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BackgroundSepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention.MethodsOur aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis.DiscussionThis study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.

Objective: To understand how the college environment might influence mental health help-seeking in Asian American undergraduates. Participants: Participants were 19 Asian American undergraduates recruited through Facebook. Methods: Participants were interviewed about attitudes toward mental health and mental health help-seeking, and thematic analysis with both inductive and deductive codes was used to analyze interview transcripts. Results: Several factors specific to the college environment encourage students to seek help: social support provided by peers and by campuses, psychological distance from home, and physical distance from home. However, other Asian American-specific factors discourage students from seeking help, such as cultural factors and stigma surrounding mental health issues. Conclusions: The college environment may encourage help-seeking, while Asian American-specific factors may discourage it. Potential interventions based on these findings may increase help-seeking rates by focusing on these encouraging factors in a culturally-sensitive way.

The field of mixed methods research embraces diversity and encourages researchers to combine different perspectives, approaches, and methods to achieve meaningful insights. Navigating such rich diversity can pose challenges that can benefit from ongoing, critical self-reflection. This article introduces the concept of cultural humility in the context of mixed methods research. We aim to enhance understanding of how cultural humility can foster awareness and encourage constructive critique of assumptions, policies, and practices in the field of mixed methods research. This article serves as a foundational resource for mixed methods researchers, practitioners, and scholars to embrace cultural humility in the field. We close with a set of prompts to spark critical self-reflection and dialogue within the field. [ABSTRACT FROM AUTHOR]

Although investigators in health sciences are increasingly interested in using mixed methods, greater adoption requires funding opportunities. Funding allocations can signal recognition of a particular methodology and proficiency of investigators in using such methods. We examined trends in prevalence of mixed methods research funded by federal agencies in the United States. We reviewed abstracts to describe the content and terminology related to mixed methods. The number of self-identified mixed methods awards (n = 535; 2009-2014) increased modestly from previous trends (n = 226; 1997-2008). Abstracts were highly variable in their depth of description and use of mixed methods terminology. We propose five elements to address when developing a scientific abstract for a mixed methods study to facilitate clear description of study design and methods.

Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents' immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures.

Background: Early detection of autism spectrum disorder (ASD) is essential to provide children with timely treatment and support. Evidence‐based screening measures make it possible to identify children with suspected ASD at an early stage. Although Japan has a universal healthcare system that covers well‐child visits, detection rates of developmental disorders, including ASD, at 18 months vary widely between municipalities (0.2%–48.0%). The reasons for this high level of variation are poorly understood. The present study aims to describe the barriers and facilitators of incorporating ASD identification during well‐child visits in Japan. Methods: This is a qualitative study that conducts semi‐structured in‐depth interviews in two municipalities of Yamanashi Prefecture. We recruited all public health nurses (n = 17) and paediatricians (n = 11) involved in the well‐child visit in each municipality and caregivers of children who also participated in the visits during the study period (n = 21). Results: We identified four themes characterizing the process of ASD identification in the target municipalities: (1) Identification of children with ASD is driven by caregivers' sense of concern, acceptance and awareness. (2) Multidisciplinary cooperation and shared decision‐making is limited. (3) Skills and training for developmental disabilities screening are underdeveloped. (4) Caregivers' expectations shape the interaction in important ways. Conclusions: Non‐standardization of screening methods, limited knowledge and skills on screening and child development among healthcare providers and poor coordination among healthcare providers and caregivers are the main barriers to effective early detection of ASD through well‐child visits. The findings suggest the importance of promoting a child‐centred care approach through the application of evidence‐based screening measures and effective information sharing. [ABSTRACT FROM AUTHOR]

Background and Objectives Area Agencies on Aging (AAAs) have funded, coordinated, and provided services since the 1960s, evolving in response to changes in policy, funding, and the political arena. Many of their usual service delivery programs and processes were severely disrupted with the onset of the coronavirus disease 2019 pandemic. Increasing evidence suggests the importance of partnerships in AAA's capacity to adapt services; however, specific examples of adaptations have been limited. We sought to understand how partnerships may have supported adaptation during the pandemic, from the perspectives of both AAAs and their partners. Research Design and Methods We conducted a secondary analysis of qualitative data from an explanatory sequential mixed-methods parent study. Data were collected from 12 AAAs diverse in terms of geographic region, governance structure and size, as well as a range of partner organizations. We completed 105 in-depth interviews from July 2020 to April 2021. A 5-member multidisciplinary team coded the data using a constant comparative method of analysis, supported by ATLAS.ti Scientific Software. Results AAAs and their partners described strategies and provided examples of ways to rapidly transform service delivery including reducing isolation, alleviating food insecurity, adapting program design and delivery, and leveraging partnerships and repurposing resources. Discussion and Implications AAAs and partner organizations are uniquely positioned to innovate during times of disruption. Findings may enhance AAA and partner portfolios of evidence-based and evidence-supported programs. [ABSTRACT FROM AUTHOR]