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Vaughn LM. Group Level Assessment Methodology as a Liberating Structure Within Qualitative and Participatory Research. Qual Health Res 2024:10497323241240654. [PMID: 38648084 DOI: 10.1177/10497323241240654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Group level assessment (GLA) is a qualitative and participatory research-to-action methodology designed to engage a large group of relevant participants throughout the research process. As originally conceived, a single GLA session is led by a trained facilitator who guides the participants through seven structured steps: climate setting, generating, appreciating, reflecting, understanding, selecting, and action. The purpose of this manuscript is to describe the 25-year trajectory and uses, contributions as a liberating structure, and adaptations of GLA.
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Affiliation(s)
- Lisa M Vaughn
- Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Educational Studies Community-Based Action Research, University of Cincinnati, Cincinnati, OH, USA
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Beck AF, Seid M, McDowell KM, Udoko M, Cronin SC, Makrozahopoulos D, Powers T, Fairbanks S, Prideaux J, Vaughn LM, Hente E, Thurmond S, Unaka NI. Building a regional pediatric asthma learning health system in support of optimal, equitable outcomes. Learn Health Syst 2024; 8:e10403. [PMID: 38633017 PMCID: PMC11019385 DOI: 10.1002/lrh2.10403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction Asthma is characterized by preventable morbidity, cost, and inequity. We sought to build an Asthma Learning Health System (ALHS) to coordinate regional pediatric asthma improvement activities. Methods We generated quantitative and qualitative insights pertinent to a better, more equitable care delivery system. We used electronic health record data to calculate asthma hospitalization rates for youth in our region. We completed an "environmental scan" to catalog the breadth of asthma-related efforts occurring in our children's hospital and across the region. We supplemented the scan with group-level assessments and focus groups with parents, clinicians, and community partners. We used insights from this descriptive epidemiology to inform the definition of shared aims, drivers, measures, and prototype interventions. Results Greater Cincinnati's youth are hospitalized for asthma at a rate three times greater than the U.S. average. Black youth are hospitalized at a rate five times greater than non-Black youth. Certain neighborhoods bear the disproportionate burden of asthma morbidity. Across Cincinnati, there are many asthma-relevant activities that seek to confront this morbidity; however, efforts are largely disconnected. Qualitative insights highlighted the importance of cross-sector coordination, evidence-based acute and preventive care, healthy homes and neighborhoods, and accountability. These insights also led to a shared, regional aim: to equitably reduce asthma-related hospitalizations. Early interventions have included population-level pattern recognition, multidisciplinary asthma action huddles, and enhanced social needs screening and response. Conclusion Learning health system methods are uniquely suited to asthma's complexity. Our nascent ALHS provides a scaffold atop which we can pursue better, more equitable regional asthma outcomes.
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Affiliation(s)
- Andrew F. Beck
- Division of General & Community PediatricsCincinnati Children'sCincinnatiOhioUSA
- Division of Hospital MedicineCincinnati Children'sCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Michael Fisher Child Health Equity CenterCincinnati Children'sCincinnatiOhioUSA
- Office of Population HealthCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Michael Seid
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | - Karen M. McDowell
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | - Mfonobong Udoko
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | - Susan C. Cronin
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | | | - Tricia Powers
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
| | - Sonja Fairbanks
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
| | - Jonelle Prideaux
- Division of Emergency MedicineCincinnati Children'sCincinnatiOhioUSA
- Qualitative Methods & Analysis CollaborativeCincinnati Children'sCincinnatiOhioUSA
| | - Lisa M. Vaughn
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children'sCincinnatiOhioUSA
- Qualitative Methods & Analysis CollaborativeCincinnati Children'sCincinnatiOhioUSA
- Criminal Justice, & Human ServicesUniversity of Cincinnati College of EducationCincinnatiOhioUSA
| | | | - Sophia Thurmond
- Department of Information ServicesCincinnati Children'sCincinnatiOhioUSA
| | - Ndidi I. Unaka
- Division of Hospital MedicineCincinnati Children'sCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Michael Fisher Child Health Equity CenterCincinnati Children'sCincinnatiOhioUSA
- Office of Population HealthCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Stough CO, Rabin J, Gates T, Garr K, Combs A, Edwards ZT, Summer SS, Woo JG, Folger AT, Ammerman RT, Nuñez M, Berndsen J, Clark MJ, Frey JR, Vaughn LM. Infant Obesity Prevention Programs for Underrepresented Mothers in a Home Visiting Program: A Qualitative and Community-Engaged Needs Assessment. Community Health Equity Res Policy 2024; 44:265-279. [PMID: 37202859 PMCID: PMC10983836 DOI: 10.1177/2752535x231176730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A qualitative, community-engaged assessment was conducted to identify needs and priorities for infant obesity prevention programs among mothers participating in home visiting programs. Thirty-two stakeholders (i.e., community partners, mothers, home visitors) affiliated with a home visiting program serving low-income families during the prenatal to age three period participated in group level assessment sessions or individual qualitative interviews. Results indicated families face many challenges to obesity prevention particularly in terms of healthy eating. An obesity prevention program can address these challenges by offering realistic feeding options and non-judgmental peer support, improving access to resources, and tailoring program content to individual family needs and preferences. Informational needs, family factors in healthy eating outcomes, and the importance of access and awareness of programs were also noted. To ensure the cultural- and contextual-relevance of infant obesity prevention programs for underserved populations, needs and preferences among community stakeholders and the focal population should be used as a roadmap for intervention development.
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Affiliation(s)
| | - Julia Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Taylor Gates
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Katlyn Garr
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Angela Combs
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | | | - Suzanne S. Summer
- Schubert Research Clinic, Cincinnati Children’s Hospital Medical Center
| | - Jessica G. Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Alonzo T. Folger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Every Child Succeeds, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Robert T. Ammerman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Every Child Succeeds, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Miguel Nuñez
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Jennifer Berndsen
- Every Child Succeeds, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Margaret J. Clark
- Every Child Succeeds, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jennifer R. Frey
- Every Child Succeeds, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lisa M. Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Educational and Community-Based Action Research, University of Cincinnati College of Education, Criminal Justice & Human Services, Cincinnati, OH
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Chuisano SA, Rafferty J, Allen A, Chang T, Diemer M, Harris K, Vaughn LM, Watkins DC, DeJonckheere M. Increasing representation and diversity in health research: A protocol of the MYHealth research training program for high school students. PLoS One 2023; 18:e0281790. [PMID: 37768968 PMCID: PMC10538793 DOI: 10.1371/journal.pone.0281790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Despite decades of calls for increased diversity in the health research workforce, disparities exist for many populations, including Black, Indigenous, and People of Color individuals, those from low-income families, and first-generation college students. To increase representation of historically marginalized populations, there is a critical need to develop programs that strengthen their path toward health research careers. High school is a critically important time to catalyze interest and rebuild engagement among youth who may have previously felt excluded from science, technology, engineering, and mathematics (STEM) and health research careers. METHODS The overall objective of the MYHealth program is to engage high school students in a community-based participatory research program focused on adolescent health. Investigators will work alongside community partners to recruit 9th through 12th graders who self-identify as a member of a group underrepresented in STEM or health research careers (e.g., based on race and ethnicity, socioeconomic status, first generation college student, disability, etc.). MYHealth students are trained to be co-researchers who work alongside academic researchers, which will help them to envision themselves as scientists capable of positively impacting their communities through research. Implemented in three phases, the MYHealth program aims to foster a continuing interest in health research careers by developing: 1) researcher identities, 2) scientific literacy, 3) scientific self-efficacy, and 4) teamwork and leadership self-efficacy. In each phase, students will build knowledge and skills in research, ethics, data collection, data analysis, and dissemination. Students will directly collaborate with and be mentored by a team that includes investigators, community advisors, scientific advisors, and youth peers. DISCUSSION Each year, a new cohort of up to 70 high school students will be enrolled in MYHealth. We anticipate the MYHealth program will increase interest and persistence in STEM and health research among groups that have been historically excluded in health research careers.
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Affiliation(s)
- Samantha A. Chuisano
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jane Rafferty
- School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alison Allen
- Rockman Et Al, San Francisco, California, United States of America
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew Diemer
- School of Education, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kara Harris
- DePaul University, Chicago, Illinois, United States of America
| | - Lisa M. Vaughn
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- School of Education, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Daphne C. Watkins
- School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
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Vaughn LM, Crosh C, Boyer K, Jenkins A. The Possibility and Promise of Action Research in Pediatrics: A Scoping Review. Clin Pediatr (Phila) 2023; 62:830-839. [PMID: 36625460 DOI: 10.1177/00099228221144838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Action research (AR) is an umbrella term encompassing a range of related research approaches and frameworks such as participatory AR, participatory research, community-based participatory research, and community-engaged research. In contrast to conventional, investigator-led research that is conducted on or about participants, AR is conducted with those who have a "stake" in the research topic. Despite growing acceptance as an established research approach, AR is noticeably limited within pediatric health care literature. Following a structured process, we conducted a scoping review to explore AR in pediatrics within the last 10 years. Twenty-eight articles met eligibility criteria. Study themes included eliciting stakeholder perspectives, improving stakeholder experiences, and developing/evaluating tools. Future AR in pediatrics should include the measurement of specific health outcomes and greater detail of the actionable steps that resulted from the research process. Action research has potential application to improve the quality and stakeholder relevance of pediatric clinical, educational, and community research.
