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Weeden T, Garofalo R, Johnson AK, Schnall R, Cervantes M, Scherr T, Kuhns LM. Assessing Preferences for Long-Acting Injectable Pre-Exposure Prophylaxis Among Young Adult Sexual Minority Men and Transgender Women. Acad Pediatr 2024:S1876-2859(24)00148-7. [PMID: 38631476 DOI: 10.1016/j.acap.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. However, oral PrEP uptake is low, particularly among sexual and gender minority youth who are vulnerable to HIV infection. Alternative methods of PrEP delivery, such as long-acting injectable (LAI) PrEP may overcome barriers and be preferred. However, attitudes and preferences of younger sexual and gender minorities towards LAI PrEP have not been well studied. The purpose of this study is to describe preferences for initiating LAI PrEP among sexual and gender minority youth. METHODS We analyzed data collected as part of an HIV prevention randomized trial from January 2022 to February 2023, using multiple regression to identify factors associated with a preference for LAI PrEP. RESULTS The study sample (N = 265) was 50% youth of color, mean age 25 years (SD=3.4, range=18-31), and primarily identified as gay (71%) and male (91%). Forty two percent had heard of LAI PrEP and 31% preferred LAI PrEP over other prevention methods. In multiple regression analysis, LAI PrEP preference was associated with identifying as White, previous PrEP experience, and perceived LAI PrEP efficacy. CONCLUSIONS We conclude that gaps in awareness exist for LAI PrEP, however it may be preferred over other prevention methods especially in White youth, those with PrEP experience and higher perceptions of its efficacy. More education and outreach are needed to prevent extension of existing race and ethnicity disparities in use of oral daily PrEP to LAI PrEP.
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Affiliation(s)
- Terrance Weeden
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Robert Garofalo
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Amy K Johnson
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Rebecca Schnall
- School of Nursing (R Schnall), Columbia University, New York City, NY
| | - Marbella Cervantes
- Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Thomas Scherr
- Department of Chemistry (T Scherr), Vanderbilt University, Nashville, Tenn
| | - Lisa M Kuhns
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill.
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House TR, Helm K, Wightman A. Building Partnerships to Improve Health Outcomes: Pediatric Patient and Family Engagement in Nephrology Practice. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:37-45. [PMID: 38403392 DOI: 10.1053/j.akdh.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 02/27/2024]
Abstract
As health care practices have evolved from a disease-oriented to patient-focused paradigm, patient and family engagement (PFE) has been recognized as an important aspect of health care delivery and outcomes. While pediatricians have long approached care delivery with a family-centered lens, PFE may be a less familiar concept to situate among related concepts such as shared decision-making, self-efficacy, patient activation, and family-centered care. Children with CKD and their families indicate a need and desire for enhanced PFE efforts in pediatric nephrology. Improving PFE offers the opportunity to provide our patients and families with skills that will positively impact their health and wellness throughout their lives. In this review, we define PFE, describe the components of and levels at which PFE occurs across the health care system, examine PFE interventions of promise, and finally suggest future directions to support PFE in pediatric nephrology.
