission to be a state with a normal or reduced number of bowel movements and no or less frequent bowel urgency, and they noted that remission would increase their ability to engage in daily activities without fear of fecal incontinence. Participants were able to map different levels of severity of bowel urgency to UNRS score ranges (scale: 0–10), and they indicated that a mean UNRS score of 5 (UC) or 4 (CD) would be the highest point on the NRS at which they would still consider their bowel urgency to be in remission. Conclusions: Bowel urgency is an important issue for patients with either moderate-to-severe UC or CD, and its remission would improve their lives. Further, these patients may still consider bowel urgency to be in remission even at UNRS scores as high as 4 or 5. Plain English summary: Bowel urgency is the sudden need to rush to the bathroom to have a bowel movement, which is common in people with ulcerative colitis and Crohn's disease. We interviewed adults with moderate or severe ulcerative colitis or Crohn's disease to better understand their experiences. They said that bowel urgency often made them feel anxious, depressed, or embarrassed and interfered with their social lives, work, and chores. Most felt that they would be in "remission" if the bowel urgency stopped or happened less often. They added that this would help them feel more relaxed and be more active. Interestingly, they would consider even a moderate amount of bowel urgency as being in "remission." This information can help healthcare providers better understand the toll that bowel urgency takes on patients with ulcerative colitis or Crohn's disease and better manage their treatment. [ABSTRACT FROM AUTHOR]

Background: Improving care coordination is a key priority for many healthcare systems. However, initiatives to improve care coordination are complex to implement and have produced mixed results. A better understanding of how to craft and support implementation of effective care coordination strategies is needed.Objective: To identify and understand the challenges and factors encountered by Patient-Aligned Care Team (PACT) staff in performing care coordination tasks in outpatient clinics in the Veterans Health Administration (VA).Design: Qualitative study using semi-structured formative evaluation interviews.Participants: Fourteen interviews with 18 clinical frontline managers and staff from 12 clinic sites across five VA health systems.Interventions: This paper reports on baseline data collected for the Coordination Toolkit and Coaching (CTAC) project. CTAC aims to improve patients' experience of care coordination within VA primary care and between PACT and other outpatient and community settings.Approach: We conducted pre-implementation telephone interviews with frontline managers and staff, primarily nurse managers.Key Results: PACT staff described challenges in aligning care coordination priorities across different levels of the VA system, including staff, patients, and leadership. Additionally, PACT staff noted challenges coordinating care both within and outside the VA, and identified resource barriers impeding their care coordination efforts. To address these challenges, staff made several recommendations for improvement, including (1) contingency staffing to address staff burnout; (2) additional PACT training for new staff; (3) clarification of care coordination roles and responsibilities; and (4) and care coordination initiatives that align both with centrally initiated care coordination programs and frontline needs.Conclusion: In the VA and similarly complex healthcare systems, our findings suggest the need for care coordination strategies that are buttressed by a system-level vision for care coordination, backed up by clear roles and responsibilities for information exchange between primary care staff and other settings, and multidimensional accountability metrics that encompass patient-, staff-, and system-level goals. [ABSTRACT FROM AUTHOR]

The widespread adoption of science-based prevention requires local infrastructures for prevention service delivery. Communities That Care (CTC) is a tested prevention service delivery system that enables a local coalition of community stakeholders to use a science-based approach to prevention and improve the behavioral health of young people. This paper uses data from the Community Youth Development Study (CYDS), a community-randomized trial of CTC, to examine the extent to which better internal team functioning of CTC coalitions increases the community-wide adoption of science-based prevention within 12 communities, relative to 12 matched comparison communities. Specifically, this paper examines the potential of both a direct relationship between coalition functioning and the community-wide adoption of science-based prevention and a direct relationship between functioning and the coalition capacities that ultimately enable the adoption of science-based prevention. Findings indicate no evidence of a direct relationship between four dimensions of coalition functioning and the community-wide adoption of a science-based approach to prevention, but suggest a relationship between coalition functioning and coalition capacities (building new member skills and establishing external linkages with existing community organizations) that enable science-based prevention. [ABSTRACT FROM AUTHOR]