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Affiliation(s)
- Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Clare Crosh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Boyer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley Jenkins
- Department of Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Lambert A, Pratt A, Conard LAE, Grigg Dean E, Page E, Vaughn LM, Lipstein EA. Supporting Gender-Related Medical Decision Making for Transgender and Gender-Diverse Individuals: A Scoping Review. Transgend Health 2023; 8:113-123. [PMID: 37013094 PMCID: PMC10066778 DOI: 10.1089/trgh.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Transgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics. Methods We searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families. Results We retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid. Conclusions There is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.
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Affiliation(s)
- Amy Lambert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashli Pratt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lee Ann E. Conard
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elaine Grigg Dean
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erica Page
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ellen A. Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Hartley K, Prideaux J, Vaughn LM. Understanding Connections between Nature and Stress among Conservation-Engaged Adolescents Using Photovoice Methodology. Int J Environ Res Public Health 2023; 20:4280. [PMID: 36901289 PMCID: PMC10001520 DOI: 10.3390/ijerph20054280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
While the literature supports positive associations between nature and adolescent mental health, mechanisms are not well understood, and assessment of nature varies widely among existing studies. To partner with the most insightful informants, we enrolled eight adolescent participants from a conservation-informed summer volunteer program, applying qualitative photovoice methodology to understand their use of nature to relieve stress. Across five group sessions, participants identified four themes: (1) Nature shows us different aspects of beauty; (2) nature helps us relieve stressful experiences by balancing our senses; (3) nature gives us space to find solutions; and (4) we want to find time to enjoy nature. At the conclusion of the project, youth participants reported that the research experience was overwhelmingly positive, enlightening, and inspired appreciation of nature. We found that, while our participants unanimously reported that nature relieved their stress, prior to this project, they were not always intentional in seeking time in nature for this purpose. Through the photovoice process, these participants noted the usefulness of nature for stress relief. We conclude with recommendations for leveraging nature to decrease adolescent stress. Our findings are relevant for families, educators, students, healthcare professionals, and anyone who works with or cares for adolescents.
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Affiliation(s)
- Kim Hartley
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Jonelle Prideaux
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Lisa M. Vaughn
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
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Cockroft JD, Rabin J, Yockey RA, Toledo I, Fain S, Jacquez F, Vaughn LM, Stryker SD. Psychometric Properties of Scales Measuring Resilience in U.S. Latinx Populations: A Systematic Review. Health Equity 2023; 7:148-160. [PMID: 36895705 PMCID: PMC9989511 DOI: 10.1089/heq.2022.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 03/06/2023] Open
Abstract
Objectives Instruments used to measure resilience have typically been developed in European or Anglosphere countries and emphasize personal factors of resilience. In addition to being a quickly growing ethnic minority group in the United States, Latinx individuals face unique stressors and protective factors that may contribute to resilience. This review sought to determine the extent to which instruments measuring resilience have been validated in U.S. Latinx populations and what domains of resilience those scales capture. Methods A systematic literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and included studies describing psychometric properties of resilience scales for Latinx individuals living in the United States. Articles were assessed for quality of psychometric validation; scales used in the final studies were assessed for representation of domains of the social ecological resilience model. Results Nine studies were included in the final review examining eight separate resilience measures. The populations of these studies were heterogeneous geographically and demographically; more than half the studies only included Latinx populations as a subgroup. The breadth and quality of psychometric validation were variable across studies. The domains represented by the scales in the review most heavily assessed individual domains of resilience. Conclusion The literature to date on psychometric validation of resilience measures in Latinx populations in the United States is limited and does not robustly capture aspects of resilience that may be particularly meaningful for Latinx populations, such as community or cultural factors. Instruments that are developed with and for Latinx populations are necessary to better understand and measure resilience in this population.
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Affiliation(s)
- Joshua D Cockroft
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julia Rabin
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, USA
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, The University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA
| | - Isabella Toledo
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan Fain
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Farrah Jacquez
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, USA
| | - Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,School of Education, University of Cincinnati College of Criminal Justice, Education, and Human Services, Cincinnati, Ohio, USA
| | - Shanna D Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Zamor RL, Vaughn LM, McCann E, Sanchez L, Page EM, Mahabee-Gittens EM. Perceptions and experiences of Latinx parents with language barriers in a pediatric emergency department: a qualitative study. BMC Health Serv Res 2022; 22:1463. [PMID: 36457015 PMCID: PMC9717444 DOI: 10.1186/s12913-022-08839-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prior research has shown disparities exist among Latinx children who require treatment for respiratory illnesses within the pediatric emergency department (PED). Limited data exist regarding Latinx families' experiences on the care they received at PEDs within non-traditional destination areas (NDA). Their experiences can identify areas of improvement to potentially reduce healthcare disparities among pediatric patients within this population. The purpose of this qualitative study was to explore the lived experiences of Latinx families with low English proficiency in the PED with a NDA. The broader purpose was to identify areas of improvement for reducing health care disparities among Latinx families. METHODS We used qualitative methods to analyze semi-structured interviews among Latinx families who presented to the PED with their 0-2 year-old child for a respiratory illness from May 2019 through January 2020. All participants had low English proficiency and requested a Spanish interpreter during registration. All interviews were transcribed and reviewed using thematic analysis based on a phenomenology framework. RESULTS Interviews were conducted with 16 Latinx parents. Thematic analysis revealed four major themes: (1) Uncertainty - Families expressed uncertainty regarding how to care for a child with distressing symptoms, (2) Communication - Families favored in-person interpreters which enhanced communication and allowed families to feel more informed, (3) System Burden - Families reported that the unfamiliarity with the US health system and lack of resources are additional burdens, and (4) Emotional Support - The emergency department visits garnered confidence and reassurance for families. CONCLUSIONS Our study identified four major themes among Latinx families within a PED of a NDA. Potential areas of interventions should focus on supporting access to an interpreter, improving information delivery, and enhancing education on community resources for families with low English proficiency.
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Affiliation(s)
- Ronine L. Zamor
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA ,grid.189967.80000 0001 0941 6502Present Address: Division of Emergency Medicine, Children’s Healthcare of Atlanta, Emory University, 1547 Clifton Road, NE 2nd Floor, Atlanta, GA 30322 USA
| | - Lisa M. Vaughn
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
| | - Erin McCann
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Luisanna Sanchez
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Erica M. Page
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - E. Melinda Mahabee-Gittens
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
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Ellis AS, Brown AM, Martini AI, Page E, Lin L, Vaughn LM. Application of a Child Sex Trafficking Screening Tool in Patients with Abuse: A Retrospective Chart Review in the Pediatric Emergency Department. J Pediatr Health Care 2022; 36:330-338. [PMID: 35219548 DOI: 10.1016/j.pedhc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool. METHOD A retrospective chart review was conducted on random patients, aged 11-17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations. RESULTS Two or more indicators from the CSEC/CST screening tool were identified in 43% (n = 121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators. DISCUSSION Targeted screening and interventions are needed to identify and help these vulnerable youth.
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Duea SR, Zimmerman EB, Vaughn LM, Dias S, Harris J. A Guide to Selecting Participatory Research Methods Based on Project and Partnership Goals. Journal of Participatory Research Methods 2022; 3. [PMID: 35799626 PMCID: PMC9258244 DOI: 10.35844/001c.32605] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Participatory research engages community stakeholders in the research process, from problem identification and developing the research question, to dissemination of results. There is increasing recognition in the field of health research that community-engaged methods can be used throughout the research process. The volume of guidance for engaging communities and conducting participatory research has grown steadily in the past 40+ years, in many countries and contexts. Further, some institutions now require stakeholder engagement in research as a condition of funding. Interest in collaborating in the research process is also growing among patients and the public. This article provides an overview for selecting participatory research methods based on project and partnerships goals.
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Affiliation(s)
| | | | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center/University of Cincinnati
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Terrizzi BF, Lambert AS, Conard LAE, Vaughn LM, Lipstein EL. Providers' Perspectives on Decision-Making About Care for Transgender Youth. Transgend Health 2022. [PMID: 37525837 PMCID: PMC10387150 DOI: 10.1089/trgh.2021.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Transgender and gender-diverse (TGD) youth face health care decisions that are complicated by both social and medical aspects of gender care. Little is known about how providers support decision-making in this context or the gaps they perceive in decision support. Objective To explore health care providers' perspectives on the decision-making processes in youth gender care. Methods We interviewed health care providers (n=17) caring for TGD youth and asked about the nature of families' decision-making, providers' role in this process, and potential improvements to existing support systems. Two independent coders coded all responses which were analyzed using thematic analysis. Results From providers' perspectives, they serve as "guides" to families through a challenging decision-making process. Youth arrive educated and eager to begin treatment, but caregivers are more hesitant. Providers lack data to address parents' concerns, and struggle to support families through interpersonal conflict. All providers recognized a need to improve decision support for families. Conclusions Providers described decision-making in this context as a multistep process where interpersonal conflict and limited data slow progress. Practice Implications There is ample opportunity to leverage insights from adult and pediatric medical decision-making research to improve decision support for providers, TGD youth, and families.