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Affiliation(s)
- Taylor R House
- Division of Pediatric Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Kelly Helm
- NephCure for Rare Kidney Disease, King of Prussia, PA
| | - Aaron Wightman
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Swartwout E, Hass EJ, Deyo P, El-Zein A, Lewis B, Rao-Gupta S. The Design and Testing of the Psychometric Properties of the Adolescent Capacity to Engage Index Instrument to Measure an Adolescent's Capacity to Engage in Healthcare. J Nurs Meas 2023; 31:458-469. [PMID: 36192123 DOI: 10.1891/jnm-2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Engagement in one's healthcare is paramount to improving health outcomes. As adolescents begin their journey into adulthood and increase involvement in their health-care decision-making, it is critical to understand their ability to be involved in their healthcare. The purpose of this instrumentation study was to develop and evaluate the psychometric properties and underlying factors of the Adolescent Capacity to Engage Index (ACEI) tool which measures the construct of an adolescent's capacity to engage in their healthcare. Methods: This study had a two-phase approach. Phase 1 consisted of the pilot and cognitive testing of the items developed based on the literature and content expertise. Phase 2 was the testing of the final 21 item revised instrument among 15- to 17-year-old online teen panel (n = 226). Results: Psychometric testing revealed a valid and reliable 21 item scale with a four-factor solution. The Cronbach's alpha for the total scale was .901. The four subscales and each subscale Cronbach's alpha were: (a) Active Participation In Healthcare with Psychosocial Support to Aid/Foster Good Healthcare Choices, (.826); (b) Transition Readiness to Self-Management with Family Support to Guide/Foster Health/Healthcare Decisions, (.825); (c) Proactivity and Empowerment to Have a Say in Health/Healthcare, (.747); and (d) Technology Use to Seek Health/Healthcare Information (.648). Conclusions: This study demonstrated the ACEI is a psychometrically sound instrument with good internal consistency for the overall scale and subscales. The ACEI can be implemented in clinical practice to measure adolescents' engagement capacity in their healthcare and identify appropriate interventions based on ACEI score. Further research to determine engagement capacity among teens of various populations is warranted.
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Affiliation(s)
- Ellen Swartwout
- Research Consultant, O'Neil Center, GetWellNetwork, Bethesda, MD, USA
| | - Edward J Hass
- Director, Consumer Insights & Market Research, Nemours Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, DE, USA
| | - Patricia Deyo
- Nurse Research Consultant, O'Neil Center, GetWellNetwork, Bethesda, MD, USA
| | - Ashley El-Zein
- Research Consultant, O'Neil Center, GetWellNetwork, Bethesda, MD, USA
| | - Brennan Lewis
- Vice President, Nursing Excellence, Children's Health, Dallas, TX, USA
| | - Suma Rao-Gupta
- Director, Patient and Family Education, Clinical and Organizational Development, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
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DiGiovanni LK, Lim AC, Kosyluk K, Loecher N, Lewald DL, Rodriguez CA, Sanders LJ. Novel Application of Dot Survey Methodology at a Youth Health Clinic: A Pilot Study. J Adolesc Health 2023; 72:616-622. [PMID: 36543632 DOI: 10.1016/j.jadohealth.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE We tested a novel dot survey methodology at our clinic that provides sexual health services to youth ages 13 to 24. We conducted two interactive dot surveys to assess their feasibility and acceptability while gaining insight into patients' attitudes about mental health. METHODS We adapted a dot survey approach to assess youths' familiarity with mental health and attitudes toward related services. We also assessed their attitudes toward participating in this survey method. All patients with scheduled appointments were eligible to participate. Participants used dot stickers to indicate their responses on survey posters displayed in the waiting room. RESULTS Three hundred patients participated between June and September 2021 (150 participants/survey). About 95% of participants liked seeing others' responses to the dot surveys, and over 70% reported that the surveys made them think more about mental health. Over 90% would participate in future dot surveys at the clinic. Survey items with the most consensus among participants included that 74.5% "really agree" youth face barriers to accessing mental health services (n = 141, mean = 4.61, standard deviation = 0.79) and 87.1% "really agree" primary care providers should ask youth about their mental health (n = 139, mean = 4.81, standard deviation = 0.59). DISCUSSION The dot surveys were effective at assessing patients' attitudes about mental health and feasible to conduct in our waiting room. Results confirmed that this survey method was well received among patients. Dot surveys can be adapted by other clinical settings to engage youth regarding their health-related attitudes.
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Affiliation(s)
- Lauren K DiGiovanni
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida
| | - Andrew C Lim
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida
| | - Kristin Kosyluk
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida
| | - Nele Loecher
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida
| | | | - Carina A Rodriguez
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida
| | - Lisa J Sanders
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida.
