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Patients living with multiple myeloma (MM) have a substantial disease burden and face multiple barriers to care. Building upon our previous research using mixed methods, this focus group research aimed to identify patients' priorities regarding specific social and identity-related needs, map these prioritized needs to the disease journey, and describe patient-generated ideas to improve patient support. Participants noted that patients with MM need a range of emotional, social, and financial support throughout the disease journey. They identified initial MM diagnosis and treatment adherence as two critical points in the MM journey where patients need the most support and assistance. The findings of this research suggest that overall, patients with MM need comprehensive support, ideally from a multidisciplinary team consisting of health care providers, patient advocates, social workers, and psychologists to help patients understand their disease and treatment options, make informed treatment decisions, adhere to treatment, and ultimately reduce their disease burden and improve outcomes. This research revealed that patients with MM need varying types and levels of support, with the most common needs including information on disease and treatment, connections to financial resources and support systems, assistance with navigating insurance options, and transportation and logistical support for medical appointments. [ABSTRACT FROM AUTHOR]

Background: Hospice care leads to improved patient and family outcomes. Hospice use among older adults with end‐stage kidney disease (ESKD) is markedly lower than among older adults with other serious illnesses, and the majority of those with ESKD who use hospice enroll in the last days of life. Here, our aim was to explore barriers to timely receipt of high‐quality hospice care for older adults with ESKD. Methods: Utilizing a qualitative study design, we conducted a secondary analysis focused on hospice, a theme that we identified in our larger overarching study that involved semi‐structured interviews with 20 nephrologists in the United States focused on treatment decision‐making in older adults with advanced chronic kidney disease. We analyzed the interview transcripts using emergent thematic analysis to develop an understanding of barriers to high‐quality hospice. Results: With a couple notable exceptions, nephrologists voiced general support for the concept of hospice, but few recalled patients of theirs who had received hospice. Nephrologists' interviews revealed two interrelated contributors to the lack of timely access to high‐quality hospice care for seriously ill older adults with ESKD: (1) nephrologists view dialysis and hospice as mutually exclusive models of care; (2) nephrologists feel unsure who should manage hospice care for patients with ESKD. The first contributor was rooted in nephrologists' narrow vision of when to consider hospice (informed, in part, by policy barriers) and, in a couple of cases, strong discomfort with hospice. The second stemmed from nephrologists' belief that neither they nor hospice are adequately prepared to provide hospice care for ESKD. Conclusions: Our findings suggest that, in addition to Medicare policy change, nephrologists need to receive more training in primary palliative care skills including in indications for hospice, initiating conversations about hospice with patients, and collaborating with hospice clinicians to care for these vulnerable patients. [ABSTRACT FROM AUTHOR]

Adolescents go through a critical process of identity formation. This time in their life can be confusing and having a mentor to provide support and guidance has proven to be helpful and may increase self-esteem, self-efficacy, problem-solving and coping skills in youth. In this qualitative narrative study, at-promise youth from historically oppressed communities (ages 12 to 15) who participated in a 12-week therapeutic youth mentoring program, were interviewed utilizing a creative method called photo-elicitation. Photo-elicitation and semi-structured questions facilitated the narrative interview process allowing the youth to share experiences surrounding identity formation through photographs. Significant findings are presented in narrative form utilizing participant quotes to capture the emotion, language, and perspective of the participants' perceptions of self and identity. Implications for mental health professionals working with adolescents during a time of self-exploration and identity formation, and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Methods: Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Results: Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P <.05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P =.057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Conclusion: Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system. [ABSTRACT FROM AUTHOR]

Background: Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care social work intervention that aims to improve delivery of goal-concordant care for hospitalized older adults with cancer discharged to skilled nursing facilities. Objective: Explore processes through which ALIGN may improve delivery of goal-concordant care to substantiate the conceptual model grounding the intervention and to inform mechanistic hypotheses of how the intervention might be effective. Design: A process evaluation triangulating findings from patient and caregiver interviews with a matrix analysis of ALIGN social worker notes. Setting/Participants: Patients (n = 6) and caregivers (n = 13) who participated in a single-arm pilot study of ALIGN in the United States and 113 intervention notes (n = 18 patients) written by 2 ALIGN social workers. Measurement: Qualitative thematic content analysis Results: Themes included the following: (1) ALIGN helped reconcile participants' misaligned expectations of rehabilitation with the reality of the patient's progressive illness; (2) ALIGN helped participants manage uncertainty and stress about forthcoming medical decision making; (3) the longitudinal nature of ALIGN allowed for iterative value-based goals of care discussions during a time when patients were changing their focus of treatment; and (4) ALIGN activated participants to advocate for their needs. Conclusions: ALIGN offers support in prognostic understanding, communication, and decision making during a pivotal time when patient and caregivers' goals have not been met and they are reassessing priorities. A larger trial is needed to understand how these processes may improve the ability of participants to make value-based decisions and aide in delivery of goal-concordant care. Clinical Trial Registration Number: NCT04882111. [ABSTRACT FROM AUTHOR]