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Affiliation(s)
- Brandon F. Terrizzi
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amy Sue Lambert
- Clinical Psychology, Gallaudet University, Washington, District of Columbia, USA
| | - Lee Ann E. Conard
- Adolescent Medicine, Transgender Health Clinic, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ellen L. Lipstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Abstract
BACKGROUND To identify contextually-relevant strategies for reducing and eventually eliminating addiction, it is imperative to engage stakeholders that are most affected by drug abuse but typically left out of the conversation, such as adolescents. AIM The aim of this study was to collaborate with 45 adolescent stakeholders participating in a school-based research program to identify areas to address addiction. METHODS Guided by a modified version of the mixed-methods concept mapping approach, adolescents were asked to brainstorm and sort a list of statements about how to address addiction in their community. The data were then analyzed via multidimensional scaling and hierarchical cluster analysis. RESULTS The concept map identified eight clusters from 75 edited statements: policing/security (e.g., increase punishment for selling drugs), helping community (e.g., create more jobs), treatment (e.g., make treatments more affordable), increased awareness (e.g., identify and help at-risk youth), communication (e.g., more communication with people who are abusing drugs), increased understanding/education (e.g., online communities for people who are abusing drugs), clean up community (e.g., clean up abandoned houses) and prevent addiction (e.g., effectively deal with peer pressure). DISCUSSION These stakeholder-driven ideas are consistent with the socioecological framework of addressing substance use and add to the credibility and transferability of individual and systemic level approaches to reducing substance use in marginalized communities. CONCLUSION This study emphasizes the feasibility of engaging adolescents in the development of contextually-relevant addiction education, prevention, and treatment interventions in underserved communities.
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Affiliation(s)
| | - Lisa M. Vaughn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
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Vaughn LM, Jacquez F, Deters A, Boards A. Group Level Assessment (GLA) as a methodological tool to facilitate science education. Res Sci Educ 2022; 52:539-551. [PMID: 35321322 PMCID: PMC8937028 DOI: 10.1007/s11165-020-09960-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Group Level Assessment (GLA) is a qualitative, participatory research methodology that can be used within science education, specifically to meet the Science and Engineering Practices dimension of the K-12 Next Generation Science Standards. In contrast to traditional qualitative research methods, GLA is a concrete methodological tool intended for large groups. GLA follows a 7-step process in which diverse stakeholders work together to generate, analyze and prioritize ideas that lead to action planning. Emphasizing personal relevance, shared decision making, systematic inquiry, and collaboration in the design and process, GLA is best positioned conceptually and theoretically within community-based participatory research and inquiry-based learning approaches. The purpose of this manuscript is to describe how GLA can be utilized as an innovative methodology to incorporate students' lived experiences in science education. We describe how to conduct GLA and provide a case example of GLA in action conducted as part of a larger science education program with students and teachers in STEM.
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Affiliation(s)
- Lisa M Vaughn
- Pediatrics Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine
| | - Farrah Jacquez
- Department of Psychology, University of Cincinnati, PO Box 2210376, Cincinnati, OH 45229
| | - Alice Deters
- University of Cincinnati, 2610 McMicken Circle, Cincinnati, OH 45221
| | - Alicia Boards
- University of Cincinnati, 2610 McMicken Circle, Cincinnati, OH 45221
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Magnusson M, Vaughn LM, Wretlind K, Forslund HB, Berg C. Facilitating health promoting ideas and actions: participatory research in an underserved Swedish residential area. BMC Public Health 2022; 22:155. [PMID: 35073898 PMCID: PMC8785534 DOI: 10.1186/s12889-021-12431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background For an intervention to contribute to decreased health gaps, people living in underserved areas must participate in the research-to-action process during the development of the intervention. The purpose of this study was to collaborate with residents living in a Swedish underserved area to generate health and wellness priorities and actions. Methods We applied Group Level Assessment (GLA) together with people living in a Swedish neighborhood where obesity, dental caries and other illnesses are prevalent. GLA is a qualitative, participatory methodology that is designed for a large group to generate and evaluate relevant needs and priorities within a lens of action for positive social change. Residents were recruited by posters, postcards and snowball sampling. In total, 47 residents participated. Eight GLA sessions were held over a five-month time period. Results The GLA sessions resulted in reflections, proposals and actions for change by the residents. Adolescent and parent need for support, improved communication and more meeting places were highlighted as priorities for promoting health and well-being. The results were presented for stakeholders in a report and an exhibition and some of the participants started a language café. Conclusions GLA emphasised the participants’ perspective. The participatory process helped them identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change.
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Schondelmeyer AC, Jenkins AM, Vaughn LM, Brady PW. Family Perspectives on Continuous Monitor Use in a Children's Hospital: A Qualitative Study. Hosp Pediatr 2021; 11:hpeds.2021-005949. [PMID: 34808668 DOI: 10.1542/hpeds.2021-005949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Alarms from continuous cardiorespiratory and pulse oximetry monitors may contribute to parental anxiety and poor sleep during hospitalization, yet families also may find monitoring reassuring. Our objective was to understand how families perceive the utility, benefits, and harms of continuous monitoring. METHODS In this single-center qualitative study, we used semistructured interviews and direct observation. We enrolled families of patients of a variety of ages and clinical diagnoses. We extracted patient demographic information (age, diagnosis) from the health record. Semistructured interviews were recorded and transcribed. Detailed field notes were taken during observations. We used an inductive thematic approach to develop and refine codes that informed the development of themes. RESULTS We recruited 24 families and conducted 23 interviews and 9 observation sessions. Respiratory conditions (eg, bronchiolitis, asthma) were the most common reason for hospitalization. The hospitalized children covered a range of ages: <4 weeks (16%), 4 weeks to 6 months (20%), 7 months to 5 years (44%), and >5 years (20%); 55% had previously been hospitalized. Families expressed varying degrees of understanding the utility of monitors and often conducted their own assessments before notifying staff about alarms. Families expected monitoring, including negative effects like sleep disruption, as part of hospitalization. Families perceived the benefit of monitoring in context of previous hospital experiences, often seeing less benefit and worrying less about alarms in subsequent hospitalizations. CONCLUSIONS Family members continue to find reassurance from cardiorespiratory monitoring despite evidence that it offers limited benefit outside of the ICU setting. Parental perspectives should be addressed in future deimplementation efforts.
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Affiliation(s)
- Amanda C Schondelmeyer
- Departments of Pediatrics
- Divisions of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashley M Jenkins
- Departments of Pediatrics
- Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Patrick W Brady
- Departments of Pediatrics
- Divisions of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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17
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Williams-Arya P, Vaughn LM, Nidey N, Sawyer M, Porter K, Froehlich TE. Striving for Structure and Stability in Cincinnati's Family Homeless Shelters: A Community-Based Participatory Research Approach. Fam Community Health 2021; 44:282-291. [PMID: 34269697 DOI: 10.1097/fch.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.
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Affiliation(s)
- Pamela Williams-Arya
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Drs Williams-Arya and Froehlich); and Divisions of Developmental and Behavioral Pediatrics (Drs Williams-Arya, Nidey, and Froehlich and Mss Sawyer and Porter), Emergency Medicine (Dr Vaughn), and Biostatistics and Epidemiology (Dr Nidey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Jenkins AM, Burns D, Horick R, Spicer B, Vaughn LM, Woodward J. Adolescents and Young Adults With Spina Bifida Transitioning to Adulthood: A Comprehensive Community-Based Needs Assessment. Acad Pediatr 2021; 21:858-867. [PMID: 33577992 PMCID: PMC8263488 DOI: 10.1016/j.acap.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Developing effective interventions to promote successful transition to adulthood for adolescents and young adults (AYA) with spina bifida (SB) requires input from SB community stakeholders, particularly AYA themselves. The goal of this study was to identify and prioritize facilitators and barriers of successful transition to a healthy adult life for AYA with SB. METHODS We utilized concept mapping, a community-engaged research methodology. We recruited a purposeful sample of SB community stakeholders: AYA with SB, parents/caregivers, pediatric and adult health care providers, and community organizations. Participants generated ideas to open-ended prompts. A subset of participants sorted responses into groups of similar ideas. Multidimensional scaling and hierarchical cluster analysis were applied to generate cluster maps. The concept map was determined by identifying the optimal cluster number that qualitatively represented meaningful and distinct concepts. Concepts were rated by participants for importance and feasibility. RESULTS Participants generated 90 unique ideas that were then sorted. The research team chose a 10-cluster concept map: coordinated and comprehensive medical care, health and wellness, self-management, self-advocacy, skills to maximize independence, inclusivity and relationship supports, physical accessibility of the environment, employment, finances, and community- and school-based resources. Self-management, self-advocacy, and inclusivity and relationship supports were rated as both highly feasible and important. CONCLUSIONS By using concept mapping to engage diverse stakeholders, including people with intellectual, development, and physical disabilities, this study prioritized less traditional areas like inclusivity and relationship supports to focus improvement efforts relevant to AYA with SB becoming healthy adults.