This study aims to analyze the scientific research progress on human fatigue assessment (HFA) by using a bibliometric method, which was conducted a systematic analyses of 28,028 scientific papers about HFA from the Web of Science database, and the results were discussed from the following perspectives: temporal distribution, geographical distribution, discipline distribution, and key words distribution. In addition, this analysis also provides the network of author co-citation and key words. The results are summarized as follows: 1) the number of papers about HFA increased rapidly since 1990s; 2) The United States is a high-yield, high-cited country with 36.70% of the world’s total literatures, and whose average citation index on HFA research is 47.89 per paper; China is the developing country with the largest number of publications, but its total citations and average citations are backward, only with an average of 21 citations per article; 3) The assessment of human fatigue shows the development trend of multidisciplinary intersecting; 4) There is a relative lack of cooperation among the world’s leading scholars; the Dutch Gijs Bleijenberg is the most published scholar in the world, who have 108 articles on HFA research; the American scholar David Cella has the most influential article, with an h-index of 36; the distribution of Chinese scholars is relatively scattered, and no one has written more than five articles; 5) All of countries in the world had the same research topics, “muscle fatigue” is an important part of the HFA; China needs to pay more attention to the fatigue assessment associated with cancer. The results of the analysis can be used to enhance our understanding of HFA research and support further research in this area. [ABSTRACT FROM AUTHOR]

In predominately immigrant neighborhoods, the nuances of immigrant life in the ethnic enclave have important, yet underappreciated impact on community health. The complexities of immigrant experiences are essential to unpacking and addressing the impact of acculturative processes on observed racial, ethnic, and class-based health disparities in the United States. These insights because they are largely unexplored are best captured qualitatively through academic-community research partnership. We established the participatory mixed method Little Village participatory community health assessment (CHA) to explore community health in an ethnic enclave. In this paper, we share findings from our qualitative component exploring: how do Residents in a Predominately Immigrant Neighborhood Perceive Community Health Needs and Assets in Little Village. Three major themes emerged: rich, health promoting community assets inherent in the ethnic enclave; cumulative chronic stress impacting the mental health of families and intra-familial strain; and, work and occupation as important but underappreciated community health determinants in an immigrant neighborhood. These nuanced findings enhanced our community health assessment and contributed to the development of two additional tailored CHA methods, a community member-administered Community Health Survey, and an oral history component that provided deeper insight on the community’s health needs and assets, and a focus for action on work as a social determinant of health at the community level. Conducting trusted community-driven health assessments that are adaptive and flexible to capture authentic needs and assets are critical, given health consequences of the new anti-immigrant rhetoric and growing socio-political tensions and fear in immigrant neighborhoods in the United States. [ABSTRACT FROM AUTHOR]

This paper examines the convergence of culture, myths, and taboos surrounding reproductive health issues African immigrant women, living in the United States, learned during childhood in their countries of origin. We also discuss how mothers’ perceptions of reproductive health education (RHE) influenced the education of their own daughters aged 10-14 years. This was a qualitative descriptive study. Data were collected via interviews and demographic survey. The sample size was 20 African immigrant mothers living in a mid-sized city in the U.S. Interviews were transcribed verbatim. Qualitative data was analyzed using qualitative content analysis. Myths and taboos related to menstruation, sexual intercourse, pregnancy, and HIV/AIDS were reported by the women interviewed. Discussion of these issues was largely taboo, and most myths the mothers learned growing up pertained to sexual intercourse, pregnancy prevention, and pregnancy termination using non-hormonal ingested substances. Myths and taboos about sexual issues are widespread in Africa and are propagated to control sexual behavior, especially that of unmarried people, particularly women. By examining these myths and taboos, we are able to somewhat contextualize the mothers’ immigrant experience regarding RHE. Although myths were reported, the majority of mothers did not appear to believe them. The most significant taboo reported was sexual intercourse. This in turn led to mothers’ overemphasis on abstinence for their daughters. It is also noteworthy that this sample contained mainly African women who overall were highly educated, spoke English, and could adequately navigate life in the U.S. It is unclear what the results would be if we were to examine African immigrant women with less achievements in these areas. [ABSTRACT FROM AUTHOR]

Examining the work of local media can be a valuable starting point for exploring the institutionally shaped cultural contexts within which local housing markets are embedded and for shedding light on market phenomena like local housing bubbles. This paper draws on a qualitative analysis of articles published in the Real Estate section of the New York Times to explore some of the meanings about homeownership, home-buying, and market behavior that were institutionally reinforced in New York City during a period of growing unease about the direction of the local market. Through the use of framing analysis, I conclude that the New York Times symbolically reinforced the contradictory role that real estate, 'the secondary circuit of capital' plays in the economy. [ABSTRACT FROM AUTHOR]