In this article, we describe the exploration of the content and quality of annual goals included in the Individualized Education Programs (IEPs) of students with disabilities in one rural U.S. school district. We utilized content analysis to understand the district's service delivery model comprehensively. Findings revealed disparities between inclusive placements and special education service delivery, suggesting that, despite high rates of inclusive placements noted on IEPs, most services occurred outside general education classrooms, especially for students with intellectual and developmental disabilities (IDD). We evaluated the quality and rigor of 546 annual goals using a rubric adapted from Kurth et al. Only 37.7% of goals were rated as rigorous, highlighting a need for clearer, more specific, and applicable goals. Notably, communication goals for students with IDD were largely absent, raising concerns about support for meaningful participation in general education settings. In addition, special factors related to communication and assistive technology were not consistently addressed in IEPs. We discuss implications for improving educational experiences for students who qualify for special education services under IDD in rural schools and highlight the value of further research and actions in this area. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is a prevalent issue among older adults in the United States that impairs quality of life. Physical activity has emerged as a costeffective and non-pharmacological treatment for chronic pain, offering benefits such as improved physical functioning, weight loss, and enhanced mood. However, promoting physical activity in older individuals with chronic pain is challenging, given the cyclical relationship between pain and sedentary behavior. The Mobile Intervention to Reduce Pain and Improve Health (MORPH) trial was designed as an innovative, mobile health (mHealth) supported intervention to address this issue by targeting daylong movement, weight loss, and mindfulness to manage pain in older adults with chronic multisite pain. The objective of this paper is to provide the result of a qualitative analysis conducted on post-intervention interviews with MORPH participants. Methods: At the conclusion of the MORPH study, 14 participants were interviewed regarding their experience with the program. All interviews were conducted by phone before being transcribed and verified. A codebook of significant takeaways was created based on these accounts. Summaries were further synthesized into themes using the principles of thematic analysis. Results: Three key themes of the MORPH intervention emerged from the qualitative interviews: MORPH technology (smart scales, Fitbit, MORPH Companion App) facilitated program adherence and accountability; MORPH intervention components (food tracking and mindfulness activities) facilitated program adherence and awareness, respectively; and, group meetings provided motivational support and accountability. Mobile health technologies, including a dedicated MORPH app, facilitated self-monitoring strategies, helped to break the cycle of old habits, and provided participants with immediate feedback on successes; however, technical issues required timely support to maintain engagement. Food tracking contributed to adherence and accountability for weight loss. Mindfulness activities increased participants' awareness of anxiety provoking thoughts and pain triggers. Finally, social support via group meetings and connection, played a crucial role in behavior change, but participants noted consistency in the delivery medium was essential to fostering genuine connections. Conclusion: Overall, the study results highlight the key considerations related to program technology, intervention components, and the value of social support that can help to guide the development of future interventions similar to MORPH. [ABSTRACT FROM AUTHOR]

Many refugee children experience trauma in early childhood. Effective, tailored interventions are needed to improve refugee children's access to preventive mental health. We interviewed refugee-serving stakeholders and parents participating in an evidence-based preventive mental health and wellness intervention adapted for Afghan refugee children and families who may have experienced trauma. Interview guide development was informed by two implementation science frameworks: the Consolidated Framework for Implementation Research and the Model for Adaptation Design and Impact. A three-person team coded transcripts via rapid qualitative analysis, and the study team reached consensus on themes. Six refugee-serving facilitators and five refugee parents discussed key determinants of successful implementation. Themes included: (i) modeling cultural humility to promote communication about emotions; (ii) needed linguistic support and referral networks to avoid miscommunications and missed communications; (iii) bridging connections between children, families and schools; (iv) different takeaways, or differing goals and expectations between facilitators and participants; and (v) timely, specific cultural considerations to overcome participation barriers. Overall, we found key determinants of successful implementation of a preventive mental health and wellness intervention for refugee children and families included adaptations to enhance cultural humility and sensitivity to cultural context while strengthening communication among facilitators, children and families. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical activity (PA) is a promising intervention for disease modification and symptom management in multiple sclerosis (MS); however, there is a lack of research focusing on PA behavior change interventions for persons newly diagnosed with MS. Such PA behavior change interventions should be developed based on a strong empirical foundation of understanding the behavior and its determinants (ie, what to target for changes to occur). To that end, this qualitative study examined factors explaining PA in persons newly diagnosed with MS and identified potential targets for future behavior change intervention development based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. METHODS: Twenty individuals diagnosed with MS within the past 2 years underwent one-on-one semistructured interviews using questions developed based on the COM-B model. Data were analyzed using reflective thematic analysis, and the identified themes were then mapped with the COM-B model. RESULTS: Factors explaining PA in the study sample were identified across the COM-B components. The typical factors include knowledge and skills to sufficiently engage in PA with appropriate approaches, ability to adapt and navigate through new environmental and social difficulties after diagnosis, and motivation resulting from a combination of factors, such as outcome expectation, belief of capabilities, role/identity, reinforcement, and emotions. CONCLUSIONS: The COM-B model was applied successfully in this study to understand PA behavior and identify potential targets for behavior change in individuals newly diagnosed with MS. Future behavior change interventions should consider addressing these factors to generate effective PA behavior change in this population. [ABSTRACT FROM AUTHOR]

AIMThis study explored the experiences of prelicensure nursing students for whom English is an additional language when preparing for and taking course examinations. BACKGROUND English-as-an-additional-language students face challenges related to language comprehension on nursing examinations. Recognizing their unique obstacles may assist in designing equitable assessments and processes that improve outcomes. METHOD Responding to 14 semistructured, guided questions, 16 students discussed their experiences preparing for and taking nursing examinations. RESULTS Three primary themes related to student academic success emerged: psychological factors, perseverance, and factors affecting outcomes. Data revealed language as a factor that affected outcomes. Positive factors of note included self-confidence and diligence to succeed. CONCLUSION The results outline challenges faced by nursing students for whom English is an additional language and include strategies for promoting equity and academic success. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic caused significant changes for family-- professional interactions. Many services shifted to telepractice, with new opportunities for parents and speech-language pathologists (SLPs) to partner for service delivery. Parent-coached models of augmentative and alternative communication (AAC) intervention provide positive outcomes for children; however, SLPs have reported difficulty building strong partnerships with families. The shift to telepractice during the COVID-19 pandemic provided a unique context to examine factors influencing parent--SLP partnerships, particularly for parents with children who use aided AAC. Method: Twenty-five parents and 25 SLPs who engaged in services with children and youth from 3 to 21 years of age who used aided AAC during the initial stages of the COVID-19 pandemic in June 2020 participated. Semistructured interviews were conducted individually with parents and SLPs to understand perspectives on whether the change in service delivery facilitated or hindered family-oriented practice. Inductive qualitative analysis was used to analyze information about the factors impacting parent--SLP partnerships. Results: The parent--SLP partnership was influenced by setting and systemic determinants, and intrinsic determinants to the parent and the SLP that included their history and rapport, beliefs about partnering, and knowledge and skills. These determinants served as barriers or facilitators to their partnership. Conclusions: It is essential to consider the relationship, expectations, and knowledge and skills that SLPs and parents bring to the partnership, along with extrinsic structural factors that can impact this partnership. Positive rapport, valued partnership, and an openness to sharing knowledge through teaming and collaboration provided for positive parent--SLP partnerships. [ABSTRACT FROM AUTHOR]