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Affiliation(s)
- Ashley M Jenkins
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center (AM Jenkins), Cincinnati, Ohio; Department of Internal Medicine, University of Cincinnati College of Medicine (AM Jenkins), Cincinnati, Ohio.
| | - Diane Burns
- Spina Bifida Coalition of Cincinnati (D Burns and R Horick), Cincinnati, Ohio
| | - Rhonda Horick
- Spina Bifida Coalition of Cincinnati (D Burns and R Horick), Cincinnati, Ohio
| | - Brittany Spicer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center (B Spicer and J Woodward), Cincinnati, Ohio
| | - Lisa M Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine (LM Vaughn and J Woodward), Cincinnati, Ohio; Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center (LM Vaughn), Cincinnati, Ohio
| | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center (B Spicer and J Woodward), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (LM Vaughn and J Woodward), Cincinnati, Ohio
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Burkett K, Kamimura-Nishimura KI, Suarez-Cano G, Ferreira-Corso L, Jacquez F, Vaughn LM. Latino-to-Latino: Promotores' Beliefs on Engaging Latino Participants in Autism Research. J Racial Ethn Health Disparities 2021; 9:1125-1134. [PMID: 34156630 DOI: 10.1007/s40615-021-01053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Latino(a) communities, promotores de salud (i.e., community health workers; promotores) are becoming critical participants in prevention, health promotion, and the delivery of health care. Although involving culturally diverse participants in research is a national priority, recruitment and retention of research participants from these groups is challenging. Therefore, there is an increased need to identify strategies for successful recruitment of participants from underrepresented minority backgrounds. Our overall study purpose was to gain promotores' perspectives on recruiting Latino(a) immigrant community members for an intervention study on autism spectrum disorders (ASD). The goal of this paper is to explore insider promotores' views on the barriers and facilitators to research participation in the Latino(a) community and learn strategies for recruiting Latino(a) participants in a nontraditional destination city. METHODS We conducted qualitative focus groups with an established group of promotores known as Latinos Unidos por la Salud (LU-Salud), who were members of a community-academic research team. Fifteen LU-Salud promotores participated in the focus groups. Focus group interviews were analyzed by using Leininger's data analysis enabler. These results will inform our partnerships with promotores and Latino(a) neighborhood agencies to increase recruitment for community-based research on promoting awareness of ASD among Latino(a) families. RESULTS Promotores were credible community members able to gain community trust and committed to improving the health and well-being of their Latino(a) community, including involving them in research. Latino(a) research involvement meant facilitating community members' engagement to overcome barriers of distrust around legal and health care systems. Challenges included legal uncertainties, language and literacy barriers, health knowledge, and economic hardship. Promotores also voiced the diversity of cultural practices (subcultures) within the Latino(a) culture that influenced: (1) research engagement, (2) guidance from promotores, (3) immersion in the Latino(a) community, and (4) health and well-being. Experienced promotores, who are living in a nontraditional migration area, believe the primary facilitator to increasing research involvement is Latino(a)-to-Latino(a) recruitment. CONCLUSIONS These findings will aid in building partnerships to recruit participants for future studies that promote early recognition of ASD in the Latino(a) community.
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Affiliation(s)
- Karen Burkett
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Nursing, 3333 Burnet Ave. MLC 4002, Cincinnati, OH, 45229, USA.
| | - Kelly I Kamimura-Nishimura
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Nursing, 3333 Burnet Ave. MLC 4002, Cincinnati, OH, 45229, USA
| | | | - Lorena Ferreira-Corso
- Department of Developmental Pediatrics, Siskin Children's Institute Center for Developmental Pediatrics, 1101 Carter Street, Chattanooga, TN, 37402, USA
| | - Farrah Jacquez
- Department of Psychology, University of Cincinnati, PO Box 210376, Cincinnati, OH, 45221, USA
| | - Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, 3333 Burnet Ave. MLC 2008, Cincinnati, OH, 45229, USA
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Stryker SD, Andrew Yockey R, Rabin J, Vaughn LM, Jacquez F. How Do We Measure Stress in Latinos in the United States? A Systematic Review. Health Equity 2021; 5:338-344. [PMID: 34036218 PMCID: PMC8140353 DOI: 10.1089/heq.2020.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Previous research has documented that Latinos report higher levels of stress than other ethnicities and are an increasing portion of the demographics of the United States. While there are many measures to assess stress and other stress-related conditions, there are no systematic reviews to date to assess whether the current measures of generalized stress are valid or reliable in Latinos in the United States. The purpose of this systematic review was to examine the current state of the literature assessing the psychometric properties in stress measures in this population. Methods: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to review the literature from January 1990 to May 2020 for studies, which measured the psychometric properties of scales measuring generalized stress in Latinos in the United States. Results: Twelve studies measured the psychometric properties of eight scales of generalized stress. The 10-item Perceived Stress Scale, the Hispanic Stress Inventory, the Hispanic Women's Social Stressor Scale, and the Family Obligation Stress Scale show the strongest reliability and validity for measuring stress in Latinos in the United States. Most studies were done in traditional immigration destinations in the United States. Conclusion: While four scales which show acceptable reliability and validity for measuring stress in Latinos in the United States, continuing to develop and further validate these scales within Latino communities will be critical to understand and address Latino stress more comprehensively. Our findings can inform health research and clinical interventions for this at-risk community.
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Affiliation(s)
- Shanna D Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robert Andrew Yockey
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Julia Rabin
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Farrah Jacquez
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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21
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Vaughn LM, DeJonckheere M. The Opportunity of Social Ecological Resilience in the Promotion of Youth Health and Wellbeing: A Narrative Review. Yale J Biol Med 2021; 94:129-141. [PMID: 33795989 PMCID: PMC7995941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Youth experience adversity that increases their risk for immediate and long-term health consequences. Resilience has traditionally been conceptualized as an internal disposition or trait that supports youth to overcome that risk and avoid the negative impact on their health and wellbeing. However, this model of resilience overemphasizes the role of the individual and their capacity to control their environment, while minimizing the integral role of relational, social, structural, and cultural contexts in which they live. Instead, social ecological resilience (SER) emphasizes the influence of social and environmental factors on individual processes and outcomes and offers different pathways for preventive interventions to promote youth health and wellbeing. Within preventive medicine, it is important for researchers and practitioners to understand the processes that support or impede SER, particularly in youth when adversity can impact health throughout the lifespan. The purpose of this review was to examine the contributions and scope of the SER model in research on youth, with the goal of advancing SER-informed research and interventions within preventive medicine. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach as a guiding framework, we conducted a narrative review of the literature. The review characterizes 37 existing studies across the fields of education, psychology, and social work in terms of topic, focal population, methods, use of SER, and implications. We conclude with recommendations for future applications of SER to promote the health and wellbeing of youth.
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Affiliation(s)
- Lisa M. Vaughn
- Cincinnati Children’s Hospital Medical
Center/University of Cincinnati College of Medicine, Joint appointment,
University of Cincinnati, Educational and Community-Based Action Research,
Cincinnati, OH, USA,To whom all correspondence should be addressed:
Lisa M. Vaughn, PhD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet
Ave. ML 2008, Cincinnati, OH 45229; Tel: 513-636-9424, Fax: 513-636-7967;
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Dexheimer JW, Greiner MV, Beal SJ, Johnson D, Kachelmeyer A, Vaughn LM. Sharing personal health record data elements in protective custody: youth and stakeholder perspectives. J Am Med Inform Assoc 2021; 26:714-721. [PMID: 31365097 DOI: 10.1093/jamia/ocz067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/15/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study sought to develop the necessary elements for a personalized health record (PHR) for youth emancipating from child protective custody (eg, foster care) by collecting thoughts and ideas from current and former foster youth and community stakeholders who have a significant amount of experience working with emancipating young people. MATERIALS AND METHODS We employed a mixed methods, participatory research design using concept mapping to identify key features for PHR across stakeholders. RESULTS In the clusters, common themes for necessary elements for a PHR included health education, health tips, medication instructions, diagnoses including severity, and website resources that could be trusted to provide reliable information, and addressed data privacy issues such as the primary user being able to choose what diagnoses to share with their trusted adult and the ability to assign a trusted adult to view a part of the record. DISCUSSION By directly involving youth in the design of the PHR, we are able to ensure we included the necessary health and life skills elements that they require. As a PHR is created for foster youth, it is important to consider the multiple uses that the data may have for emancipated youth. CONCLUSION A PHR for foster youth needs to include an appropriate combination of information and education for a vulnerable population. In addition to providing some of their basic health and custody information, a PHR provides an opportunity to give them information that can be trusted to explain common diagnoses, medications, and family health history risks.