This paper reports a qualitative study on the Chinese language learning trajectories of non-native Chinese instructors as successful Chinese language learners . While some literature has been found on studying good learners of English and other languages, there is a lack of research on studying good learners of the Chinese language, especially on their life-long Chinese learning process. Six active instructors teaching Chinese at K-12 schools or universities in the United States, whose native language is English, were interviewed on a one-on-one basis with an auto/biographical approach. This approach, as one type of narrative inquiries under a qualitative paradigm, has been increasingly used in the study of English language learners. Findings of the study include that the six participants all had experiences studying in Greater China, and all held lifelong learning attitude as well as demonstrated various self-regulation strategies with strong self-motivation and dedication. While they all took Chinese classes at college, only two of them studied prior to college, which is encouraging for Chinese learners who were unable to learn Chinese from an early age. This study helps to fill the gap in literature on good language learners of Chinese, and provides educational implications for Chinese language learners, instructors, researchers, and other stakeholders. [ABSTRACT FROM AUTHOR]

This paper reports findings from a study that compared older (n = 21, ≥ age 50) and younger (n = 96, ≤ age 49) African Americans' stories (N = 117) of living with HIV/AIDS to determine how they make sense of the experience. The purpose was to: (1) identify and describe the cultural models African Americans use to inform their stories of living with HIV/AIDS, and (2) to compare older and younger adults' HIV stories. To characterize the cultural models engaged in the telling of these HIV stories, we conducted schema analysis. Analyses documented six diverse schemas, ranging from "Stages of Grief", "12 Steps", "Wake Up Call", "Continuity of Life", to "Angry and Fearful", "Shocked and Amazed". Comparison conducted by age group showed older adults more frequently expressed their story of living with HIV as "Stages of Grief" and "Continuity of Life", whereas younger adults expressed their stories as "12 Steps" and "Wake Up Call". Findings contribute by documenting African American stories of living with HIV/AIDS, important heterogeneity in cultural schemas for experiences of living with HIV and differences by age group. These findings may help by identifying the cultural resources as well as challenges experienced with aging while living with HIV/AIDS for African Americans. [ABSTRACT FROM AUTHOR]

Research centered on the socioemotional benefits of religion and religious congregations for young people has highlighted largely positive outcomes for both young people and religious congregations. However, fewer studies have explored whether transgender young people receive those same socioemotional benefits from being religiously affiliated. Using secondary quantitative data from the 2015 US Transgender Survey, this study examined the religious experiences of transgender young people (aged 18–24). The data indicate that individual demographics (e.g., race, gender identity, sexual orientation, religious affiliation) affected the religious experiences of transgender young people, including leaving their congregations due to the fear of being rejected. More research is needed on the socioemotional benefits of religious affiliation for transgender young people. [ABSTRACT FROM AUTHOR]

Purpose: Accommodations are vital for protecting equal access and increasing the employment of people with disabilities. However, the evidence on whether employers are willing or resistant to provide accommodations is mixed. We explore reactions to accommodations specifically associated with Assistive Technologies (AT). While the presence of such a device should reassure hiring managers about the abilities of the candidate to do the job, they also risk raising new questions and uncertainties. Methods: Hypothetical job candidates with and without disabilities were presented to participants with hiring experience to examine perceptions of employability, risk, and trust. Several conditions included the candidate describing the use of AT (i.e., an exosuit) and requesting accommodations, with and without extra technical or enthusiastic language to explain the specific device. Results: Quantitative and qualitative results show that the request for accommodations, in general, is problematic. And while using the exosuit seems to benefit perceptions of trust, it still seems risky and does not categorically improve employability perceptions. Extra language provided by the candidate to explain the device did not improve outcomes but did (in the case of enthusiastic language) make people more open to seeing the positive aspects of the device. Conclusion: While using an AT is a positive advance for a job candidate with a disability, the perceptual risk and the salience of the disability are both increased. Future work is needed to explore the options for better reassuring hiring managers about such devices. [ABSTRACT FROM AUTHOR]

In this paper, we explore hope in the context of living with chronic pain. Individuals with chronic pain from temporomandibular disorder(s) were interviewed four to five times over the course of their 18-month participation in a clinical trial investigating the effectiveness of Traditional Chinese Medicine. We sought to understand shifts in participants' descriptions of expectations and hopefulness, particularly with regard to the work involved in counterbalancing positive thinking with buffers against disappointment. We found hope to be a dynamic and multifaceted mindset as distinct from being a single entity to be measured. Drawing upon Polanyi's concept of tacit knowing, we explore how different ways of hoping emerge and index one another in participant narratives. We offer a working typology of hope and raise as an issue the manner in which the paradox of hope--hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair--complicates simplistic notions of the relationship between positive thinking and the placebo response. [ABSTRACT FROM AUTHOR]