Persons with lower limb loss (PwLLL) must self-manage their residual limb and their prosthesis to prevent self-management related complications (SMRC). However, the experience of PwLLL as it relates to self-management has not been reported. Thus, the purpose of this study was to explore the experience of self-management from the perspective of PwLLL, prosthetists, and physical therapists. This study had a qualitative design. Twenty-three participants were interviewed (PwLLL = 10, prosthetists = 7, physical therapists = 6). Interviews were transcribed and then coded using constant comparison. Four prominent themes were developed from the transcripts: (1) embodying the duty of self-management, (2) being a vigilant self-advocate, (3) setting goals collaboratively, and (4) making informed decisions. Each of the four themes were influenced by the health beliefs of the PwLLL, specifically motivation and presence of an internal locus of control. Clinicians should emphasize the therapeutic relationship, including open communication, collaborative goal setting, and promoting an internal locus of control in interactions with PwLLL, as it may play a role in decreasing SMRC and improving clinical outcomes. Self-management is a crucial aspect of preventing secondary complications associated with limb loss and prosthesis use. Self-management requires an internal locus of control, problem-solving abilities, and foundational knowledge Clinicians can promote self-management through collaborative goal setting and systematic education. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to assess whether the change from in-person to virtual interviews was associated with differences in applicant and match location geography. METHODS: We conducted a retrospective study of all U.S. applicants to a large pediatric residency. Distances from applicants to our residency program (applicant-to-program) and residency location (applicant-to-match) were compared across demographic subgroups and eras, defined as pre-COVID (2018-2020) and COVID (2021-2022). RESULTS: Applicant-to-program distance (pre-COVID median 737 miles, IQR 265, 1254; COVID median 739 miles; IQR 268, 1284, P = .31) did not change across eras. While overall applicant-to-match distance (pre-COVID median 425 miles, IQR 88, 1142; COVID median 354 miles; IQR 80, 1084, P = .11) did not change, subgroup analysis revealed that applicant-to-match distance for those not participating in a couples match was farther during the pre-COVID era (430 vs 340 miles, P = .04). CONCLUSIONS: A transition to virtual interviews was associated with shorter distance between applicants and residency location for those matching alone at a large, urban pediatric residency. While decisions about where to apply appeared unchanged, rank list decisions may have been impacted by virtual interviews for these applicants. Further study to describe geographic considerations in the virtual era are needed to inform advancement of larger workforce goals. [ABSTRACT FROM AUTHOR]

Work ability, or the perception of one's ability to work presently and in the future, may impact quality of life (QOL) among young adult (YA) cancer survivors. Through a convergent mixed methods design, we explored work ability, work-related goals, and QOL among YA hematologic cancer survivors within five years of diagnosis. We described associations at the individual- and microsystem (work)- levels; and compared factors across low and high work ability groups. Participants (N = 40) completed a survey and interview via digital platforms. Qualitative analysis revealed self-assessed declines in work ability led to questioning work-related goals and influenced QOL. Integrated analysis led to the development of four profiles, growing our understanding of work's influence on QOL for YA cancer survivors, and identifying components YAs considered when contemplating work-related goals after a cancer diagnosis. Larger studies are needed to elucidate these profiles and identify modifiable factors to inform targeted interventions to improve QOL. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is highly individualized in terms of its flare ups and periods of remission. Each patient's unique experience requires a high level of personalization in terms of treatment making it necessary to understand what their goals for living are. This study explores patient perceptions on how the burden of RA shapes patients' goals for living and their preferences for symptom and side-effect management within the United States. Fifteen patients diagnosed with RA with varying lengths of diagnosis were interviewed. A thematic analysis was conducted to construct a conceptual framework. Emerging themes identified disease burdens as: (1) inability to perform essential needs, (2) negative feelings about disease, and (3) its influence on relationships. These burdens shaped desired goals for living which guided the symptom and side-effect priorities the patient wanted managed. Practitioners should consider patient goals and preferences in conjunction with disease progression when engaging in treatment decisions. [ABSTRACT FROM AUTHOR]

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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]

Cardiovascular (CV) disease is the leading cause of death among women in the United States, making CV risk screening and management a women's health priority. Objectives were to elicit barriers and facilitators to CV risk identification and reduction among women veterans, and iteratively cocreate clinical tools to identify CV risk factors and promote goal-setting for lifestyle changes. We conducted three exploratory focus groups with 21 Veterans Health Administration primary care team members and piloted patient CV screeners with brief interviews with 19 patients from two Veterans Health Administration women's clinics to inform toolkit development. We then conducted two focus groups and one interview for feedback from a total of 12 staff on the proposed toolkit components. Transcripts were summarized, and a matrix analysis was used to synthesize qualitative findings. Provider-identified barriers included difficulties disseminating CV information in clinic, limited patient knowledge, and lack of organized resources for provider communication and available referrals. Women's complex health needs were notable challenges to CV risk reduction. Facilitators included having a single place to track patient CV risks (e.g., an electronic template note), a patient screening worksheet, and aids to complete referrals. Patient-identified barriers included difficulties balancing health, finances, and physical and mental health concerns. Facilitators included resources for accountability and gender-specific information about CV risks and complications. Providers requested easy, accessible tools in the electronic record with gender-specific CV data and resources linked. Patients requested lifestyle change supports, including trustworthy sources vetted by providers. Iteratively eliciting end-users' perspectives is critical to developing user-friendly, clinically relevant tools. CV risk reduction among women veterans will require multilevel tools and resources that meet providers' and women's needs. [ABSTRACT FROM AUTHOR]