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Affiliation(s)
- Judith W Dexheimer
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary V Greiner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sarah J Beal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Darius Johnson
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrea Kachelmeyer
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M Vaughn
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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DiMascio TC, Zhen-Duan J, Rabin J, Vaughn LM, Jacquez F. Intercultural differences in healthcare experiences of Latinos in a nontraditional destination area. Fam Syst Health 2020; 38:232-241. [PMID: 32955282 DOI: 10.1037/fsh0000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Disparities in health care access for Latinos are well documented, but little is known about how they may impact immigrants from diverse countries of origin differently. Immigrants in nontraditional destination areas face greater disparities, allowing more robust comparison of Latino heritage groups in such regions. Method: Mexican (N = 258) and Guatemalan (N = 143) participants were recruited for a community-based participatory research (CBPR) initiative in Cincinnati, Ohio: Latinos Unidos por la Salud (LU-Salud). Community partners recruited Latino immigrants to complete a brief survey about health care difficulties. Mixed methods data analysis was employed using t tests, Fisher's exact test, and a qualitative content analysis approach to analyze group differences. Results: Although both groups reported challenges, Guatemalans reported greater difficulty navigating health care. Conversely, Mexicans more commonly used local resources like health fairs to seek health information and described fewer language barriers. Qualitatively, Guatemalans and Mexicans had different perceptions of the biggest health problem for Latinos in Cincinnati. Notably, Mexicans identified major chronic diseases as community health problems. Discussion: Mexicans and Guatemalans show different patterns of health care engagement and express distinct concerns. Future work should consider the role of health literacy in informing the heterogenous experiences and needs of Latinos from diverse countries of origin. Further, interventions should train health care providers to provide culturally sensitive services, with interpreters available in multiple languages to address heterogenous language needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Julia Rabin
- Department of Psychology, University of Cincinnati
| | - Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Dribin TE, Sampson HA, Camargo CA, Brousseau DC, Spergel JM, Neuman MI, Shaker M, Campbell RL, Michelson KA, Rudders SA, Assa'ad AH, Risma KA, Castells M, Schneider LC, Wang J, Lee J, Mistry RD, Vyles D, Vaughn LM, Schumacher DJ, Witry JK, Viswanathan S, Page EM, Schnadower D. Persistent, refractory, and biphasic anaphylaxis: A multidisciplinary Delphi study. J Allergy Clin Immunol 2020; 146:1089-1096. [PMID: 32853640 DOI: 10.1016/j.jaci.2020.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of inconsistent definitions for anaphylaxis outcomes limits our understanding of the natural history and epidemiology of anaphylaxis, hindering clinical practice and research efforts. OBJECTIVE Our aim was to develop consensus definitions for clinically relevant anaphylaxis outcomes by utilizing a multidisciplinary group of clinical and research experts in anaphylaxis. METHODS Using Delphi methodology, we developed agenda topics and drafted questions to review during monthly conference calls. Through online surveys, a 19-member panel consisting of experts in allergy and/or immunology and emergency medicine rated their level of agreement with the appropriateness of statements on a scale of 1 to 9. A median value of 1.0 to 3.4 was considered inappropriate, a median value of 3.5 to 6.9 was considered uncertain, and a median value of 7.0 to 9.0 was considered appropriate. A disagreement index was then calculated, with values less than 1.0 categorized as "consensus reached." If consensus was not reached after the initial survey, subsequent surveys incorporating the aggregate de-identified responses from prior surveys were sent to panel members. This process was repeated until consensus was reached or 4 survey rounds had been completed, after which the question was categorized as "no consensus reached." RESULTS The panel developed outcome definitions for persistent, refractory, and biphasic anaphylaxis, as well as for persistent and biphasic nonanaphylactic reactions. There was also consensus among panel members regarding the need to develop an anaphylaxis severity grading system. CONCLUSION Dissemination and application of these definitions in clinical care and research will help standardize the terminology used to describe anaphylaxis outcomes and serve as the foundation for future research, including research aimed at development of an anaphylaxis severity grading system.
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Affiliation(s)
- Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Hugh A Sampson
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - David C Brousseau
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine, Hanover, NH; Dartmouth-Hitchcock Medical Center, Hanover, NH
| | | | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Susan A Rudders
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Amal H Assa'ad
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly A Risma
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York
| | - Juhee Lee
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Rakesh D Mistry
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colo
| | - David Vyles
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John K Witry
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shiv Viswanathan
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Alwan RM, Schumacher DJ, Cicek-Okay S, Jernigan S, Beydoun A, Salem T, Vaughn LM. Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children. PLoS One 2020; 15:e0237081. [PMID: 32764783 PMCID: PMC7413502 DOI: 10.1371/journal.pone.0237081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews. METHODS Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach. RESULTS Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources. CONCLUSION This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.
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Affiliation(s)
- Riham M. Alwan
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Daniel J. Schumacher
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Sevsem Cicek-Okay
- College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, United States of America
| | - Sarah Jernigan
- College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, OH, United States of America
| | - Ahmed Beydoun
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
| | - Tasnim Salem
- Independent Consultant, Dallas, TX, United States of America
| | - Lisa M. Vaughn
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, OH, United States of America
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Vilvens HL, Vaughn LM, Southworth H, Denny SA, Gittelman MA. Personalising Safe Sleep Messaging for Infant Caregivers in the United States. Health Soc Care Community 2020; 28:891-902. [PMID: 31847057 DOI: 10.1111/hsc.12920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 10/26/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
The purpose of our study was to better understand why parents/caregivers might not practice safe sleep behaviours. In autumn 2016, we conducted 'pulse' interviews with 124 parents/caregivers of children under the age of one year at a variety of local community events, festivals and meetings in cities with high infant mortality rates around the Midwestern US state of Ohio. Through an inductive approach, pulse interviews were analysed using thematic coding and an iterative process which followed for further clarification of themes (Qualitative Research in Psychology, 2006, 3, 77; BMC Medical Research Methodology, 2013, 13, 117). The six major themes of underlying reasons why parents/caregivers might not practice safe sleep behaviours that were identified in our coding process included the following: (a) culture and family tradition, (b) knowledge about safe sleep practices, (c) resource access, (d) stressed out parents, (f) lack of support and (g) fear for safety of baby. Using the descriptive findings from the pulse interviews, qualitative themes and key informant validation feedback, we developed four diverse fictional characters or personas of parents/caregivers who are most likely to practice unsafe sleep behaviours. These personas are characteristic scenarios which imitate parent and caregiver experiences with unsafe sleep behaviours. The personas are currently being used to influence development of health promotion and education programs personalised for parents/caregivers of infants less than one year to encourage safe sleep practices.
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Affiliation(s)
| | - Lisa M Vaughn
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Michael A Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH
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Vaughn LM, Sunny CE, Lindquist-Grantz R, King C, Brent D, Boyd S, Grupp-Phelan J. Successful Suicide Screening in the Pediatric Emergency Department: Youth, Parent, Researcher, and Clinician Perspectives. Arch Suicide Res 2020; 24:124-141. [PMID: 30537901 PMCID: PMC6559878 DOI: 10.1080/13811118.2018.1541034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to include youth, parents, researchers, and clinicians in the identification of feasible and acceptable strategies for teen suicide screening in the pediatric emergency department (ED). Concept mapping methodology was used to elicit stakeholder responses. Regarding the most important result of suicide screening for teens in the pediatric ED, suicide prevention and education for parents, friends, and community members was rated easiest to implement, while short- and long-term follow-up and treatment was rated most important. In terms of successful suicide screening for teens in the pediatric ED, provision of resources and information was rated most feasible, and a safe, friendly, private screening environment was rated most important. The concept maps can be used to align suicide risk screening with the priorities and recommendations of pediatric ED stakeholders.
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Magnusson M, Forslund HB, Berg C, Wretlind K, Hallmyr M, Hedström C, Vaughn LM. Health promoting ideas and actions generated by community engagement in an underserved Swedish area. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
For an intervention to contribute to decreased health gaps, people living in underserved areas must participate in the research-to-action process during the development of the intervention.
Methods for increased engagement and participation have been developed within the community-based participatory research (CBPR) paradigm. Group Level Assessment (GLA) is a qualitative, participatory methodology that is designed for a large group to generate and evaluate relevant needs and priorities within a lens of action for positive social change. Influence of researchers is tuned down in favour of partnership and impact from the community. Ideally, the process results in participant-driven data and relevant action plans. The aim was to apply GLA to generate reflections on the situation in the community, aligning towards action for change.
Methods
We applied GLA together with people living in Gårdsten, an underserved Swedish suburb where obesity, caries and other illnesses are prevalent. Residents were recruited by posters and post cards at a community center and by snowball sampling. In total, 47 residents attended at least one of eight GLA sessions held over a five-month time period. The majority were women. Outcomes were reflections, suggestions and actions for change.
Results
Themes were: resident pride of the area, the importance of communication and of places to meet, a feeling of being abandoned by society, and a desire for more collaboration between schools and parents. Immediate results were a language café and inquiries from the community about information regarding teeth, food and health. When the results were presented for stakeholders in a report and an exhibition, new collaborations were founded and old were refreshed.
Conclusions
GLA helped residents identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change.
Key messages
Participatory processes that directly engage community residents can result in fruitful discussions and actions. Methodologies like GLA that support such processes may contribute to closing the health gap.