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Allen J, Creedy DK, Mills K, Gamble J. Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women. BMJ Open 2023; 13:e065720. [PMID: 36898741 PMCID: PMC10008331 DOI: 10.1136/bmjopen-2022-065720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE To examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations. DESIGN Systematic review. ELIGIBILITY CRITERIA Original studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, sampling people receiving outpatient healthcare including pregnant women. DATA SOURCES CINAHL Complete, Medline, EMBASE and PubMed were searched in April 2022. RISK OF BIAS Study quality was independently assessed by two reviewers using an adapted COSMIN risk of bias quality appraisal checklist. Tools were also mapped against the Synergistic Health Engagement model, which centres on women's buy-in to maternity care. INCLUDED STUDIES Nineteen studies were included from Canada, Germany, Italy, the Netherlands, Sweden, the UK and the USA. Four tools were used with pregnant populations, two tools with vulnerable non-pregnant populations, six tools measured patient-provider relationship, four measured patient activation, and three tools measured both relationship and activation. RESULTS Tools that measured engagement in maternity care assessed some of the following constructs: communication or information sharing, woman-centred care, health guidance, shared decision-making, sufficient time, availability, provider attributes, discriminatory or respectful care. None of the maternity engagement tools assessed the key construct of buy-in. While non-maternity health engagement tools measured some elements of buy-in (self-care, feeling hopeful about treatment), other elements (disclosing risks to healthcare providers and acting on health advice), which are significant for vulnerable populations, were rarely measured. CONCLUSIONS AND IMPLICATIONS Health engagement is hypothesised as the mechanism by which midwifery-led care reduces the risk of perinatal morbidity for vulnerable women. To test this hypothesis, a new assessment tool is required that addresses all the relevant constructs of the Synergistic Health Engagement model, developed for and psychometrically assessed in the target group. PROSPERO REGISTRATION NUMBER CRD42020214102.
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Affiliation(s)
- Jyai Allen
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Kyly Mills
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Jenny Gamble
- School of Nursing, Midwifery and Health, Coventry University Faculty of Health and Life Sciences, Coventry, UK
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Courtwright SE, Jones J, Barton A, Peterson K, Eigen K, Feuerstein J, Pawa A, Pawa A, Northridge J, Pall H. Adolescents with chronic conditions: Engagement with children's mental health systems during the Covid-19 pandemic. J SPEC PEDIATR NURS 2023; 28:e12403. [PMID: 36815596 DOI: 10.1111/jspn.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice. DESIGN AND METHODS Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10-20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology. RESULTS One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker-Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (β = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (β = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (β = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (β = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until "it was really, really bad" citing fear, stigma, and lack of connectedness with providers as barriers. PRACTICE IMPLICATIONS Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.
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Affiliation(s)
- Suzanne E Courtwright
- Office of Research and Scholarship, University of Colorado College of Nursing, Colorado, USA
| | - Jacqueline Jones
- Office of Research and Scholarship, University of Colorado College of Nursing, Colorado, USA
| | - Amy Barton
- Office of Research and Scholarship, University of Colorado College of Nursing, Colorado, USA
| | - Kerry Peterson
- Office of Research and Scholarship, University of Colorado College of Nursing, Colorado, USA
| | - Karen Eigen
- Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.,Department of Emergency Medicine, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA
| | - Jessica Feuerstein
- Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.,Department of Emergency Medicine, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA.,Department of Adolescent Medicine, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA
| | - Anil Pawa
- Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.,Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Hackensack, New Jersey, USA
| | - Akhil Pawa
- Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.,Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Hackensack, New Jersey, USA
| | - Jennifer Northridge
- Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.,Department of Adolescent Medicine, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA
| | - Harpreet Pall
- Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.,Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Hackensack, New Jersey, USA
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7
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Watson D, Mhlaba M, Molelekeng G, Chauke TA, Simao SC, Jenner S, Ware LJ, Barker M. How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods. Int J Equity Health 2023; 22:17. [PMID: 36698119 PMCID: PMC9876416 DOI: 10.1186/s12939-022-01794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. METHODS Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. FINDINGS The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. DISCUSSION Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa. .,Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Mimi Mhlaba
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Gontse Molelekeng
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thulani Andrew Chauke
- grid.412801.e0000 0004 0610 3238Department of Adult, College of Education, Community and Continuing Education, University of South Africa, Pretoria, South Africa
| | - Sara Correia Simao
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah Jenner
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Lisa J. Ware
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa ,grid.11951.3d0000 0004 1937 1135DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- grid.5491.90000 0004 1936 9297Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.5491.90000 0004 1936 9297School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK ,grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ,grid.430506.40000 0004 0465 4079NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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8
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Diaz JE, Sandh S, Schnall R, Garofalo R, Kuhns LM, Pearson CR, Bruce J, Batey DS, Radix A, Belkind U, Hidalgo MA, Hirshfield S. Predictors of Past-Year Health Care Utilization Among Young Men Who Have Sex with Men Using Andersen's Behavioral Model of Health Service Use. LGBT Health 2022; 9:471-478. [PMID: 35867076 PMCID: PMC9587774 DOI: 10.1089/lgbt.2021.0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersen's behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctor's offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSM's health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.