Background: Primary palliative care is needed to meet the complex needs of patients with serious illness and their families. However, patient perceptions of primary palliative care are not well understood and can inform subsequent primary palliative care interventions and implementation. Objective: Elicit the patient perspective on a primary palliative care intervention, Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA), from patient perspectives. Design: Qualitative study using patient interviews and two methods of triangulation. Setting/Subjects: Between July 2014 and September 2015, we interviewed 45 patients who participated in the intervention in a Veterans Affairs (VA) (primary site), academic, and urban safety-net health system in the United States. Main Measures: Participants were asked about what was most and least helpful, how the intervention affected participants' lives, and what should be changed about the intervention. Data were analyzed using a general inductive approach. To enhance validity of the results, we triangulated the findings from patient interviews, reviews of care coordinator documentation, and interprofessional palliative care providers. Results: The six themes identified that primary care intervention: (1) Cared for My Psychosocial Needs, (2) Encouraged Self-Management, (3) Medication Recommendations Worked, (4) Facilitated Goal Attainment, (5) Team was Beneficial, and (6) Good Visit Timing. Conclusions: Participants experienced benefits from the primary palliative care intervention and attributed these benefits to individualized assessment and support, facilitation of skill building and self-management, and oversight from an interprofessional care team. Future primary palliative care interventions may benefit from targeting these specific patient-valued processes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs). Design/methodology/approach: The authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis. Findings: The transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability. Originality/value: Younger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI. [ABSTRACT FROM AUTHOR]

Background: During October 2016 through May 2018, a learning community was convened to focus on policies and programs to increase access to the full range of contraceptive options for women of reproductive age. The Increasing Access to Contraception (IAC) Learning Community included 27 jurisdictions, with teams from each jurisdiction consisting of state health department leaders, program staff, and provider champions. At the kick-off meeting, teams from each jurisdiction created action plans that outlined their goals. Methods: We contacted jurisdictions during May–June 2019, 1 year after the learning community ended, and invited them to complete a post-assessment of goal achievement and sustainment through semi-structured interviews over the telephone or via email. Results: Follow-up information was collected from 26 jurisdictions (96%) that participated in the learning community. The teams from these jurisdictions had created 79 total goals. At the time of the learning community closing meeting in May 2018, 35 goals (44%) had been achieved. Three jurisdictions achieved all their goals by the close of the learning community. At the time of the post-assessment 1 year later, jurisdictions were sustaining efforts for 69 (87%) of the total goals. In every jurisdiction, work on at least one goal that originated in the learning community was sustained. Conclusions: The jurisdictions that participated in the IAC Learning Community continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation. [ABSTRACT FROM AUTHOR]

Purpose: Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method: An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results: Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions: Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners can play a pivotal role in supporting breastfeeding mothers as they transition to and form new routines for this occupation. Objective: To explore whether occupational therapy programming can assist breastfeeding mothers in reaching their personal occupation-based wellness goals. Design: Mixed-methods design that involved development of an occupational profile and a goal attainment scale (GAS). After the intervention, participants rescored their GAS goals and completed a semistructured exit interview. Setting: Nonprofit lactation center located in the suburbs of a large mid-Atlantic U.S. city. Participants: Women recruited through convenience sampling who had been breastfeeding an infant for <6 mo, who were not currently weaning, and who had met with a lactation consultant at least once since giving birth were eligible (N = 17). Intervention: Group occupational therapy that consisted of 10 weekly 1-hr sessions. Topics were based on occupational profiles, GAS scores, and lactation consultant input. Outcomes and Measures: Each participant created and scored three goals using the GAS before and after the intervention. Results: Data from 14 of the 17 participants were analyzed. The average postintervention GAS score was 56.50 (M = 50), indicating that most personal wellness goals were reached. Thematic analysis revealed that occupational therapy programming helped mothers persevere with breastfeeding, feel more confident as new parents, and value both themselves and their baby. Conclusions and Relevance: There is an increasing role for occupational therapy practitioners in helping new mothers reach their personal wellness goals in ways that support their ability to continue breastfeeding. What This Article Adds: Maternal wellness and breastfeeding represent an emerging area of practice in which occupational therapy practitioners can provide new mothers with physical, social, and psychological supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. This study provides foundational evidence in support of this collaboration. Maternal wellness and breastfeeding is an emerging area of practice in which occupational therapy practitioners can provide new mothers with supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. [ABSTRACT FROM AUTHOR]

AIM: The aim of this research was to identify factors that facilitated successful completion of a prelicensure registered nursing program for African American men. BACKGROUND: Successful completion of prelicensure nursing programs by African American men can increase diversity in the nursing profession. Further investigation is needed to understand the factors that can lead to success in completing prelicensure programs. METHOD: An explanatory, multiple-case study design was used to explore the personal characteristics, perspectives, and life events of African American men who completed prelicensure nursing programs. RESULTS; The five factors that influenced success were establishing goals, securing financial resources, maintaining family as a support system, meeting academic expectations, and developing a sense of belonging. CONCLUSION: Recommendations for how nurse educators can implement strategies to promote success for this population of students are discussed. [ABSTRACT FROM AUTHOR]