The US needs engaged and skilled psychiatrists to support the recovery of people with severe mental illnesses and we are currently facing a shortage. This paper examines what attracts providers to community psychiatry and what sustains them in their work. Focus groups and interviews were used to elicit the perspectives of prescribing clinicians in three community mental health clinics in the US. Community psychiatry has inherent challenges, including facing high-risk decisions, encountering intense affects, and occasionally witnessing bad outcomes. Psychiatrists are motivated and sustained in this work by (1) cultivating relationships with patients and colleagues, (2) focusing on the mission of promoting recovery, and (3) engaging with clinical practice as intellectually stimulating work. Administrators support the engagement and morale of psychiatrists by creating workflows that allow psychiatrists to meaningfully apply their expertise to support patients' recovery. These findings hold implications for recruiting and retaining a new generation of physicians. [ABSTRACT FROM AUTHOR]

Young Latina women (YLW) in the US and in Alabama are disproportionately affected by sexual health disparities. Our community based participatory research (CBPR) study's purpose was to examine YLW's perceptions and experiences of sexual healthcare access (SHCA) toward developing community-driven, multilevel intervention strategies. We conducted 20 semi-structured qualitative interviews with YLW between 15 and 19 years old and who had been in the US for 5 or more years. We content-analyzed the data guided by the Socioecological Model of Sexual Health (SEMSH). We began analyses by coding independently, built consensus on the codes, then finished coding transcripts independently. Sixty-five percent of participants were US-born and 60% had health insurance. Participants identified barriers/facilitators to SHCA including discrimination in clinical settings and embarrassment/stigma about SHCA. Our study is the first in AL to use CBPR to work with YLW. Interventions should consider the multi-level and intersectional nature of SHCA challenges. [ABSTRACT FROM AUTHOR]

Disasters share a common potential for significant ecological and psychosocial disruption at the individual, community, and societal levels, and are especially harmful to members of social groups in vulnerable situations, including youth in foster care and those recently emancipated from care. These young people are susceptible to mental health challenges and understanding their resiliency is key to mitigating pandemic-related harms. This qualitative study aims to (1) understand how the COVID-19 pandemic affected the mental health of older youth between the ages of 18 and 23 (M = 20.5 years, S.D. = 1.7 years), currently in or aged out of foster care (M = 5.9 years in care, S.D. = 4.4 years), and experiencing mental health challenges, and (2) gain insight into the resiliency that supports young people in dealing with these challenges. Twenty-six young people (77% female-identifying, 38% White, 27% Hispanic) in the USA participated in in-depth interviews. Salient themes include: 1) supportive relationships, 2) adaptive coping skills and mindsets, and 3) environmental, institutional, and social supports. Results amplify the voices of these young people concerning the impact of COVID-19 on their mental health and foreground the dynamic strategies they are using to alleviate their distress. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Life satisfaction can be assessed either globally or with regard to satisfaction with specific domains of life. The latter multidimensional approach presumes science has delineated with confidence the specific domains most relevant to evaluating whether the criteria for a good life have been met. This paper shares results of a qualitative study of the perceived determinants of life satisfaction among 30 high school students who were diverse in terms of mental health; 6-10 participants were classified as complete mental health, vulnerable, symptomatic but content, or troubled at two time points separated by a year. Thematic analyses of transcribed individual interviews suggested eight themes that capture the domains of life adolescents perceive influence their happiness. These themes are compared and contrasted to domains included in existing multi-dimensional measures of youth life satisfaction. The factors likely to be particularly salient to students with different levels of mental health are noted. [ABSTRACT FROM AUTHOR]

The likely intensification of extreme droughts from climate change in many regions across the United States has increased interest amongst researchers and water managers to understand not only the magnitude of drought impacts and their consequences on water resources, but also what they can do to prevent, respond to, and adapt to these impacts. Building and mobilizing 'adaptive capacity' can help in this pursuit. Researchers anticipate that drought preparedness measures will increase adaptive capacity, but there has been minimal testing of this and other assumptions about the governance and institutional determinants of adaptive capacity. This paper draws from recent extreme droughts in Arizona and Georgia to empirically assess adaptive capacity across spatial and temporal scales. It combines quantitative and qualitative methodologies to identify a handful of heuristics for increasing adaptive capacity of water management to extreme droughts and climate change, and also highlights potential tradeoffs in building and mobilizing adaptive capacity across space and time. [ABSTRACT FROM AUTHOR]

Nonresponse caused by denied access and hazardous conditions are a concern for the USDA Forest Service, Forest Inventory and Analysis (FIA) program, whose mission is to quantify status and trends in forest resources across the USA. Any appreciable amount of nonresponse can cause bias in FIA's estimates of population parameters. This paper will quantify the magnitude of nonresponse and describe the mechanisms that result in nonresponse, describe and qualitatively evaluate FIA's assumptions regarding nonresponse, provide a recommendation concerning plot replacement strategies, and identify appropriate strategies to pursue that minimize bias. The nonresponse rates ranged from 0% to 21% and differed by land owner group; with denied access to private land the leading cause of nonresponse. Current FIA estimators assume that nonresponse occurs at random. Although in most cases this assumption appears tenable, a qualitative assessment indicates a few situations where the assumption is not tenable. In the short-term, we recommend that FIA use stratification schemes that make the missing at random assumption tenable. We recommend the examination of alternative estimation techniques that use appropriate weighting and auxiliary information to mitigate the effects of nonresponse. We recommend the replacement of nonresponse sample locations not be used. [ABSTRACT FROM AUTHOR]

