"I'm Worth Saving": Making Sense of Medication Taking in a Care Coordination Organization

"Taking Charge and Being Responsible": A Qualitative Study of Meaning Making and Motivations for Preexposure Prophylaxis Adherence Among Gay, Bisexual, and Other Sexual Minoritized Men Engaged in Alcohol Misuse in Kentucky

ABSTRACT

Our qualitative study explores meaning making and motivation for preexposure prophylaxis (PrEP) adherence and engagement among gay, bisexual, and other sexual minoritized men (GBSMM) who misuse alcohol. Nineteen interviews with 10 participants who screened positive for harmful alcohol consumption (Alcohol Use Disorders Identification Test scores > 8) indicated that PrEP meaning making contributes to mental well-being, serving as a stabilizing ritual. Motivation for engagement included a commitment to proactive health management and personal and community safety. In the analysis, meaning making and motivation converged through themes of (a) identity affirmation, (b) accountability for self-care, (c) peace of mind, and (d) agency. Complementary themes included relationship dynamics and strategies for adherence. Participants' alcohol use was also explored, examining its intersections with the themes and understandings of PrEP and social well-being. Recommendations include integrating motivational enhancements into the care continuum to increase PrEP adherence and engagement with clinical care and community support among patients misusing alcohol.

"We're All in This Together": Farmers' Reactions to the Farmer Suicide Crisis

Farmer suicide rates continue to increase, with levels being 1.5 times higher than the national rate. This has led agricultural and public health groups to craft and distribute farm stress and suicide messages to help farmers. However, suicide rates remain at critical levels indicating that there may be a disconnect between existing efforts and farmer sensemaking of the crisis. Utilizing the Theory of Memorable Messages (ToMM), this study explored how farmers are reacting to messages and conversations about the farmer suicide crisis. Interviews with 25 participants found most had heard about farmer suicide concerns. When asked about their memorable conversations, farmers reflected a complex sensemaking process that included themes of memorable conversation types ranging from externalization to acceptance and message themes oriented around concern for self and others within these conversation types. Overall, most farmers externalized the risk of suicide to other farmers. However, even though participants did not see themselves at risk, their responses often showed deep concern for helping other farmers. These results are discussed in light of sensemaking and memorable conversations, with practical implications for future messaging efforts around farmer suicide.

Responsibility of follow-up regarding medical recommendations in primary care and challenging patients: The perspective of doctors, nurses, pharmacists, and administrative staff

OBJECTIVE

This study examines the way healthcare staff describe challenging patients and perceive responsibility for follow-up of patients with chronic conditions.

METHODS

Interviews were conducted with 46 healthcare staff (15 primary care physicians/12 nurses/15 administrative staff/4 pharmacists) at 12 clinics in Israel. They were audiotaped, transcribed, and thematically analyzed using Atlas qualitative data analysis software.

RESULTS

Participants defined patients as "challenging" either because they are less likely to follow medical recommendations or are felt to overconsume care. Staff believed that patients did not follow medical recommendations because they were indifferent, unaware, in denial about deteriorating medical condition, or fear of the unknown. Participants generally perceived a shared responsibility for follow-up between the staff and the patient. Staff who endorsed closer relationships with staff members expressed empathy toward challenging patients and felt responsible for follow-up.

CONCLUSIONS

Healthcare staff perceive themselves as partially responsible for helping patients follow up with medical recommendations. Cohesive staff relationships may promote higher levels of empathy toward challenging patients and may contribute to helping patients follow up with recommended care. Practice implications To improve follow-up with medical recommendations, there is a need to develop and test interventions to promote more cohesive ties among clinic staff.

"I Just Don't Know What to Believe": Sensemaking during the COVID-19 Pandemic among Criminal Legal Involved Communities

During the COVID-19 pandemic in the United States, those involved with the criminal legal system experience disproportionate vulnerability to infection, transmission, and mortality, facing additional systemic barriers due to criminal legal involvement (CLI) (e.g., prior incarcerations or probationary status affecting employability or housing security). We use Weick's (1979) model of sensemaking as a theoretical framework to inform our examination of CLI individuals' experiences during the pandemic. The primary objective of this paper is to explore the process of sensemaking amid misinformation, trust/mistrust, and vulnerability during the pandemic among CLI communities in three central states (Illinois, Louisiana, and Arkansas). We conducted seven online focus groups (n = 44), between December 2020 and January 2021, from the targeted communities about their awareness of misinformation, trusted or distrusted sources, attitudes about COVID-19 health behaviors (including testing, protective behaviors such as mask-wearing and social distancing, and vaccination), and experiences with the criminal legal system during the pandemic. The concept of equivocality was at the core of the narratives shared among participants, with uncertainty emerging as a meta-theme across all focus groups. The findings of this study should prove useful for those who are developing messaging to combat mis/disinformation and overcome mis/distrust with the medical system and government institutions among those who are disenfranchised.

Factors Influencing Adherence to Antipsychotic Medications in Women with Delusional Disorder: A Narrative Review

BACKGROUND

Adherence to medication regimens is of great importance in psychiatry because drugs sometimes need to be taken for long durations in order to maintain health and function.

OBJECTIVE

To review influences on adherence to antipsychotic medications, the treatment of choice for delusional disorder (DD), and to focus on adherence in women with DD.

METHOD

A non-systematic narrative review of papers published since 2000 using PubMed and Google Scholar and focusing on women with DD and medication adherence.

RESULTS

Several factors have been identified as exerting influence on adherence in women with persistent delusional symptoms who are treated with antipsychotics. Personality features, intensity of delusion, perception of adverse effects, and cognitive impairment are patient factors. Clinical time spent with the patient, clarity of communication and regular drug monitoring are responsibilities of the health provider. Factors that neither patient nor clinician can control are the social determinants of health such as poverty, easy access to healthcare, and cultural variables.

CONCLUSIONS

There has been little investigation into factors that influence adherence in the target population discussed here -e.g. women with DD. Preliminary results of this literature search indicate that solutions from outside the field of DD may apply to this population. Overall, a solid therapeutic alliance appears to be the best hedge against non-adherence.