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There is limited research that specifically explores paternal involvement during pregnancy and childbirth. To address this gap, we completed a series of focus groups with fathers to examine social, cultural, and environmental factors that influence behaviors among new fathers while also providing community perspectives on men's experiences seeking care pre- and postdelivery. We used a phenomenological thematic approach to analyze data from 10 focus groups from five of the six Alliance for Innovation on Maternal Health-Community Care Initiative pilot sites collected between November 2021 and April 2022. The average age of fathers was 33.9 years (range = 24-61 years). The majority (86.25%) of men were African American, and approximately one sixth of focus group participants (16.25%) were Hispanic or Latino. Four key themes emerged: the importance and meaning of fatherhood, accessibility during pregnancy and childbirth, engagement during pregnancy and childbirth, and responsibility of fathers during pregnancy and childbirth. These fathers not only understood and embraced the awesome responsibility they had for their unborn child, but they also recognized and were invested in being present, accessible, engaged, and responsible to the pregnant woman during the pregnancy. Practitioners and policy makers should work to engage fathers as early in the pregnancy as possible; monitor father's mental health and financial stress; provide resources to educate fathers on maternal health, pregnancy, and childbirth; and emphasize fathers' rights, roles, and responsibilities.

BackgroundBlack Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear.ObjectiveTo evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease.Data sourcesMedline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases.Review methodsOnly randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done.ResultsEleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence.Discussion/conclusionStudy findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.

BackgroundIn the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients.MethodsMedline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review.ResultsOnly three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance.Discussion/conclusionFurther research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.

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In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans. [ABSTRACT FROM AUTHOR]

Background: This cross‐sectional study explored how masculinity beliefs may influence colorectal cancer (CRC) screening participation among ethnic subgroups of screening‐age–eligible (45–75 years) Hispanic/Latino men. Methods: Using a consumer panel, we recruited self‐identified Hispanic/Latino men fluent in English or Spanish, and residing in Florida, New York, or Texas. The Masculinity Barriers to Medical Care (MBMC) scale and its six subscales were used to assess masculinity beliefs. Multivariable logistic regression was used to estimate the association between MBMC and CRC screening participation, adjusting for Hispanic/Latino subgroup, marital status, survey language, age group, and health insurance status. Results were then stratified by Hispanic/Latino subgroup. Results: Of the participants (n=611), approximately 31% identified as Puerto Rican, 30% as other Hispanic/Latino, 26% as Mexican, and 14% as Cuban; 63% had ever been screened for CRC. We found no differences in the prevalence of screening participation by Hispanic/Latino subgroup. The majority of participants had completed both a stool‐based test and an exam‐based screening test (29.3%). After adjusting for confounding, MBMC reduced the odds of screening participation. Slight MBMC‐subscale differences were observed by Hispanic/Latino subgroup. For example, higher scores on the Restrictive Emotionality subscale were associated with a lower likelihood of screening participation among Puerto Rican men, but higher odds of screening for Cuban men. Conclusions: Masculinity barriers to CRC screening may exist. Tailored interventions to address masculinity barriers among specific Latino subgroups may improve CRC screening uptake in this population. [ABSTRACT FROM AUTHOR]

Education usually shows a relationship with self-rated health such that those with highest education have the best health and those with lowest education have the worst health. We examine these educational gradients among Asian immigrants and whether they differ by country of origin, duration in the United States, and generational status. Migration theories suggest that recent immigrants from poorer countries should show a weaker relationship between education and health than US-born Whites. Acculturation theory further suggests that differences in gradients across country of origin should diminish for longer-term immigrants and the US-born and that these groups should display gradients similar to US-born Whites. We use the March Current Population Survey (2000 - 2010) to examine educational gradients in self-rated health among recent immigrants (≤ 15 years duration), longer-term immigrants (> 15 years duration), and second generation US-born Asians from China (n = 4473), India (n = 4,307), the Philippines (n = 5746), South Korea (n = 2760), and Japan (n = 1265). We find weak or non-significant educational gradients among recent Asian immigrants across the five countries of origin. There is no indication that longer-term immigrants display significant differences across educational status. Only second generation Chinese and Filipinos show significant differences by educational status. Overall, Asians show an attenuated relationship between education and self-rated health compared to US-Whites that persists over duration in the US and generational status. Our findings show shortcomings in migration and acculturation theories to explain these gradient patterns. Future research could use binational data or explore psychosocial factors to identify potential suppressors of educational gradients.

Qualitative methods help us understand context, explore new phenomena, identify new research questions, and uncover new models of change. To better understand how researchers in health education and health behavior use qualitative methods, we reviewed qualitative articles published in "Health Education & Behavior" from 2000 to 2015. We identified 48 articles that met our inclusion criteria and extracted information on the qualitative inquiry framework, use of theory, data collection methods, sampling strategy, general analysis approach, and reporting of results. Use of common qualitative inquiry frameworks was rare, with just one grounded theory study, five ethnographies, and one case study. No studies were framed using phenomenological or narrative inquiry approaches. Theory was used most commonly to select sensitizing constructs for analysis (41.7%) and to inform development of data collection instruments (27.1%). Interviews were the most common data collection method (66.7%), with focus groups next most common (39.6%). Sampling was typically purposive (87.5%), although often not labeled as such. Almost all (95.8%) the articles used quotes to illustrate themes and more than half (58.3%) used descriptors of magnitude (e.g., most, some) to report findings. The use of qualitative methods by health education and behavior researchers could be enriched with more intentional application of a broader range of inquiry frameworks. More deliberate application of a range of inquiry frameworks has the potential to broaden the types of research questions asked, application and generation of theory, study design, analytic strategies, and reporting of results.