The Force Concept Inventory (FCI) is a multiple choice test designed to monitor students’ understanding of the conceptual domain of force and related kinematics (Hestenes et al. Physics Teacher 30:141–158 1992; Halloun et al., 1995, Online at http://modeling.asu.edu/R&E/Research.html). It has gained wide popularity among both researchers and physics instructors in the United States and elsewhere. The FCI has also been criticized, and its validity as a measure of the coherence of a student’s understanding of the force concept has been questioned. In this paper we provide a characterization of students’ conceptual coherence and a way to evaluate it using the FCI. We divide students’ conceptual coherence into three aspects: representational coherence (the ability to use multiple representations and move between them), contextual coherence (the ability to apply a concept across a variety of contexts), and conceptual framework coherence (the ability to fit related concepts together, i.e. to integrate and differentiate between them). Postinstruction FCI results and interview data from two Finnish high school groups ( n=49 total) are discussed; the data provide evidence that the FCI can be used to evaluate students’ conceptual coherence—especially contextual coherence—of the force concept. [ABSTRACT FROM AUTHOR]

This paper explores the question, “How do Jewish men and women who have become Orthodox ( baalei teshuvah) compare in their constructions of spirituality, work, learning, religious practices, and community?” It is based on a qualitative research study that included interviews with 48 baalei teshuvah (24 men, 24 women), two focus groups, and ten key informant interviews. Participants were from the East Coast of the USA. We found the women more affirmative about their spirituality and feelings about community; men identified with these experiences but not the terminology. The men gave more attention to work and to their struggles integrating work and religion. The women expressed excitement about learning whereas the men conveyed self-consciousness over their language and learning deficiencies. [ABSTRACT FROM AUTHOR]

Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations. [ABSTRACT FROM AUTHOR]

Background: The regulatory environment is one of the key factors in successfully bringing an innovative medical product, like a drug-device combination product, to market. This paper offers insight into the experiences of those involved in obtaining regulatory approval of drug-device combination products in the European Union and the United States. Methods: The research consisted of two phases, qualitative data collection (through semi-structured interviews) and analysis, followed by quantitative data collection (through an online survey) and analysis. Results: A conceptual model was developed that depicted the facilitating factors for obtaining regulatory approval of a drug-device combination product, relevant to the European Union and United States systems, respectively. Conclusions: This model provides, for the first time, a comprehensive understanding of these factors, providing a foundation that could be adapted to reflect specific drug-device combination products. This research demonstrated originality of approach in interviewing thought leaders in the life sciences sector as well as conducting a survey that spans two of the largest jurisdictions for drug-device combination products in the world. [ABSTRACT FROM AUTHOR]

Ethnography has become a useful method in procuring sensitive infonnation from the 'hidden population' who may not be accessed with quantitative survey techniques. Researchers are generating huge amounts of qualitative/textual data. Qualitative data require careful planning in storage, coding retrieval, and analysis. Personal computers have solved data management problems, but data analysis remains problematic. The paper describes some qualitative data management and analytic problems faced by a team of ethnographers engaged in a longitudinal epidemiological study of cocaine and crack distribution/abuse in New York City. Ethnographic data was collected through multisession open-ended interviews with more than one hundred cocaine/crack dealers and extensive field-notes were kept Compared to other programs, a hypertext software - Folio Views - was more useful in solving (a) data management and (b) analytical pmblems. Authors used this software to handle more than twenty-five thousand pages of texts; search and sort the database by any words or codes; and retrieve relevant textual materials needed to complete comparative and thematic analysis. Authors analyzed the data from outsiders' point of view (etic) as well as from the viewpoint of the subject populations (emic). [ABSTRACT FROM AUTHOR]