There is a dearth of available supports and services aimed specifically at parents with disabilities. The Parent-Centered Planning (PCP) intervention was developed to fill this gap, aiming to enhance supports for parenting for parents with disabilities. This brief approach was modeled after person-centered planning, with a focus specifically on parenting. This qualitative paper explores the experiences of a sample of parents (N = 13) with physical, intellectual and/or developmental disabilities who participated in a pilot study of PCP. Our study found that nearly all parents participating in the intervention strengthened relationships during the process of participation in PCP, clarified their goals related to parenting, and made progress toward their identified goals. The study also found that parents had mental health concerns, often related specifically to their disability supports. The article describes the nuances of these findings and discusses the implications for practice and future research. [ABSTRACT FROM AUTHOR]

Problem: Medical students perceive honors grading during core clerkships as unfair and inequitable, and negatively impacting their learning and wellbeing. Eliminating honors grading, a powerful extrinsic motivator, and emphasizing formative feedback may address these problems and promote intrinsic motivation and learning. However, it is unknown how transitioning from honors to pass/fail grading with enhanced formative feedback in the core clerkship year may affect student learning experiences, wellbeing, and perceptions of the learning environment. Intervention: Core clerkship grading was transitioned from honors/pass/fail to pass/fail at one US medical school. In addition, the requirement for students to obtain formative supervisor feedback was formalized to twice per week. Context: This qualitative study utilized semi-structured interviews to explore the perceptions among core clerkship students of learning and assessment. Interview questions addressed motivation, wellbeing, learning behaviors, team dynamics, feedback, and student and supervisor attitudes regarding assessment changes. The authors analyzed data inductively using thematic analysis informed by sensitizing concepts related to theories of motivation (goal orientation theory and self-determination theory). Impact: Eighteen students participated, including five with experience in both honors-eligible and pass/fail clerkships. The authors identified three major themes in students' descriptions of the change in approach to assessment: student engagement in clerkships, wellbeing, and recognition of learning context. Student engagement subthemes included intrinsic motivation for patient care rather than performing; sense of agency over learning, including ability to set learning priorities, seek and receive feedback, take learning risks, and disagree with supervisors, and collaborative relationships with peers and team members. Positive wellbeing was characterized by low stress, sense of authenticity with team members, prioritized physical health, and attention to personal life. Learning context subthemes included recognition of variability of clerkship contexts with pass/fail grading mitigating fairness and equity concerns, support of the grading change from residents and some attendings, and implications surrounding future stress and residency selection. Lessons Learned: Students perceive a transition from honors grading to pass/fail with increased feedback as supporting their engagement in learning, intrinsic motivation, and wellbeing. Drivers of wellbeing appear to include students' feelings of control, achieved through the ability to seek learning opportunities, teaching, and constructive feedback without the perceived need to focus on impressing others. Ongoing evaluation of the consequences of this shift in assessment is needed. [ABSTRACT FROM AUTHOR]

Background: Goal Attainment Scaling (GAS) is advocated as a meaningful outcome measure for parents and clinicians using an Ayres Sensory Integration® Intervention (ASI) approach. Although used in several treatment effectiveness studies, reliability of therapist goal writing and scoring has not been established in this area. Method: Ten occupational therapists and 40 parents of children receiving ASI participated across two clinical sites. The interview therapists and inter-rater therapists wrote GAS goals based on the same goalsetting interviews conducted with parents. Follow-up parent interviews were conducted post-ASI intervention, and the GAS goals were rated by both the interview therapists and inter-rater therapists. Results: Seventy-eight percent of interview therapist and inter-rater therapist-written goals agreed on content. Intra Class Correlation coefficient of agreement between the two sets of raters was .70 for the total score. Control of bias for establishing and rating the projected level of performance and scaled GAS goals was within an acceptable range. Conclusion: Findings contribute reliability evidence for use of GAS with children with sensory processing and integration challenges. Two therapists, from different clinical sites who were unfamiliar with the child, identified goal areas, wrote similar GAS goals based on the same parent interview, and scored goals post intervention with good inter-rater reliability. [ABSTRACT FROM AUTHOR]

PURPOSE Pediatric cancer survivorship rates continue to improve, although disease- and treatment-related neurocognitive impacts substantively affect survivors' educational access and availability for learning. Receiving formal educational supports substantially improves survivors' academic progress and graduation rates; however, parents of survivors report obtaining such support is stressful, in part due to limited knowledge on their part and that of their oncology providers. METHODS Parents (N = 195) of pediatric survivors across the United States were surveyed to explore specific barriers to obtaining appropriate educational supports and the facilitating role of the oncologist. RESULTS Parent-reported barriers included limited access to formal educational supports, under-referral to neuropsychology services, and need for more information about available supports and how best to advocate for these, when needed. Not only were few survivors (35.4%) referred for neuropsychological evaluation, standard of care for many pediatric survivors, but survivors were more than five times more likely to be retained in grade compared with the national retention rate. When obtained, parents reported that the neuropsychological consultation and associated report were helpful in increasing their own understanding and addressing barriers to obtaining adequate supports for their children. CONCLUSION Given the important role of neuropsychological evaluation for survivors and their families, bringing referral rates more in line with national guidelines represents a critical target for oncologists. With adequate training in relevant issues, the oncologist is positioned to be a key support to survivors and their families in ensuring access to neuropsychological services and reducing barriers to an appropriate education. [ABSTRACT FROM AUTHOR]

Nonprofit and governmental relations become increasingly formidable with a nonprofit's number of public funding streams. Complexity of conflicting funding regulations traps the nonprofit in a state of dysfunction. Interviews with managers currently working in domestic violence advocacy organizations (DVAOs) in the United States are analyzed with a grounded analysis approach to identify the outcome of policy conflict tied to their multiple public funding streams. An unspoken policy narrative emerges that underlies more overt social policy narratives. This emergent narrative drives organizational activities toward accountability tasks and away from mission fulfillment tasks. DVAOs are bound within institutional gridlock. [ABSTRACT FROM AUTHOR]