Data analysis is one of the most important, yet least understood, stages of the qualitative research process. Through rigorous analysis, data can illuminate the complexity of human behavior, inform interventions, and give voice to people's lived experiences. While significant progress has been made in advancing the rigor of qualitative analysis, the process often remains nebulous. To better understand how our field conducts and reports qualitative analysis, we reviewed qualitative articles published in "Health Education & Behavior" between 2000 and 2015. Two independent reviewers abstracted information in the following categories: data management software, coding approach, analytic approach, indicators of trustworthiness, and reflexivity. Of the 48 (n = 48) articles identified, the majority (n = 31) reported using qualitative software to manage data. Double-coding transcripts was the most common coding method (n = 23); however, nearly one third of articles did not clearly describe the coding approach. Although the terminology used to describe the analytic process varied widely, we identified four overarching trajectories common to most articles (n = 37). Trajectories differed in their use of inductive and deductive coding approaches, formal coding templates, and rounds or levels of coding. Trajectories culminated in the iterative review of coded data to identify emergent themes. Few articles explicitly discussed trustworthiness or reflexivity. Member checks (n = 9), triangulation of methods (n = 8), and peer debriefing (n = 7) were the most common procedures. Variation in the type and depth of information provided poses challenges to assessing quality and enabling replication. Greater transparency and more intentional application of diverse analytic methods can advance the rigor and impact of qualitative research in our field.

Background While successful health promotion efforts among Black men have been implemented at barbershops, the focus has largely been on outcomes as opposed to the processes by which outcomes are produced. An understanding of processes can be leveraged in the design and implementation of future efforts to improve the health of Black men. Purpose The objectives of the present study were to: (i) understand peer-derived sources of health-related support at the barbershop and (ii) understand the role of the barbershop in promoting health among Black men. Methods Seven focus groups were conducted at barbershops used predominately by Black men. Each focus group lasted between 45 and 60 min. Using a thematic approach, each focus group was independently coded by two coders using a codebook derived from an inductive and deductive approach. The results were confirmed with members of the community advisory board. Results Three themes emerged: (i) dynamic and candid exchange of health-related support at the barbershop; (ii) tailored forms of health-related and judgment-free communication that provide encouragement and increase motivation; and (iii) characteristics of a supportive environment at the barbershop that facilitate health-related communication. Conclusions The findings of the present study offer a potential pathway for public health efforts seeking to improve health among Black men. Those interested in designing and implementing these efforts can create tailored programs for Black men by recognizing and leveraging the unique dynamics of health-related conversations at the barbershop. [ABSTRACT FROM AUTHOR]

Black men have a greater risk of prostate cancer as well as worse quality of life and more decisional regret after prostate cancer treatment compared to non-Hispanic White men. Furthermore, patients with prostate cancer who primarily obtain information on the internet have significantly more decisional regret compared to other information sources. Our objective was to explore the perspectives of Black patients on the use and impact of the internet for their prostate cancer care. In 2022–2023, we conducted seven virtual focus groups with Black patients with prostate cancer (n = 22). Transcripts were independently analyzed by two experienced researchers using a constant comparative method. Online sources were commonly used by participants throughout their cancer journey, although informational needs varied over time. Patient factors affected use (e.g., physical health and experience with the internet), and family members played an active role in online information-seeking. The internet was used before and after visits to the doctor. Key topics that participants searched for online included nutrition and lifestyle, treatment options, and prostate cancer in Black men. Men reported many downstream benefits with internet use including feeling more empowered in decision-making, reducing anxiety about treatment and providing greater accountability for research. However, they also reported negative impacts such as feeling overwhelmed or discouraged sorting through the information to identify high-quality content that is personally relevant, as well as increased anxiety or loss of sleep from overuse. In summary, online sources have the potential to positively impact the cancer journey by reinforcing or supplementing information from health care providers, but can be harmful if the information is poor quality, not representative, or the internet is overused. [ABSTRACT FROM AUTHOR]

Many studies, but not all, suggest that immigrant health worsens with duration of residence in the United States. Cohort effects may explain the inconsistent findings; not only are cohort effects confounded with duration, but the timing of entry into the United States may also create qualitatively different migration experiences. The present study tests for duration and cohort patterns among Asian immigrants to the United States across six year-of-entry cohorts (pre-1980, 1981-85, 1986-90, 1991-95, 1996-2000, 2001-05). Data come from the Asian American sample (n = 44,002) of the 1994-2009 waves of the National Health Interview Survey. The data show cohort differences for self-rated health, such that more recent cohorts showed improved baseline health compared to older cohorts. After accounting for cohorts, there was no significant change in self-rated health by duration of residence. Older cohorts actually showed improving self-rated health with longer duration. Obesity showed the opposite pattern; there were no differences across cohorts, but duration in the United States correlated with higher obesity. These results imply that immigrant health is not simply an issue of duration and adaptation; instead, they underscore the utility of considering cohorts as broader contexts of migration. Collectively, the results encourage future research that more carefully examines the etiological mechanisms that drive immigrant health.