Racial trauma has long been an issue in American society. Recent incidents of racial violence, including the attack and murder of George Floyd and the rise of anti-Asian hate have garnered significant media attention. People often use social media to express their emotions and perspectives on national events, and it has become a popular forum for posting and commenting on content related to timely social issues. In effort to understand individual perspectives, and experiences of racial trauma discussed on social media, we analyzed content labeled with the hashtag "racial trauma" on TikTok during significant racial incidents from March 2020 to May 2022. Results of content analysis showed six themes, (1) encountering racism, (2) traumatic experiences, (3) consequences of experiencing racial trauma, (4) expressing difficult feelings, (5) questioning and challenging oppression, denial, and privilege, and (6) a call to action: raising awareness. Findings inform clinicians' understanding of how their clients experience racial trauma. Clinical implications for incorporating a nuanced understanding of racial trauma in mental health treatment are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Maternal & Child Health Journal is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study uses in-depth, qualitative interviews to examine the facilitators/supports and barriers/challenges faced by parents reentering their communities after incarceration. Findings are framed within the context of Bronfenbrenner's ecological framework. Parents reentering their communities after incarceration often face a host of challenges related to their reentry experience (e.g. finding housing/employment) and their parenting experience (e.g. navigating familial relationships). Parenting scholars have urged communities to adopt holistic intervention methods at each level of the ecological model—including an individual's microsystem, mesosystem, exosystem, and macrosystem to help families experiencing this trauma thrive. In order to examine which areas within the ecological system families are receiving support (and which areas are still lacking), this study uses qualitative data from 14 semi-structured interviews with parents who recently reentered their communities after incarceration and had a minor child at the time of reentry. Interviews were recorded, transcribed, and coded based on a priori themes. Participants listed both barriers/challenges and facilitators/strengths at reentry that fell into three main categories including 1. Access to children or resources, 2. Social connections, 3. Personal introspection related to parenting. Barriers and supports are described within each level of the ecological model. Findings suggest interventions are needed to buffer, support, and help reentering parents gain parenting skills/knowledge, spend quality time with their children, and access reentry programs to help parents/children develop healthy attachment and promote smoother reintegration into their community. These interventions should be implemented at various levels within the ecological model. Highlights: We examine the experiences of parents during incarceration and reentry using Bronfenbrenner's ecological model. At the microsystem level, parent/child relationships were strained because of lack of connections, problematic behavior, and lack of social support. At the mesosystem level, parents experienced challenges with reentry programming, prison policies, and custody issues. At the exosystem level, parents discussed difficulty finding housing/employment that was sufficient for their families. At the macrosystem level, parents described how wide-spread policies (e.g., background checks, prison policies) impacted them on an individual level. [ABSTRACT FROM AUTHOR]

Background: Refractory chronic cough (RCC), a cough lasting longer than 8 weeks with an unexplained underlying etiology and unresponsive to conventional treatment, can have substantial effects on patients' quality of life. For assessment of the efficacy of antitussive medication in clinical trials in RCC, patient-reported outcome (PRO) instruments should be fit for purpose with appropriate content validity. Here we describe the qualitative testing of a newly developed PRO instrument: the Severity of Chronic Cough Diary (SCCD). Methods: The SCCD was developed to assess patients' symptom experience of cough in patients with RCC. A preliminary version was tested and refined based on an iterative process in a qualitative study. In total, three rounds of interviews were conducted with adult participants diagnosed with RCC in the USA (n = 19) and UK (n = 10). Rounds 1–3 consisted of hybrid concept elicitation (CE) interviews and cognitive interviews (CIs), with Round 3 also including interviews in a subset of participants (n = 5) about the usability of the SCCD as administered on an electronic handheld device. Results: The CE interviews identified concepts important to patients' experiences related to RCC that were broadly in line with the concepts in the preliminary version of the SCCD. Participants provided positive feedback on the draft SCCD across all CI rounds, reporting the instrument to be relevant and straightforward to complete, and containing a comprehensive set of concepts to evaluate their symptom experience of RCC. Participants demonstrated a good understanding of proposed item wording, response options, and the 24-hour recall period, and thought completion of the SCCD on the electronic device was easy. Following revisions based on results from each interview round, the SCCD at the end of this qualitative research study had 14 items assessing the concepts of: cough symptoms (five items), symptoms related to cough (four items), disruption to activities due to cough (three items), and disruption to sleep due to cough (two items). Conclusions: The results of this study provide qualitative evidence supporting the content validity of the SCCD as a PRO instrument for evaluating outcomes of therapies for RCC in clinical trials. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) is an inherited disease which causes premature atherosclerotic cardiovascular disease. However, less than 10% of individuals with FH have been identified. Objective: To assess parental perspectives for inclusion of FH on routine newborn screening (NBS) and to highlight potential benefits, harms, and ethical concerns. Methods: Telephone interviews of two groups were conducted: 1) parents of children diagnosed with FH, and 2) parents of children diagnosed with a genetic condition through NBS. Stratified purposive sampling was used to ensure adequate representation. The 11 telephone interviews were conducted in 30-min sessions guided by a semi-structured interview script. At the beginning of the interview, participants were educated on the NBS process and FH. The interviews were transcribed verbatim, and a thematic analysis was performed in multiple steps. Results: All interviewees indicated that they would be interested in having their child be screened for FH on the newborn screen. Reasons supporting screening during the newborn period included knowing their child's diagnosis, the ability to screen family members for FH, incorporation of lifestyle changes, and access to preventive care. Negatives surrounding screening during the newborn period included increased stress or anxiety, knowledge, stigma, and the delay from diagnosis to initiation of pharmacotherapy for FH. Conclusion: While these interviewees were in favor of NBS for FH, further education of parents and clinicians is needed to ensure proper implementation. The results of this study may be useful to formulate family notification and care protocols for newborns diagnosed with FH and other diseases. Significance: What is already known on this subject? Familial hypercholesterolemia is a common inherited disorder that predisposes to early cardiovascular disease, but most affected individuals are not diagnosed. Childhood cholesterol screening is an effective but underutilized diagnostic tool. Previous studies report parents find childhood cholesterol screening acceptable, but it is not known if screening newborns would also be acceptable. What does this study add? Interviewees found screening newborns for familial hypercholesterolemia acceptable and would agree to screen their own newborn. The ability to screen other family members and access to early treatment were important factors in their decision to screen. Education of clinicians about familial hypercholesterolemia was an important concern raised by interviewees. [ABSTRACT FROM AUTHOR]