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Affiliation(s)
- José E Diaz
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Center for Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Simon Sandh
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA.,Department of Population and Family Health, Mailman School of Public Health, New York, New York, USA
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa M Kuhns
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington School of Social Work, Seattle, Washington, USA
| | - Josh Bruce
- Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Uri Belkind
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Marco A Hidalgo
- Medicine-Pediatrics Division, General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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9
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Lestishock L, Nova S, Disabato J. Improving Adolescent and Young Adult Engagement in the Process of Transitioning to Adult Care. J Adolesc Health 2021; 69:424-431. [PMID: 33762131 DOI: 10.1016/j.jadohealth.2021.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/14/2020] [Accepted: 01/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Health care transition (HCT) is the complex process of changing from pediatric to adult-centered care. Comprehensive HCT processes have been associated with improved outcomes in all elements of the Triple Aim. Nationally accepted best practices emphasize Six Core Elements of HCT, including the use of transition readiness assessment tools completed during clinic visits. Specifically, Got Transition's tools include two 0-10 point self-report scales on the validated domains of importance of changing to an adult provider and managing their healthcare, and confidence in their ability to transition. The aim of this quality improvement project (QIP) was to improve the engagement of adolescents and young adults (AYAs), aged 14-20, in the process of transitioning from pediatric to adult care. The sub-aim focused specifically on parent/caregiver engagement in transition, using the same scales in a tool for parents/caregivers. An urban federally qualified health center initiated this QIP. METHODS This QIP utilized the Institute for Healthcare Improvement Model for Improvement and plan-do-study-act cycles. RESULTS Eighty-five AYAs and 40 parents/caregivers completed readiness assessments twice. Scores improved overall, reaching statistical significance with a small change in AYA mean scores for importance (.94) and confidence (.75). Provision of a transition policy and completion of readiness assessments by AYAs and parents/caregivers met the 70% goal. Patient portal enrollments increased from 4.2% to 12.5%, although did not meet the 30% goal. CONCLUSIONS Engagement of AYAs and parents/caregivers was improved as a result of this QIP. Successful routine implementation of transition process measures demonstrated improved clinic-wide communication.
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Affiliation(s)
- Lisa Lestishock
- Ravenswood Family Health Center, East Palo Alto, California; Division of Adolescent Medicine, Stanford Children's Health, Menlo Park, California.
| | - Sandra Nova
- Ravenswood Family Health Center, East Palo Alto, California
| | - Jennifer Disabato
- College of Nursing & School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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10
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Comulada WS, Step M, Fletcher JB, Tanner AE, Dowshen NL, Arayasirikul S, Keglovitz Baker K, Zuniga J, Swendeman D, Medich M, Kao UH, Northrup A, Nieto O, Brooks RA. Predictors of Internet Health Information-Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study. J Med Internet Res 2020; 22:e18309. [PMID: 33136057 PMCID: PMC7669436 DOI: 10.2196/18309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 06/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. OBJECTIVE This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. METHODS Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. RESULTS Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. CONCLUSIONS Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information-seeking behavior may also be used to develop and tailor digital health interventions for these young adults.