Nearly 80% of persons with multiple sclerosis (MS) do not engage in sufficient amounts of exercise for managing symptoms and improving quality of life. We have addressed this problem by developing a systematic line of qualitative research targeting the patient–provider interaction for promotion of exercise within comprehensive MS care. This research resulted in a conceptual model that guides health care providers in promoting exercise among persons with MS. The current study involves a final evaluation of the model based on semistructured interviews with 28 MS health care providers. Providers perceived that the model was a strong conceptualization of practice that reflected the MS illness course and supported exercise behavior change, but more steps were required to translate the model from concept into practice, including improved clarity of the model, and the development of practice models. The evaluation yielded a final conceptual model for exercise promotion in MS through the patient–provider interaction. [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]

Meritocratic beliefs continue to be widely accepted in the United States; nonetheless, upward mobility is out of reach for many American women due to pervasive barriers to accessing decent work. The present study aims to explore American women's work aspirations and beliefs in the American Dream (the premise that no matter where people come from, with hard work, they can achieve prosperity) in light of the gap between this notion and the social inequalities in their working lives. We conducted semistructured interviews with 17 American women from diverse racial, educational, and work backgrounds to examine these women's work aspirations and beliefs on the American Dream. Qualitative content analysis yielded 3 domains: (a) aspiring for work that fulfills essential human needs, (b) multilayered influences on women's work aspirations, and (c) making sense of work aspirations in relation to beliefs on the American Dream. Our findings highlight the importance of relationships and systemic factors in shaping women's work aspirations. In addition, women's beliefs on the American Dream reflect complex interactions between endorsing meritocratic beliefs and their personal experiences. Implications for counseling psychology theory, research, and practice are discussed. Public Significance Statement: This study shares voices of American women from diverse backgrounds by documenting women's work aspirations and beliefs in the American ethos of meritocracy in relation to their working lives. It provides insights on individual, interpersonal, and systemic factors that affect women's work-related experiences and aspirations. [ABSTRACT FROM AUTHOR]

Communication about organ donation at the time of imminent death is a meaningful, yet less understood, area of health communication. We employed a multiple goals framework to explore family normative perceptions of organ donation and the conversational goal tensions experienced during a family member's imminent death. Semi-structured interviews were conducted with 14 family members who refused to donate when approached by an organ procurement coordinator (OPC) upon the imminent death of a family member. Thematic analysis revealed that family members described their decisions to refuse donation as (a) last acts of love, (b) responses to unnecessary requests, and (c) consistent with the known beliefs of the patient. Participants described several goal tensions operating within the organ donation conversation itself, including (a) the management of frequent requests, (b) pressure to donate, and (c) enduring unwanted requests from the OPC. Communication goals frameworks offer practical insights for improving organ-related conversations. [ABSTRACT FROM AUTHOR]

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians' goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice. [ABSTRACT FROM AUTHOR]

Purpose: Community-based exercise can support long-term management of Parkinson's disease, although it is not known if personal goals are met in these programs. The objectives of this study were to: (1) examine the goals of community based exercise programs from the participant and instructor perspectives; (2) establish the extent to which these programs meet self-described exercise outcomes; and (3) explore participant and instructor perspectives on barriers to meeting exercise expectations. Materials and Methods: This study explores the experiences of people with Parkinson's disease participating in a structured exercise program at six community sites. A mixed-methods approach was used, including participant and instructor interviews, assessment of exercise intensity, and mapping of exercise dosage to participant goals. Twenty-four exercise participants provided interview, quality of life, and exercise intensity data. Results: Twenty-one participants exercised for primary management of their Parkinson's disease. None met the exercise dosage necessary to meet this primary objective, although 60% met exercise dosage required to prevent disuse deconditioning. Participants and instructors did not describe similar goals for the community-based exercise program. Conclusions: Community-based exercise programs could be optimized by better aligning participant goals and exercise intensity. [ABSTRACT FROM AUTHOR]

Aims: Individualized goals are the foundation for physical therapy services and outcomes. This research describes school-based physical therapists' (PTs) experiences and perceptions of how student goals impact services and outcomes. Methods: Twenty school-based PTs participated in one of five semi-structured focus groups on goal development and use. Therapists were recruited from 113 therapists who participated in a study of school-based physical therapy outcomes. Two researchers conducted thematic analysis of written transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Four themes emerged related to how goals impact services: (1) the nature of services, (2) intervention strategies, (3) teaming, and (4) flexibility of services. Three themes emerged related to how goals impact outcomes: (1) natural linkages among goals, services, and outcomes; (2) goals impact teaming to achieve outcomes; and (3) specifics of the goal matter. Therapists also reported a range of student and environmental factors that impact services and outcomes. Conclusions: Therapists perceive that goals influence services and outcomes in complex ways, especially due to the flexibility and individualization needed in school-based practice. This study helps school-based PTs understand and reflect on how individualized goals influence services and optimize student outcomes. [ABSTRACT FROM AUTHOR]

Complex trauma can have a significant negative impact on the developing brain and occupational performance of children and adolescents. This study explored current practice in occupational therapy in complex trauma utilizing interviews and interpretive descriptive analysis. Nine experienced occupational therapists identified functional concerns that were mapped onto the International Classification of Functioning, Disability and Health framework. Findings indicated the importance of caregiver involvement in treatment, interventions to address bottom-up processes, advanced training, and being connected with other therapists who serve this population. Given the range of interventions with this complex population, occupational therapists have a unique opportunity to contribute to this emerging area of practice. [ABSTRACT FROM AUTHOR]