Background: The Symptoms of Infection with Coronavirus-19 (SIC) is a 30-item patient-reported outcome (PRO) measure scored by body system composites to assess signs/symptoms of coronavirus disease 2019 (COVID-19). In addition to cross-sectional and longitudinal psychometric evaluations, qualitative exit interviews were conducted to support the content validity of the SIC. Methods: In a cross-sectional study, adults diagnosed with COVID-19 in the United States completed the web-based SIC and additional PRO measures. A subset was invited to participate in phone-based exit interviews. Longitudinal psychometric properties were assessed in ENSEMBLE2, a multinational, randomized, double-blind, placebo-controlled, phase 3 trial of the Ad26.COV2.S COVID-19 vaccine. Psychometric properties evaluated included structure, scoring, reliability, construct validity, discriminating ability, responsiveness, and meaningful change thresholds of SIC items and composite scores. Results: In the cross-sectional study, 152 participants completed the SIC (mean age, 51.0 ± 18.6 years) and 20 completed follow-up interviews. Fatigue (77.6%), feeling unwell (65.8%), and cough (60.5%) were symptoms most frequently reported. SIC inter-item correlations were all positive and mostly moderate (r ≥ 0.3) and statistically significant. SIC items and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) scores correlated as hypothesized (all r ≥ 0.32). Internal consistency reliabilities of all SIC composite scores were satisfactory (Cronbach's alpha, 0.69–0.91). SIC composite scores correlated moderately (r = 0.30–0.49) to strongly (r ≥ 0.50) with PROMIS-29 scores and Patient Global Impression of Severity (PGIS) ratings (all P < 0.01). A variety of signs/symptoms were cited in exit interviews, and participants considered the SIC straightforward, comprehensive, and easy to use. From ENSEMBLE2, 183 participants with laboratory-confirmed moderate to severe/critical COVID-19 were included (51.5 ± 14.8 years). Strong test-retest reliabilities were observed for most SIC composite scores (intraclass correlations ≥ 0.60). Statistically significant differences across PGIS severity levels were found for all but 1 composite score, supporting known-groups validity. All SIC composite scores demonstrated responsiveness based on changes in PGIS. Conclusions: The psychometric evaluations provided strong evidence for the reliability and validity of the SIC for measuring COVID-19 symptoms, supporting its use in vaccine and treatment trials. In exit interviews, participants described a broad range of signs/symptoms consistent with previous research, further supporting the content validity and format of the SIC. Plain english summary: Coronavirus disease 2019 (COVID-19) is a serious disease that continues to evolve globally. Researchers developed the Symptoms of Infection with Coronavirus-19 (SIC), a 30-item questionnaire designed for patients to report signs and symptoms of COVID-19. In this study, the researchers formally analyzed how well the SIC measures the patient experience with COVID-19, using survey and clinical trial data as well as telephone interviews. Adults with COVID-19 and at least 2 bothersome symptoms completed the web-based survey, and some of these individuals also participated in in-depth interviews. Participants in a clinical trial for a COVID-19 vaccine also completed the SIC measure. The SIC was compared with other commonly used questionnaires that evaluate patient experience. The most commonly reported symptoms of COVID-19 were fatigue, feeling unwell, cough, weakness, and headache. The items for individual symptoms (e.g., "cough") and combined scores for body systems (e.g., "respiratory system") performed well in statistical analyses. Participants found the SIC to be straightforward, comprehensive, and easy to use. The SIC may prove useful in the future for vaccine and treatment trials for COVID-19. [ABSTRACT FROM AUTHOR]