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Affiliation(s)
- Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mary Step
- College of Public Health, Kent State University, Kent, OH, United States
| | | | - Amanda E Tanner
- Department of Public Health, University of North Carolina Greensboro, Greensboro, NC, United States
| | - Nadia L Dowshen
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sean Arayasirikul
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | | | - James Zuniga
- Howard Brown Health Center, Chicago, IL, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States
| | - Melissa Medich
- Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, Veterans Affairs Greater Los Angeles Health Care System, US Department of Veteran Affairs, Los Angeles, CA, United States
| | - Uyen H Kao
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adam Northrup
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Omar Nieto
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ronald A Brooks
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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11
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Engel DMC, Paul M, Chalasani S, Gonsalves L, Ross DA, Chandra-Mouli V, Cole CB, de Carvalho Eriksson C, Hayes B, Philipose A, Beadle S, Ferguson BJ. A Package of Sexual and Reproductive Health and Rights Interventions-What Does It Mean for Adolescents? J Adolesc Health 2019; 65:S41-S50. [PMID: 31761003 DOI: 10.1016/j.jadohealth.2019.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022]
Abstract
This article analyzes the relevance of the comprehensive definition of sexual and reproductive health and rights (SRHR) to adolescents and identifies adolescent-specific implications for the implementation of an essential package of SRHR interventions. The delivery of a comprehensive approach to SRHR targeting adolescents is underpinned by five principles-equity, quality, accountability, multisectorality, and meaningful engagement. All SRHR interventions included in the package are relevant to adolescents, given the diversity of adolescents' SRHR needs and considering their specific attributes, circumstances, and experiences. Ensuring that this package is available, accessible, and acceptable to adolescents requires an approach that looks at adolescents as being biologically and socially distinct from other age groups and acknowledges that they face some specific barriers when accessing SRHR services. This article provides cross-cutting strategies for the implementation of a comprehensive approach to SRHR for adolescents and specific considerations in delivering each intervention in the package of essential SRHR interventions. To further implement the International Conference on Population and Development Programme of Action, a prerequisite for achieving the Sustainable Development Goals, SRHR interventions must be adolescent responsive, delivered through multiple platforms, leveraging multisectoral collaboration, and strengthening accountability and participation.
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Affiliation(s)
| | - Mandira Paul
- Technical Division, United Nations Population Fund, New York, New York
| | - Satvika Chalasani
- Technical Division, United Nations Population Fund, New York, New York
| | - Lianne Gonsalves
- Department of Reproductive Health and Research, World Health Organization/Human Reproduction Programme, Geneva, Switzerland
| | - David Anthony Ross
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research, World Health Organization/Human Reproduction Programme, Geneva, Switzerland
| | | | | | - Brendan Hayes
- Global Financing Facility, World Bank, Washington, DC
| | - Anandita Philipose
- Eastern and Southern Regional Office, United Nations Population Fund, Johannesburg, South Africa
| | - Sally Beadle
- Section of Health and Education, United Nations Educational, Scientific and Cultural Organization, Paris, France
| | - B Jane Ferguson
- Independent Consultant, Adolescent Health and Development, Tannay, Switzerland
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12
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Beaudry J, Consigli A, Clark C, Robinson KJ. Getting Ready for Adult Healthcare: Designing a Chatbot to Coach Adolescents with Special Health Needs Through the Transitions of Care. J Pediatr Nurs 2019; 49:85-91. [PMID: 31644960 DOI: 10.1016/j.pedn.2019.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The AAP, AFP, and ACP have authored statements and recommendations to clinicians about the importance of the transition from pediatric to adult care. The Got Transition program provides a framework and resources based on AAP, AFP and ACP recommendations to promote skill attainment in self-care. Engaging adolescents along the transition journey has proven challenging. Use of smartphones, text messaging, and social media are prevalent among teenagers, offering a unique opportunity to engage teenagers in their preferred channel to provide tools and resources to help them successfully transition to adult focused care. METHODS A multidisciplinary team of clinicians, quality improvement facilitators, and human-centered designers at the University of Vermont (UVM) Children's Hospital designed tools for teens with chronic conditions that support the Got Transition recommendations. Using a co-creative design process, we created a novel tool to increase engagement among teenagers. We conducted a pilot study of 13 teenagers with a chronic medical condition using a text messaging platform (chatbot) with scripted interactions to increase engagement and deliver educational content according to Got Transition. RESULTS Mean engagement was 97% during the study period. Qualitative feedback from study participants suggests our chatbot should be extended and shows promise to help teenagers attain self-care skills on the transition journey. CONCLUSIONS A scripted text messaging platform is feasible and appears to be well-received by patients and caregivers. Furthermore, our approach emphasizes the need to engage teenagers through multiple platforms to effectively serve as "coaches" during the transition to adult care.