Despite significant research on purpose in adolescence and early adulthood, little is known about purpose in older adults. This paper defines purpose as ongoing commitment to and sustained action toward goals that are meaningful to the self and aim to contribute beyond the self. This study of purpose in later life draws on interviews of 102 respondents drawn from a U.S. nationally representative sample of 1198 men and women aged 50–92. Eighteen interviewees are identified as exemplars of purpose beyond the self and are matched with a comparison group of non-purposeful peers. Interview coding revealed that, in contrast to the non-purposeful comparison group, the purpose exemplars describe their lives as including several interconnected sources of well-being: purpose beyond the self, positive relationships, positive life engagement, a sense of competence, and freedom balanced with the desire to contribute. Implications for practitioners and the public are discussed. [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]

Developmental theory historically viewed demanding roles (at home, job) as important developmental contexts. However, adolescents' participation in these roles has fallen. This qualitative research examined role experiences in United States youth development programs. A central question among others was, "How can youth experience internal motivation fulfilling externally imposed role obligations?" We interviewed 73 youth with substantive work roles (e.g., Leader, Reporter, and Teacher) in 13 arts, science-technology, and leadership programs. Youth (51% female) were 14- to 18-years-old and ethnically diverse. We used grounded-theory methods suited to understanding youth's active learning processes in context. Findings illuminated youth's experiences in 4 important transactions or "steps." Youth: (a) accepted roles based on personal goals, (b) encountered difficult challenges similar to adult roles (e.g., conflicting viewpoints, role strain), (c) drew on resources to overcome challenges and fulfill role demands, and (d) learned through these experiences. Across these steps, findings suggested 3 powerful development processes. First, youth experienced multiple sources of internal motivation (e.g., agency within roles, personal and social investment, and "good pressure"), which fostered high engagement in role performance and learning. Second, experiences grappling with and fulfilling difficult role demands helped youth build important competencies for action (e.g., strategic thinking, perseverance). Third, youth's experience of accountability to others served as a powerful driver of responsibility development: Because youth were invested, they took ownership of obligations to others and learned responsive modes of thinking and acting, which they transferred to family, school, and elsewhere. We propose that teens would benefit from more opportunities for role experiences like these. [ABSTRACT FROM AUTHOR]

This paper analyzes the results of an 18 month study of a variety of participants involved in written reflection on their learning, both in classes at two universities in the Southern US or in voluntary focus groups. The purpose of the study was to analyze the effects of including autobiographical tools in written reflection. Participants used three tools from the genre of autobiography as they reflected on their learning inside either course content, internship experiences, experiential learning, or goal-setting. Over 500 samples were gathered, offering a large data set for analysis of what kinds of best practice produce quality reflective writing. Through analysis of the data and student surveys and interviews, results show increased attention to critical thinking and metacognition; expressed flexibility, adaptability, and ability to handle ambiguity; and value in connection to others/empathy-building as a result of incorporating autobiographical tools in reflective prompts. The study indicated that reflections using the same autobiographical tool over the course of several sessions seemed to produce deeper levels of reflection and more engagement with the autobiographical tool. Of the three autobiographical tools used in the study, the tool that seemed most helpful to participants was reflection as storytelling that revealed aspects of the self. [ABSTRACT FROM AUTHOR]

Background Middle-aged and older adults requiring skilled home healthcare ('home health') services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition. Objectives (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers' perspectives and (2) Identify IMrelated process failures. Methods Multisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams. Results We identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults' and informal caregivers' mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information). Conclusions IM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions. [ABSTRACT FROM AUTHOR]

Purpose: Research indicates that geriatric education continues to be inadequate across the health professions and graduates are unprepared to care for the increasing numbers of older adults. The purpose of this study was to explore dental hygiene practitioners' perspectives regarding whether their dental hygiene education prepared them to treat older adults in community and institutional settings. Methods: A qualitative phenomenological study design was utilized to conduct in-depth interviews with a purposive sample of dental hygienists currently providing care for older adult patients in alternative practice settings. Results: Fifteen dental hygienists from across the U.S. working with older patients in alternative settings, met the inclusion criteria (n=15). Common themes related to dental hygiene practice emerged from the qualitative data included: adapting patient care to alternative settings; emotional toll on the practitioner; physical challenges; outcome goals for treatment; need for hands-on clinical experience in alternative settings as dental hygiene students; and working as part of an interprofessional team. Conclusion: Participants generally agreed that they were not prepared to care for dependent older adults in alternative settings as part of their dental hygiene education. Clinical experiences working with older adults in alternative settings, as part of the dental hygiene clinical curriculum, are needed to prepare graduates to care for this growing population. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms. METHODS: In this single-blinded, randomized controlled trial conducted at 6 US hospital- based HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control arm ([1] developmental history, [2] safety tips, and [3] nutrition and exercise tips). The General Health Assessment for Children measured patient-reported HIV-specific symptoms. Latent class analyses clustered individual patients based on symptom patterns. Path analysis examined the mediating role of dyadic treatment congruence with respect to the intervention effect on symptom patterns. RESULTS: Patients were a mean age of 17.8 years old, 54% male, and 93% African American. Latent class analysis identified 2 latent HIV-symptom classes at 12 months: higher symptoms and suffering (27%) and lower symptoms and suffering (73%). FACE pACP had positive effect on dyadic treatment congruence ( = .65; 95% CI: 0.04 to 1.28), and higher treatment congruence had a negative effect on symptoms and suffering ( = -1.14; 95% CI: 2.55 to -0.24). Therefore, FACE pACP decreased the likelihood of symptoms and suffering through better dyadic treatment congruence (- = -.69; 95% CI: -2.14 to -0.006). Higher religiousness ( = 2.19; 95% CI: 0.22 to 4.70) predicted symptoms and suffering. CONCLUSIONS: FACE pACP increased and maintained agreement about goals of care longitudinally, which lowered adolescents' physical symptoms and suffering, suggesting that early pACP is worthwhile. [ABSTRACT FROM AUTHOR]