Adolescents and sexual minority men (SMM) are high priority groups in the United Nations' 2021 − 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determinants as well as a range of 17 strategies that were used in 90 instances to support intervention implementation. We highlight lessons learned in the implementation research process and provide recommendations for researchers considering future HIV implementation science studies with adolescent SMM. [ABSTRACT FROM AUTHOR]

Purpose: Some hospitals in the United States (US) use intensive care 20 times more than others. Since intensive care is lifesaving for some but potentially harmful for others, there is a need to understand factors that influence how intensive care unit (ICU) admission decisions are made. Methods: A qualitative analysis of eight US hospitals was conducted with semi-structured, one-on-one interviews supplemented by site visits and clinical observations. Results: A total of 87 participants (24 nurses, 52 physicians, and 11 other staff) were interviewed, and 40 h were spent observing ICU operations across the eight hospitals. Four hospital-level factors were identified that influenced ICU admission decision-making. First, availability of intermediate care led to reallocation of patients who might otherwise be sent to an ICU. Second, participants stressed the importance of ICU nurse availability as a key modifier of ICU capacity. Patients cared for by experienced general care physicians and nurses were less likely to receive ICU care. Third, smaller or rural hospitals opted for longer emergency department patient-stays over ICU admission to expedite interhospital transfer of critically ill patients. Fourth, lack of clarity in ICU admission policies led clinicians to feel pressured to use ICU care for patients who might otherwise not have received it. Conclusion: Health care systems should evaluate their use of ICU care and establish institutional patterns that ensure ICU admission decisions are patient-centered but also account for resources and constraints particular to each hospital. [ABSTRACT FROM AUTHOR]

This study examined how students with orthopedic impairments experienced strategies identified in the literature to support 'inclusion'. An interpretative phenomenological analysis research approach was used, and six students with orthopedic impairments (age 10–14 years) served as participants. Data sources were written prompts, semi-structured, audiotaped interviews, and reflective interview notes. Based on thematic data analysis, four themes were constructed: "It's kind of embarrassing": experiences with support; "I don't want to be different": equipment, activity, and rule modifications; "I like to be a part of the conversation": autonomy and choice in PE; and "I would rather be like the other students": discussing disability. The experiences portrayed through these themes highlighted the differential effects of these explicated strategies, where each strategy contributed to feelings of inclusion, as well as marginalization among participants. As such, the findings indicated that 'inclusive' strategies should not be considered as blanket recommendations; instead, attempts to promote 'inclusion' of students with disabilities should start with a reflexive look at the unique needs of each individual student. [ABSTRACT FROM AUTHOR]

Background: To capture the broad range of treatment burden issues experienced by adolescent and adult people with hemophilia (PWH), the Hemophilia Treatment Experience Measure (Hemo-TEM) was developed. We describe the development of this new hemophilia-specific patient-reported outcome (PRO) measure including concept elicitation, cognitive debriefing, and psychometric validation. Results: Concept elicitation interviews were conducted with 5 clinical experts and 30 adult PWH in the United States (US). The qualitative analysis of these interviews and a review of the literature informed the PRO measure development. The project team reviewed concept endorsement rates and generated a 27-item preliminary version of the Hemo-TEM. Cognitive debriefing interviews were conducted to ensure participant understanding and item relevance in samples of (adolescent (n = 20) and adult (n = 14)) PWH in the US. The refined, validation-ready version of the Hemo-TEM included 30 items. Lastly, data from 3 clinical trials comprised the 4 analysis sets used for the psychometric validation with a sample size of N = 88. Item reduction dropped 4 items resulting in a final 26-item measure. Factor analysis generated 5 domains in the Hemo-TEM [injection difficulties (3 items), physical impact (6 items), treatment bother (7 items), interference with daily life (4 items), and emotional impact (6 items)] and a total score. All scores were reliable [internally consistent (0.84–0.88)]. For convergent validity, with the exception of one domain, all hypothesized associations were met. Preliminary sensitivity to change effect sizes were between − 0.30 and − 0.70. Meaningful change thresholds ranged from 6 points (physical impact and emotional impact) to 10 points (treatment bother) with 8 points for the Hemo-TEM total score. Conclusions: Findings from the concept elicitation, cognitive debriefing, and psychometric validation phases provide evidence that the Hemo-TEM is a well-designed, valid, and reliable measure of the burden of hemophilia treatment, including treatment impact on adolescent and adult PWH. [ABSTRACT FROM AUTHOR]