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Affiliation(s)
- Jeremy Beaudry
- hiCOlab, University of Vermont Health Network Medical Group, United States of America
| | - Alyssa Consigli
- Vermont Child Health Improvement Program, Larner College of Medicine at the University of Vermont, United States of America
| | - Colleen Clark
- University of Vermont Medical Center, United States of America
| | - Keith J Robinson
- University of Vermont Medical Center, United States of America; University of Vermont Children's Hospital, United States of America.
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13
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Siembida EJ, Kadan-Lottick NS, Moss K, Bellizzi KM. Adolescent cancer patients' perceived quality of cancer care: The roles of patient engagement and supporting independence. PATIENT EDUCATION AND COUNSELING 2018; 101:1683-1689. [PMID: 29661702 PMCID: PMC6057810 DOI: 10.1016/j.pec.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/02/2018] [Accepted: 04/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES A lack of focus on variation in engagement among cancer populations of differing developmental stages led us to examine the associations between patient engagement, the patient-provider relationship, cognitive development, readiness to transition to adulthood (transitional readiness) and perceived quality of care. METHODS A sample of 101 adolescent cancer patients (diagnosed 10-20 years) completed survey items concerning patient engagement, dimensions of the patient-provider relationship, cognitive development, transitional readiness, and demographic characteristics using an iPad/tablet during a routine clinic visit. RESULTS Patient engagement was not significantly associated with perceived quality of care (b = .02, 95% CI: -0.06, 0.11). Instead, adolescents with providers that supported their independence (b = .34, 95% CI: 0.17, 0.52) were significantly more likely to perceive higher quality care. CONCLUSION Supportive patient-provider relationships are an integral part of adolescents' perceptions of quality of care. Adolescents are still gaining important skills for navigating the medical system, and the patient-provider relationship may provide an important scaffolding relationship to help adolescents build independence in their treatment experience. PRACTICE IMPLICATIONS Identifying potential mechanisms through which adolescents can provide their opinion, ask questions, and participate in their treatment plan will help in supporting adolescent independence and improve quality of care.
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Affiliation(s)
- Elizabeth J Siembida
- Department of Human Development of Family Studies, University of Connecticut, Storrs, CT, USA.
| | - Nina S Kadan-Lottick
- Section of Pediatric Hematology-Oncology, Yale University School of Medicine, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Kerry Moss
- Connecticut Children's Medical Center, Hartford, CT, USA; University of Connecticut's School of Medicine, Farmington, CT, USA
| | - Keith M Bellizzi
- Department of Human Development of Family Studies, University of Connecticut, Storrs, CT, USA
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14
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Robards F, Kang M, Usherwood T, Sanci L. How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review. J Adolesc Health 2018; 62:365-381. [PMID: 29429819 DOI: 10.1016/j.jadohealth.2017.10.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/08/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. METHODS Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. RESULTS Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. CONCLUSIONS Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia.