Abstract The purpose of the present study is two-fold. First, it aims to develop a theoretical model of the acculturative process of immigrant adolescents based on the understanding of the relationships among acculturative stress, coping, and growth. Second, it aims to propose a typology that offers distinct patterns in the process of acculturation and the resulting outcomes. Using the grounded theory method, the study identified stress related to communication problems, ethnic prejudice, academic pressure, homesickness, and interpersonal conflict. The lack of social support and the school climate were identified as contextual factors of perceived stress. Peer mediation and motivation were identified as intervention factors of coping behaviors. The immigrant adolescent coping behaviors included media use for emotional release, focus on a goal, connectedness to the home country, and the creation of social capital in the host country. The typology of different acculturative patterns classified immigrant adolescents into three types: adaptive, academic, and competent. Based on the findings, the significance of family functioning, peer mediation, self-expansion motivation, and coping behaviors to create social capital for immigrant adolescents' normal development was discussed. Highlights • Integrates stress-coping, stress-related growth, and developmental perspectives. • Social support and school climate are contextual factors of perceived stress • Peer mediation and self-expansion motives are intervention factors of coping behaviors • Media use, goal focus, home country connect, social capital creation were coping behaviors • The competent type of immigrant adolescents exhibited the process of stress-related growth and the achievement of developmental tasks [ABSTRACT FROM AUTHOR]

In this study, the authors aimed to discover how community college students with traumatic brain injury (TBI) engaged within the community college and beyond in terms of their lifestyles, goals, relationships, and strategies. A phenomenological research design was used. Interview data was recorded, transcribed, and coded. Students included 12 persons between the ages of 18 and 36 years of age, all of whom attended a community college in a large city in the southwestern part of the United States. Three themes emerged, which revealed various facets of their struggles in navigating post-injury relationships and social engagement. However, students were largely positive about their futures and had made dramatic adjustments. Study findings provide insights on how students with TBI in postsecondary settings perceive their post-injury relationships and social engagement. Study findings offer information to influence research, policy, and practices to serve the needs of students with TBI in postsecondary settings. [ABSTRACT FROM AUTHOR]

Objective: To examine the well-documented mental and physical health problems suffered by undergraduate women sexually assaulted while on campus with an exploration of how the trauma impacts a survivor's lifetime education trajectory and career attainment. Participants: In November and December 2015, researchers recruited US participants using an online crowdsourcing tool and a Listserv for sexual violence prevention and response professionals. Methods: Of 316 women who completed initial screening, 89 qualified to complete a Qualtrics survey. Eighty-one participants completed the online survey, and 32 participated in phone interviews. Results: Ninety-one percent of the participants reported health problems related to the assault that they attributed to difficulties they faced in their attainment of their education and career goals. Conclusions: The findings suggest the importance of simultaneously examining the effects of human capital losses and mental and physical health problems attributed to the costly public health problem of campus sexual assault. [ABSTRACT FROM AUTHOR]

Context: Although recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear.Objectives: To describe perceptions of the timing and content of GoC conversations among oncologists and patients with advanced cancer.Methods: Semi-structured interviews with oncologists and patients at four hospitals in New York and Connecticut. We analyzed data using interpretive description.Results: Oncologists (n = 21) were 67% male, averaged 46 years old (range 34-68 years), and had a mean 20 years (range 8-42 years) in practice. Advanced cancer patients (n = 39) were 59% female with a mean age of 58 years (range 26-88 years). Oncologists and patients viewed GoC conversations along an initial, intermediate, and final continuum. Oncologists reported having initial GoC conversations to build rapport, provide disease information, and clarify and consider treatment intent and options. Intermediate conversations focused on changes in treatment and side effects. Final conversations occurred when patients were hospice-eligible and covered the shift to comfort care, a treatment summary, and advance directives. Timing and content were influenced by cancer type, disease status, and emotional state. Patients supported beginning GoC conversations early, but had different preferences for content of initial conversations. Some wanted complete information; others found this overwhelming. Patients felt intermediate GoC conversations should occur at decision points with time for processing. Content of intermediate and final conversations was dependent on patients' prognosis, questions, and treatment decisions.Conclusion: Although GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content. [ABSTRACT FROM AUTHOR]

Scholars and public health advocates have expressed optimism about the potential for the health-in-all-policies approach to address social disparities in health, but little research has been done on whether it promotes health equity in practice. Based on sixty-five in-depth interviews with US officials in the public and private sectors conducted in five states in 2016-17, we found a relationship between the use of the approach and the prominence of health equity as a policy concern. In emphasizing the social determinants of health, the approach gives public officials and policy entrepreneurs a framework for promoting this goal. In some areas, we found a gradual transition in focus from health generally to health equity. Overall, we found that practitioners of the approach introduce equity selectively and strategically. [ABSTRACT FROM AUTHOR]

What it means to be man is shaped by racial, ethnic, and cultural factors. In this paper, we explore what determines and comprises middle-aged and older African American men's definitions of manhood. Using a thematic approach, we examined the semantic differences noted in the verbs chosen to define a man, the characteristics that were most important to how they saw themselves, and the characteristics that were most important to them to portray to others. Analyzing data from 64 interviews with urban African American men 35-76 from the Southeastern United States, we found that manhood was a concept that reflected key characteristics and traits, demonstrated deeper qualities or attributes, and revealed their inherent nature or character. While previous research sought to identify attributes of manhood that defined adult African American males, the current study was conducted to characterize how middle-aged and older African American men defined manhood and its key components through exploring how they wanted to see themselves and what traits they wanted to portray to others. What a man is or should be was defined by attributes that reflected a foundation of character that not only exemplified gendered values, goals, and roles, but that also demonstrated religious and cultural values and beliefs. For these men, manhood was more than a compilation of traits but a reflection of who they were at a deeper level. These ideals were rooted in an amalgamation of gendered ideals, cultural norms, religious doctrine and beliefs, and age-related priorities. [ABSTRACT FROM AUTHOR]