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Affiliation(s)
- M Magnusson
- Public Health Unit, Angered Hospital, SV Hospital Group, Region Västra Götaland, Sweden
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - H B Forslund
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - C Berg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - K Wretlind
- Public Dental Service Västra Götaland, Region Västra Götaland, University of Malmö, Sweden
| | - M Hallmyr
- Public Health Unit, Angered Hospital, SV Hospital Group, Region Västra Götaland, Sweden
| | - C Hedström
- Public Health Unit, Angered Hospital, SV Hospital Group, Region Västra Götaland, Sweden
| | - L M Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
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29
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Affiliation(s)
- Lisa M Vaughn
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa DeJonckheere
- University of Michigan Medical School, Department of Family Medicine, Ann Arbor, Michigan
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Schondelmeyer AC, Jenkins AM, Allison B, Timmons KM, Loechtenfeldt AM, Pope-Smyth ST, Vaughn LM. Factors Influencing Use of Continuous Physiologic Monitors for Hospitalized Pediatric Patients. Hosp Pediatr 2019; 9:423-428. [PMID: 31043435 DOI: 10.1542/hpeds.2019-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Continuous physiologic monitors (CPMs) generate frequent alarms and are used for up to 50% of children who are hospitalized outside of the ICU. Our objective was to assess factors that influence the decision to use CPMs. METHODS In this qualitative study, we used group-level assessment, a structured method designed to engage diverse stakeholder groups. We recruited clinicians and other staff who work on a 48-bed hospital medicine unit at a freestanding children's hospital. We developed a list of open-ended prompts used to address CPM use on inpatient units. Demographic data were collected from each participant. We conducted 6 sessions to permit maximum participation among all groups, and themes from all sessions were merged and distilled. RESULTS Participants (n = 78) included nurses (37%), attending physicians (17%), pediatric residents (32%), and unit staff (eg, unit coordinator; 14%). Participants identified several themes. First, there are patient factors (eg, complexity and instability) for which CPMs are useful. Second, participants perceived that alarms have negative effects on families (eg, anxiety and sleep deprivation). Third, CPMs are often used as surrogates for clinical assessments. Fourth, CPM alarms cause anxiety and fatigue for frontline staff. Fifth, the decision to use CPMs should be, but is not often, a team decision. Sixth, and finally, there are issues related to the monitor system's setup that reduces its utility. CONCLUSIONS Hospital medicine staff identified patient-, staff-, and system-level factors relevant to CPM use for children who were hospitalized. These data will inform the development of system-level interventions to improve CPM use and address high alarm rates.
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Affiliation(s)
- Amanda C Schondelmeyer
- Divisions of Hospital Medicine and .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashley M Jenkins
- Divisions of Hospital Medicine and.,Department of Internal Medicine, University of Cincinnati Hospital, Cincinnati, Ohio
| | | | | | | | - Sally T Pope-Smyth
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa M Vaughn
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.,Emergency Medicine
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DeJonckheere M, Vaughn LM. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health 2019; 7:e000057. [PMID: 32148704 PMCID: PMC6910737 DOI: 10.1136/fmch-2018-000057] [Citation(s) in RCA: 354] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/04/2018] [Accepted: 01/23/2019] [Indexed: 12/05/2022] Open
Abstract
Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research. This method typically consists of a dialogue between researcher and participant, guided by a flexible interview protocol and supplemented by follow-up questions, probes and comments. The method allows the researcher to collect open-ended data, to explore participant thoughts, feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues. The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings. We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings. Overall, semistructured interviewing requires both a relational focus and practice in the skills of facilitation. Skills include: (1) determining the purpose and scope of the study; (2) identifying participants; (3) considering ethical issues; (4) planning logistical aspects; (5) developing the interview guide; (6) establishing trust and rapport; (7) conducting the interview; (8) memoing and reflection; (9) analysing the data; (10) demonstrating the trustworthiness of the research; and (11) presenting findings in a paper or report. Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings. Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality. Semistructured interviewing can be a powerful tool for family physicians, primary care providers and other health services researchers to use to understand the thoughts, beliefs and experiences of individuals. Despite the utility, semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches. In order to elucidate this method, we provide practical guidance for researchers, including novice researchers and those with few resources, to use semistructured interviewing as a data collection strategy. We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.
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Affiliation(s)
| | - Lisa M Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Vaughn LM, Jacquez F, Suarez-Cano G. Developing and implementing a stress and coping intervention in partnership with Latino immigrant coresearchers. Translational Issues in Psychological Science 2019. [DOI: 10.1037/tps0000172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vaughn LM, Whetstone C, Boards A, Busch MD, Magnusson M, Määttä S. Partnering with insiders: A review of peer models across community-engaged research, education and social care. Health Soc Care Community 2018; 26:769-786. [PMID: 29512217 DOI: 10.1111/hsc.12562] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Within community-engaged research, education and social care, peer models that partner with local "insiders" are increasingly common. Peer models are composed of insider "lay" community members who often share similarities or background with a project's target population. Peers are not academically trained, but work alongside researchers and professionals to carry out specific tasks within a project, or in the truest sense of partnership, peers collaborate throughout the project from start to finish as an equal member of the team. Although peer models are used widely, the literature lacks consistency and clarity. This systematic review of literature used a qualitative thematic synthesis to examine and report how, where and why peer models have been used in research, education and social care. We examined the language and titles used to describe the peers, details of their involvement in community-engaged projects, the setting, content/topic of study, level of engagement and related benefits/outcomes of such models. Focusing on the last 10 years, we conducted a comprehensive literature search twice between September 2016 and June 2017. The search resulted in 814 articles which were assessed for eligibility. Overall, 251 articles met our inclusion criteria and were categorised into three categories: empirical (n = 115); process/descriptive (n = 93); and "about" peers (n = 43). Findings suggest that there is a wide variety of peers, titles and terminology associated with peer models. There is inconsistency in how these models are used and implemented in research studies and projects. The majority of articles used an employment peer model, while only a handful involved peers in all phases of the project. The results of this literature review contribute to understanding the use, development and evolution of peer models. We highlight potential benefits of peer models for peers, their communities and community-engaged work, and we offer recommendations for future implementation of peer models.
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Affiliation(s)
- Lisa M Vaughn
- Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Alicia Boards
- Educational and Community-Based Action Research, University of Cincinnati, Cincinnati, OH, USA
| | - Melida D Busch
- Edward L. Pratt Research Library, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Sylvia Määttä
- Department of Healthcare Improvement, Western Region, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Vaughn LM, Jacquez F, Zhen-Duan J. Perspectives of Community Co-Researchers About Group Dynamics and Equitable Partnership Within a Community-Academic Research Team. Health Educ Behav 2018; 45:682-689. [PMID: 29618239 DOI: 10.1177/1090198118769374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Equitable partnership processes and group dynamics, including individual, relational, and structural factors, have been identified as key ingredients to successful community-based participatory research partnerships. The purpose of this qualitative study was to investigate the key aspects of group dynamics and partnership from the perspectives of community members serving as co-researchers. Semistructured, in-depth interviews were conducted with 15 Latino immigrant co-researchers from an intervention project with Latinos Unidos por la Salud (LU-Salud), a community research team composed of Latino immigrant community members and academic investigators working in a health research partnership. A deductive framework approach guided the interview process and qualitative data analysis. The LU-Salud co-researchers described relationships, personal growth, beliefs/identity motivation (individual dynamics), coexistence (relational dynamics), diversity, and power/resource sharing (structural dynamics) as key foundational aspects of the community-academic partnership. Building on existing CBPR and team science frameworks, these findings demonstrate that group dynamics and partnership processes are fundamental drivers of individual-level motivation and meaning making, which ultimately sustain efforts of community partners to engage with the research team and also contribute to the achievement of intended research outcomes.
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Affiliation(s)
- Lisa M Vaughn
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Keck CS, Creaghead NA, Turkstra LS, Vaughn LM, Kelchner LN. Pragmatic skills after childhood traumatic brain injury: Parents' perspectives. J Commun Disord 2017; 69:106-118. [PMID: 28898709 DOI: 10.1016/j.jcomdis.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/02/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to characterize pragmatic deficits after childhood traumatic brain injury (TBI) within the home environment social contexts where they occur. We used a descriptive qualitative approach to describe parents' experiences in communicating with their child with TBI. Participants were ten mothers of children ages 6-12 years who had sustained a moderate to severe TBI more than one year prior to the study. Mothers' experiences were collected through semi-structured interviews and questionnaires. Interviews were analyzed using a deductive framework to develop social contexts and pragmatic deficit themes for communication in the home. Overall, mothers primarily described their children with TBI as exhibiting average or near average pragmatic skills at home, but nine observed some pragmatic deficits and/or social behavior problems. There were four in-home social contexts in which pragmatic deficits were observed. Emergent themes also included outside-of-the home social contexts and social behavior problems. There was some overlap of pragmatic deficit and social behavior problem themes among contexts, but many deficits were context specific. This study's pragmatic deficit themes expanded on prior childhood TBI pragmatic investigations by identifying contexts in and outside of the home in which pragmatic deficits may occur after TBI. Learning Outcomes Readers will be able to describe the day-to-day social contexts that may be impacted by pragmatic deficits after childhood TBI. Readers will be able to compare the pragmatic deficit themes identified as occurring in the home to those occurring outside of the home.