| | - Melissa Kang
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia; Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Usherwood
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
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15
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Ragan KR, Bednarczyk RA, Butler SM, Omer SB. Missed opportunities for catch-up human papillomavirus vaccination among university undergraduates: Identifying health decision-making behaviors and uptake barriers. Vaccine 2017; 36:331-341. [PMID: 28755837 DOI: 10.1016/j.vaccine.2017.07.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Suboptimal adolescent human papillomavirus (HPV) vaccine rates in the US highlight the need for catch-up vaccination. When teenagers enter college, there may be a shift in healthcare decision-making from parents and guardians to the students themselves. Little is known about factors influencing college students' healthcare decision-making processes. STUDY DESIGN We evaluated HPV vaccine decision-making among 18-to-26-year-old college students through a self-administered, anonymous, cross-sectional survey. This survey was distributed to a sample of men and women in classroom settings at two universities. Categorical data comparisons were conducted using Chi-square and Fisher's exact tests. Multivariate Poisson regression was used to model initiation of HPV vaccine and compute prevalence ratios while controlling for key influential covariates at the 0.05 alpha level. RESULTS A total of 527 students participated (response proportion=93.1%). Overall, 55.8% of participants received the HPV vaccine. Encouraging conversations with doctors and/or parents/guardians were identified as one of the most influential factors to increase vaccine uptake. Among students who received encouragement from both a doctor and parent, 95.8% received the vaccine. Campaigns about cancer prevention were viewed as more influential than those that focus on preventing genital warts. Approximately one-third of students indicated they didn't know where to get the HPV vaccine. Women were more likely to report that their parents would not let them get the HPV vaccine compared to men (26.7% vs. 2.3%). The majority of students (77.3%) indicated their parents were sometimes, equally, or mostly involved in making decisions about receiving vaccines (other than flu). CONCLUSION Students' decision-making is greatly influenced by their parents; therefore, interventions for this population should work to increase students' control over decision-making while also addressing parental concerns.
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Affiliation(s)
- Kathleen R Ragan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Robert A Bednarczyk
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Cancer Prevention and Control Program, Winship Cancer Institute, 1365-C Clifton Rd NE, Atlanta, GA 30322, USA; Emory Vaccine Center, 954 Gatewood Rd, Atlanta, GA 30329, USA.
| | - Scott M Butler
- School of Health and Human Performance, Georgia College, 231 W. Hancock St, Milledgeville, GA 31061, USA.
| | - Saad B Omer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Emory Vaccine Center, 954 Gatewood Rd, Atlanta, GA 30329, USA; Department of Pediatrics, School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA.
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16
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Ramos MM, Sebastian RA, Stumbo SP, McGrath J, Fairbrother G. Measuring Unmet Needs for Anticipatory Guidance Among Adolescents at School-Based Health Centers. J Adolesc Health 2017; 60:720-726. [PMID: 28254388 DOI: 10.1016/j.jadohealth.2016.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Our previously validated Youth Engagement with Health Services survey measures adolescent health care quality. The survey response format allows adolescents to indicate whether their needs for anticipatory guidance were met. Here, we describe the unmet needs for anticipatory guidance reported by adolescents and identify adolescent characteristics related to unmet needs for guidance. METHODS We administered the survey in 2013-2014 to 540 adolescents who used school-based health centers in Colorado and New Mexico. A participant was considered to have unmet needs for anticipatory guidance if they indicated that guidance was needed on a given topic but not received or guidance was received that did not meet their needs. We calculated proportions of students with unmet needs for guidance and examined associations between unmet needs for guidance and participant characteristics using the chi-square test and logistic regression. RESULTS Among participants, 47.4% reported at least one unmet need for guidance from a health care provider in the past year. Topics with the highest proportions of adolescents reporting unmet needs included healthy diet (19.5%), stress (18.0%), and body image (17.0%). In logistic regression modeling, adolescents at risk for depression and those with minority or immigrant status had increased unmet needs for guidance. Adolescents reporting receipt of patient-centered care were less likely to report unmet needs for guidance. CONCLUSIONS The Youth Engagement with Health Services survey provides needs-based measurement of anticipatory guidance received that may support targeted improvements in the delivery of adolescent preventive counseling. Interventions to improve patient-centered care and preventive counseling for vulnerable youth populations may be warranted.
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Affiliation(s)
- Mary M Ramos
- Department of Pediatrics, Envision New Mexico, University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Rachel A Sebastian
- Child Policy and Population Health, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott P Stumbo
- Department of Population, Family, and Reproductive Health, Child and Adolescent Health Measurement Initiative, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jane McGrath
- Department of Pediatrics, Envision New Mexico, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Allen J, Kildea S, Stapleton H. How optimal caseload midwifery can modify predictors for preterm birth in young women: Integrated findings from a mixed methods study. Midwifery 2016; 41:30-38. [PMID: 27498186 DOI: 10.1016/j.midw.2016.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/06/2016] [Accepted: 07/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE to identify possible mechanisms by which caseload midwifery reduces preterm birth for young childbearing women. DESIGN a mixed methods triangulation, convergence design was used to answer the research question 'How does the way maternity care is provided affect the health and well-being of young women and their babies?' The project generated quantitative and qualitative findings which were collected and analysed concurrently then separately analysed and published. The research design enabled integration of the quantitative and qualitative findings for further interpretation through a critical pragmatic lens. SETTING a tertiary maternity hospital in Australia providing care to approximately 500 pregnant young women (aged 21 years or less) each year. Three distinct models of care were offered: caseload midwifery, young women's clinic, and standard 'fragmented' care. PARTICIPANTS a cohort study included data from 1971 young women and babies during 2008-2012. An ethnographic study included analysis of focus group interviews with four caseload midwives in the young women's midwifery group practice; as well as ten pregnant and postnatal young women receiving caseload midwifery care. FINDINGS integrated analysis of the quantitative and qualitative findings suggested particular features in the model of care which facilitated young women turning up for antenatal care (at an earlier gestation and more frequently) and buying in to the process (disclosing risks, engaging in self-care activities and accepting referrals for assistance). We conceptualised that Optimal Caseload Midwifery promotes Synergistic Health Engagement between midwife and the young woman. KEY CONCLUSIONS optimal Caseload Midwifery (which includes midwives with specific personal attributes and philosophical commitments, along with appropriate institutional infrastructure and support) facilitates midwives and young clients to develop trusting relationships and engage in maternity care. Health engagement can modify predictors for preterm birth that are common amongst pregnant adolescents by promoting earlier maternity booking, sufficient antenatal care, greater emotional resilience, ideal gestational weight gain, less smoking/drug use, and fewer untreated genito-urinary infections. IMPLICATIONS FOR PRACTICE the institutional infrastructure and managerial support for caseload midwifery should value and prioritise the philosophical commitments and personal attributes required to optimise the model. Furthermore the location of visits, between appointment access to primary midwife, and back-up system should be organised to optimise the midwife-woman relationship in order to promote the young woman's engagement with maternity care.
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Affiliation(s)
- J Allen
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| | - S Kildea
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 1, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia.
| | - H Stapleton
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia.
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Cené CW, Johnson BH, Wells N, Baker B, Davis R, Turchi R. A Narrative Review of Patient and Family Engagement: The "Foundation" of the Medical "Home". Med Care 2016; 54:697-705. [PMID: 27111748 PMCID: PMC4907812 DOI: 10.1097/mlr.0000000000000548] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. METHODS We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. RESULTS Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. CONCLUSIONS Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.
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Affiliation(s)
- Crystal W. Cené
- Division of General Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | | | - Beverly Baker
- National Center for Family Professional Partnerships, Family Voices, Inc
| | - Renee Davis
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
| | - Renee Turchi
- Division of General Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, PA
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
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Dewberry C, Jackson DJR. The Perceived Nature and Incidence of Dysfunctional Assessment Center Features and Processes. INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT 2016. [DOI: 10.1111/ijsa.12140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Chris Dewberry
- Department of Organizational Psychology, Birkbeck; University of London; Malet Street London WC1E 7HX UK
| | - Duncan J. R. Jackson
- Department of Organizational Psychology, Birkbeck; University of London; Malet Street London WC1E 7HX UK
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20
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Hagell A, Rigby E, Perrow F. Promoting health literacy in secondary schools: A review. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjsn.2015.10.2.82] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ann Hagell
- Chartered psychologist and research lead, Association for Young People's Health, London
| | - Emma Rigby
- Chief executive, Association for Young People's Health, London
| | - Frances Perrow
- Health literacy project lead, Association for Young People's Health
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21
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The promise and potential of adolescent engagement in health. J Adolesc Health 2014; 55:314. [PMID: 25151052 DOI: 10.1016/j.jadohealth.2014.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 11/22/2022]
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