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Affiliation(s)
- Casey S Keck
- University of Cincinnati, Department of Communication Sciences and Disorders, 3202 Eden Ave., Cincinnati, OH 45267, United States.
| | - Nancy A Creaghead
- University of Cincinnati, Department of Communication Sciences and Disorders, 3202 Eden Ave., Cincinnati, OH 45267, United States.
| | - Lyn S Turkstra
- University of Wisconsin-Madison, Department of Communication Sciences and Disorders, 474 Goodnight Hall, 1975 Willow Dr., Madison, WI 53706, United States.
| | - Lisa M Vaughn
- Cincinnati Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, United States.
| | - Lisa N Kelchner
- University of Cincinnati, Department of Communication Sciences and Disorders, 3202 Eden Ave., Cincinnati, OH 45267, United States.
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Bignall ONR, Raglin Bignall WJ, Vaughn LM, Unaka NI. Fathers Know Best: Inner-City African American Fathers' Perceptions Regarding Their Involvement in the Pediatric Medical Home. J Racial Ethn Health Disparities 2017; 5:617-622. [PMID: 28730559 DOI: 10.1007/s40615-017-0407-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite nearly three in four African American (AA) children being born to unwed mothers, AA fathers maintain relatively high levels of parenting engagement, whether or not they live with their children. While father involvement correlates with decreased adverse child health outcomes, the nature of AA father involvement in child health-including engagement in the pediatric medical home-remains largely unexplored. Our study aimed to assess perceptions of pediatric medical home participation among a cohort of urban, AA fathers. METHODS Group level assessments (GLA; N = 17) were conducted among AA fathers in an urban, Midwestern neighborhood to examine perceptions regarding pediatric medical home involvement. Study participants generated themes based on GLA responses, and study staff used grounded theory as a framework for qualitative analysis of thematic data. RESULTS Fathers desired to have their parental role acknowledged by mothers and pediatricians. They perceived unrecognized parenting strengths, including being role models, teachers, and providers for their children. Respondents endorsed uncertainty navigating the pediatric health care system, unawareness of their children's pediatric appointments, and feeling excluded from health care decision-making by their children's mothers and pediatric providers. CONCLUSIONS In our cohort, AA fathers have a strong desire to be involved in their children's healthy development, but feel marginalized in their parenting role. AA fathers want improved communication with physicians and their children's mothers and to be actively included in health care decision-making. Enhanced efforts to engage fathers in the pediatric medical home may lead to improved health outcomes and reduced disparities for minority children.
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Affiliation(s)
| | | | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ndidi I Unaka
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Vaughn LM, DeJonckheere M, Pratap JN. Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care. J Child Health Care 2017; 21:14-24. [PMID: 27282548 DOI: 10.1177/1367493516645858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.
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Affiliation(s)
- Lisa M Vaughn
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Vaughn LM, Jacquez F, Zhen-Duan J, Graham C, Marschner D. Latinos Unidos por la Salud: The Process of Developing an Immigrant
Community Research Team. ACTA ACUST UNITED AC 2017. [DOI: 10.33596/coll.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vaughn LM, Jones JR, Booth E, Burke JG. Concept mapping methodology and community-engaged research: A perfect pairing. Eval Program Plann 2017; 60:229-237. [PMID: 27591958 DOI: 10.1016/j.evalprogplan.2016.08.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 05/28/2023]
Abstract
Concept mapping methodology as refined by Trochim et al. is uniquely suited to engage communities in all aspects of research from project set-up to data collection to interpreting results to dissemination of results, and an increasing number of research studies have utilized the methodology for exploring complex health issues in communities. In the current manuscript, we present the results of a literature search of peer-reviewed articles in health-related research where concept mapping was used in collaboration with the community. A total of 103 articles met the inclusion criteria. We first address how community engagement was defined in the articles and then focus on the articles describing high community engagement and the associated community outcomes/benefits and methodological challenges. A majority (61%; n=63) of the articles were classified as low to moderate community engagement and participation while 38% (n=39) of the articles were classified as high community engagement and participation. The results of this literature review enhance our understanding of how concept mapping can be used in direct collaboration with communities and highlights the many potential benefits for both researchers and communities.
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Affiliation(s)
- Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 2008, Cincinnati, OH 45229, United States.
| | - Jennifer R Jones
- Community PARTners Core of CTSI, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, 130 DeSoto Street, Parran Hall Room 226, Pittsburgh, PA 15261, United States.
| | - Emily Booth
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 2008, Cincinnati, OH 45229, United States.
| | - Jessica G Burke
- Department of Behavioral & Community Health Sciences, University of Pittsburgh, Graduate School of Public Health, 218 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, United States.
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Topmiller M, Zhen-Duan J, Jacquez FJ, Vaughn LM. Place Matters in Non-Traditional Migration Areas: Exploring Barriers to Healthcare for Latino Immigrants by Region, Neighborhood, and Community Health Center. J Racial Ethn Health Disparities 2016; 4:1214-1223. [PMID: 28039603 DOI: 10.1007/s40615-016-0329-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022]
Abstract
This paper identifies differences in adult Latino immigrant barriers to healthcare in the Cincinnati area in Hamilton County, OH, on three levels: by region, by neighborhood, and by community health center. Secondary data analysis was performed on 439 surveys. Respondents were aggregated by the geographic regions and neighborhoods where they live and by two community health centers where they receive care. Outcome measures included pragmatic and skill barrier indices adapted from the Barriers to Care Questionnaire (BCQ); the pragmatics index consists logistical barriers, including transportation and cost; the skills index is made up of items related to navigating the healthcare system, including communicating with physicians and completing paperwork. The results indicate that immigrant Latinos living in western Cincinnati and northern Hamilton County face significantly higher pragmatic barriers to care, while Latino immigrants going to a community health center in western Cincinnati have significantly fewer pragmatic and skill barriers than immigrants utilizing a nearby community health center. Because healthcare options for undocumented immigrants do not improve with the Affordable Care Act, community health centers will continue to serve as their primary source of care. This is particularly true in non-traditional migration areas, where immigrants tend to be isolated and lack resources. Efforts to improve access to healthcare for immigrant Latinos require place-based approaches that allow for targeted resources to improve care in these locations. This study helps to fill that need by identifying variation in barriers to care on multiple levels and offering strategies to alleviate these barriers.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape Division, American Academy of Family Physicians, Leawood, KS, USA.
| | - Jenny Zhen-Duan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45220, USA
| | - Farrah J Jacquez
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45220, USA
| | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
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Vaughn LM, Jacquez F. Pediatric Prevention and Intervention in the Community. J Prev Interv Community 2016; 39:177-81. [PMID: 26308305 DOI: 10.1080/10852352.2011.576954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The health of children is largely influenced by the factors in their immediate environment, including their families, schools, and neighborhoods. However, according to Bronfenbrenner's ecological systems theory, children are also influenced by larger social systems that indirectly effect development, like the school system and the cultural values and traditions of the larger society. This issue of the Journal of Prevention and Intervention in the Community highlights research that investigates the importance of the various ecological systems on child health. Three articles focus on issues with particular relevance in pediatrics, including tobacco prevention, injury prevention, and sexually transmitted infection treatment. Two articles focus on community-engaged intervention programs to treat chronic childhood issues. Finally, one article focuses on the interaction between culture and pediatric health beliefs.
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Affiliation(s)
- Lisa M Vaughn
- a Division of General and Community Pediatrics and Emergency Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA
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Vaughn LM, Jacquez F, Marschner D, McLinden D. See what we say: using concept mapping to visualize Latino immigrant’s strategies for health interventions. Int J Public Health 2016; 61:837-45. [DOI: 10.1007/s00038-016-0838-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/05/2016] [Accepted: 05/11/2016] [Indexed: 11/29/2022] Open
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Ewan LA, McLinden D, Biro F, DeJonckheere M, Vaughn LM. Mapping the Views of Adolescent Health Stakeholders. J Adolesc Health 2016; 58:24-32. [PMID: 26707227 DOI: 10.1016/j.jadohealth.2015.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Health research that includes youth and family stakeholders increases the contextual relevance of findings, which can benefit both the researchers and stakeholders involved. The goal of this study was to identify youth and family adolescent health priorities and to explore strategies to address these concerns. METHODS Stakeholders identified important adolescent health concerns, perceptions of which were then explored using concept mapping. Concept mapping is a mixed-method participatory research approach that invites input from various stakeholders. In response to prompts, stakeholders suggested ways to address the identified health conditions. Adolescent participants then sorted the statements into groups based on content similarity and rated the statements for importance and feasibility. Multidimensional scaling and cluster analysis were then applied to create the concept maps. RESULTS Stakeholders identified sexually transmitted infections (STIs) and obesity as the health conditions they considered most important. The concept map for STIs identified 7 clusters: General sex education, support and empowerment, testing and treatment, community involvement and awareness, prevention and protection, parental involvement in sex education, and media. The obesity concept map portrayed 8 clusters: Healthy food choices, obesity education, support systems, clinical and community involvement, community support for exercise, physical activity, nutrition support, and nutrition education. Ratings were generally higher for importance than for feasibility. CONCLUSIONS The concept maps demonstrate stakeholder-driven ideas about approaches to target STIs and obesity in this context. Strategies at multiple social ecological levels were emphasized. The concept maps can be used to generate discussion regarding these topics and to identify interventions.
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Affiliation(s)
- Lindsay A Ewan
- Department of Pediatrics, Section of Adolescent Medicine, The Children's Hospital at OU Medical Center, OU College of Medicine, Oklahoma City, Oklahoma.
| | - Daniel McLinden
- Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Frank Biro
- Department of Pediatrics, Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa DeJonckheere
- College of Education, Criminal Justice, & Human Services, School of Education, University of Cincinnati, Cincinnati, Ohio
| | - Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; College of Education, Criminal Justice, & Human Services, School of Education, University of Cincinnati, Cincinnati, Ohio
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Bignall WJR, Jacquez F, Vaughn LM. Attributions of Mental Illness: An Ethnically Diverse Community Perspective. Community Ment Health J 2015; 51:540-5. [PMID: 25536943 DOI: 10.1007/s10597-014-9820-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 12/11/2014] [Indexed: 11/26/2022]
Abstract
Although the prevalence of mental illness is similar across ethnic groups, a large disparity exists in the utilization of services. Mental health attributions, causal beliefs regarding the etiology of mental illness, may contribute to this disparity. To understand mental health attributions across diverse ethnic backgrounds, we conducted focus groups with African American (n = 8; 24 %), Asian American (n = 6; 18 %), Latino/Hispanic (n = 9; 26 %), and White (n = 11; 32 %) participants. We solicited attributions about 19 mental health disorders, each representing major sub-categories of the DSM-IV. Using a grounded theory approach, participant responses were categorized into 12 themes: Biological, Normalization, Personal Characteristic, Personal Choice, Just World, Spiritual, Family, Social Other, Environment, Trauma, Stress, and Diagnosis. Results indicate that ethnic minorities are more likely than Whites to mention spirituality and normalization causes. Understanding ethnic minority mental health attributions is critical to promote treatment-seeking behaviors and inform culturally responsive community-based mental health services.
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Affiliation(s)
- Whitney J Raglin Bignall
- Department of Psychology, University of Cincinnati, 5121 Edwards Building One, PO Box 2120376, Cincinnati, OH, 45221-0376, USA,
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Abstract
In response to a lack of information related to girls' health in a low-income community, an initiative was developed to create a community-wide vision for girls' health. A forum was conducted following a photovoice project to generate sustainable action steps. Forty-four participants attended the forum. Key action steps included decreasing barriers to participation in girls' programs, offering leadership roles and interpersonal communication skills for girls in the community, and engaging girls in community organizations. Integral to the forum's success were the initial photos, which provided a bridge from understanding the issues of girls' health to the development of the action steps.
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Affiliation(s)
- M Elizabeth Miller
- Kinesiology & Health, Miami University, Oxford, Ohio (Dr Miller); and Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Joint Appointment in Education Studies, University of Cincinnati College of Education, Criminal Justice, and Human Services (Dr Vaughn)
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Szaflarski M, Vaughn LM, McLinden D, Wess Y, Ruffner A. Using concept mapping to mobilize a Black faith community to address HIV. Int Public Health J 2015; 7:117-130. [PMID: 28239439 PMCID: PMC5325719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research that partners with community stakeholders increases contextual relevance and community buy-in and maximizes the chance for intervention success. Within a framework of an academic-community partnership, this project assessed a Black faith-community's needs and opportunities to address HIV. We used concept mapping to identify/prioritize specific HIV-related strategies that would be acceptable to congregations. Ninety stakeholders brainstormed strategies to address HIV; 21 sorted strategies into groups and rated their importance and feasibility. Multidimensional scaling and cluster analysis were applied to the sorting to produce maps that illustrated the stakeholders' conceptual thinking about HIV interventions. Of 278 responses, 93 were used in the sorting task. The visual maps represented eight clusters: church acceptance of people living with HIV; education (most feasible); mobilization and communication; church/leaders' empowerment; church involvement/collaboration; safety/HIV prevention; media outreach; and, stigma (most important). Concept mapping clarified multifaceted issues of HIV in the Black faith community. The results will guide HIV programming in congregations.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology and Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, Alabama, USA; Mailing address: HHB 460Q, 1720 2 Ave S, Birmingham, AL 35294-1152, USA; ; Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa M Vaughn
- Department of Pediatrics, University of Cincinnati and Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Mailing address: 3333 Burnet Ave., ML 2008, Cincinnati, OH 45229-3039, USA;
| | - Daniel McLinden
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Mailing address: 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA;
| | - Yolanda Wess
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA; Mailing address: 200 Albert Sabin Way, Holmes Bldg, Rm 3103; Cincinnati, OH 45267-0405, USA;
| | - Andrew Ruffner
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Mailing address: 231 Sabin Way, ML 0769, Cincinnati, OH 45267, USA;
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Abstract
Group-level assessment (GLA) is a qualitative and participatory large group method in which timely and valid data are collaboratively generated and interactively evaluated with relevant stakeholders leading to the development of participant-driven data and relevant action plans. This method is useful across a wide range of evaluation purposes in many environments. GLA involves bringing a large group of participants together to build a common database through the co-identification of relevant needs, judgments, and priorities. The GLA process proceeds through the following seven steps: climate setting, generating, appreciating, reflecting, understanding, selecting, and action. This article describes the methodological development and process of conducting a GLA and its various applications across the evaluation spectrum. We highlight several exemplars where GLA was used in order to demonstrate the particular nuances of working with different sizes and types of groups and to elaborate on our learnings from the wide applicability of the method.
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Affiliation(s)
- Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abstract
A photovoice project was conducted with pediatric bone marrow transplant (BMT) patients to examine their coping skills and interpretation of their experience during a BMT, especially when hospitalized. We also wanted to determine how photovoice could be used within a pediatric BMT unit. Sixteen children (ages 4-14) and 2 young adults (ages 22 and 25) from a pediatric BMT unit participated in the project. Six BMT outpatients participated in the data analysis and evaluation phase. Fourteen clinical staff evaluated the impact of the project on their practice. Three primary themes emerged from the pre- and post-BMT photos, accompanying detailed notes, and BMT outpatient analysis of the photos: (a) BMT is "torture," (b) BMT is "time slipping away," and (c) BMT requires normalization, comfort, distraction, and support. BMT patients and staff concluded that photovoice helped express and release emotions regarding the challenges of BMT. BMT staff noted that the results of this project reminded them of the importance of being patient-centered and mindful of patient experience and the therapeutic relationship.
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Affiliation(s)
| | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Ragsdale JR, Vaughn LM, Klein M. Characterizing the adequacy, effectiveness, and barriers related to research mentorship among junior pediatric hospitalists and general pediatricians at a large academic institution. Hosp Pediatr 2014; 4:93-8. [PMID: 24584979 DOI: 10.1542/hpeds.2013-0075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this qualitative study was to characterize the adequacy, effectiveness, and barriers related to research mentorship among junior pediatric hospitalists and general pediatricians at a large academic institution. METHODS Junior faculty and staff physicians in hospital medicine and general pediatrics at a large academic institution were invited to participate in this qualitative study. In-depth interviews were conducted. Experienced mentors were invited to be interviewed for theoretical sampling. Interviews were conducted and analyzed by using grounded theory methodology. RESULTS Twenty-six (75%) of the eligible physicians, pediatric hospitalists representing 65% of this sample, agreed to be interviewed about their mentoring experiences. Satisfied and dissatisfied participants expressed similar mentoring themes: acquisition of research skills, academic productivity, and career development. Four experienced mentors were interviewed and provided rationale for mentoring clinicians in research. Both groups of participants agreed that institutional support is vital for promoting mentorship. CONCLUSIONS Junior pediatric hospitalists and general pediatricians indicated considerable interest in being mentored to learn to do clinical research. Developing faculty and staff physicians to their utmost potential is critical for advancement in academic medicine. Mentoring clinical physicians seeking to add research skills and academic productivity to their practice merits study as an innovative path to develop clinical investigators. Hospital medicine, as a rapidly developing pediatric specialty, is well-positioned to implement the necessary infrastructure to mentor junior faculty in their academic pursuits, thereby optimizing the potential impact for individuals, families, learners, and institutions.
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Szaflarski M, Vaughn LM, Chambers C, Harris M, Ruffner A, Wess Y, Mosley L, Smith C. Engaging Religious Institutions to Address Racial Disparities in HIV/AIDS: A Case of Academic-Community Partnership. Int J Res Serv Learn Community Engagem 2014; 2:95-114. [PMID: 28239643 PMCID: PMC5325098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
African Americans face the most severe burden of HIV among all racial and ethnic groups. Direct involvement of faith leaders and faith communities is increasingly suggested as a primary strategy to reduce HIV-related disparities, and Black churches are uniquely positioned to address HIV stigma, prevention, and care in African American communities. The authors describe an academic-community partnership to engage Black churches to address HIV in a predominantly African American, urban, southern Midwest location. The opportunities, process, and challenges in forming this academic-community partnership with Black churches can be used to guide future efforts toward engaging faith institutions, academia, and other community partners in the fight against HIV.
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Affiliation(s)
| | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center and University of Cincinnati
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