Trust in federal COVID-19 vaccine oversight and parents' willingness to vaccinate their children against COVID-19: a cross-sectional study.

BACKGROUND: Over half of the youth population in the United States, aged 6 months to 17 years, have not received the Coronavirus Disease 2019 (COVID-19) vaccine. Given parents' central role in vaccinating their children, we examined associations between parents' trust of the federal oversight of COVID-19 vaccine safety and their willingness to vaccinate their children against COVID-19. METHODS: This cross-sectional study included 975 parents of minor children residing in Philadelphia who completed the online survey between September 2021 and February 2022. Trust was measured using a four-point Likert scale ranging from 'do not trust' to 'fully trust' for two variables: (1) trust in federal oversight of COVID-19 vaccine safety for children and (2) trust in federal oversight of COVID-19 vaccine safety for the general public. A multiple logistic regression evaluated associations between trust and parents' willingness to vaccinate their children, which was measured on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree.' The analysis was adjusted for race/ethnicity, age, sexual orientation, gender, education, insurance, and parents' vaccination status. RESULTS: Analyses included 975 parents whose children had not previously been vaccinated against COVID-19 (mean age 36.79, standard deviation 6.4; 42.1% racial/ethnic minorities; 93.2% heterosexual; and 73.7% with a college degree). Greater trust regarding federal oversight of COVID-19 vaccine safety for children [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.13-2.04] and for the public (aOR = 1.58, 95% CI: 1.17-2.14) were each associated with increased willingness to have their child vaccinated against COVID-19. Unvaccinated parents had decreased willingness compared to parents who had received at least one dose of the vaccine (aOR = 0.14, 95% CI: 0.04-0.41). College-graduate parents exhibited increased willingness compared to those without a college degree (aOR = 2.07, 95% CI: 1.52-2.81). Non-heterosexual parents showed increased willingness compared to heterosexual parents (aOR = 2.30, 95% CI: 1.20-4.76). CONCLUSIONS: Trust in federal COVID-19 vaccine oversight was associated with parental willingness to vaccinate their children against COVID-19 among parents whose children have not yet been vaccinated. Identifying and addressing causes of mistrust are crucial next steps to promote child vaccination. Intervention efforts to address trust gaps should remain a public health priority.

Dismantling structural racism in nursing research.

Dismantling structural racism in nursing research is key to achieving health equity for populations that experience disproportionate burden of health disparities. Several nursing organizations have advocated for the nursing profession to address structural racism in the discipline and the Future of Nursing 2020 to 2030: Charting a Path to Achieve Health Equity specifically calls for research that addresses equity and social justice. Bold calls to conduct research to address structural racism notwithstanding, what remains less clear are the strategies needed. We propose key considerations for the design of research to address structural racism and offer examples from behavioral and biobehavioral research designed to dismantle structural racism.

Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.

BACKGROUND: In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. PURPOSE: The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. METHODS: Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. FINDINGS: This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. DISCUSSION: This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

Parents ASSIST (Advancing Supportive and Sexuality-Inclusive Sex Talks): Iterative Development of a Sex Communication Video Series for Parents of Gay, Bisexual, and Queer Male Adolescents.

Effective parent-child sex communication enhances heterosexual youths' efficacy to engage in health promotive behaviors, yet there is scarce research on parent-child sex communication with gay, bisexual, and queer (GBQ) sons during adolescence. Our aim is to describe the development of Parents ASSIST, a web-based series of animated videos for parents of GBQ adolescent males focused on (a) parental education about sexual health topics pertinent to this population's same-sex concerns, (b) modeling of communication skills for parents to broach and sustain inclusive discussions at home, and (c) norming the role of providers as reliable sources of support when parents seek GBQ-related health information. Community-based advisory boards, comprised of parents and health care providers, respectively, informed the intervention development. Based on study notes and the research team's reflections, we present lessons learned that focus on content-based and logistical challenges that arose during the intervention development process. This study extends practice and patient education by providing an innovative, primary intervention that partners with parents of an underserved youth population.

Testing the Efficacy of a Web-Based Parent-Adolescent Sexual Communication Intervention Among Puerto Ricans.

This randomized controlled trial tested the efficacy of a Web-based intervention to increase sexual communication between parents and adolescents. Parent/adolescent dyads (n = 660) were recruited from communities in the San Juan area and randomly assigned to the Cuídalos sexual communication or physical activity program. Parent assessments were obtained preintervention and at 3-, 6-, and 12-month follow-up. Parents in the experimental group reported significantly more sexual communication (ie, peer pressure, sexual prevention, protection, risk) over time than parents in the control group. Results support the efficacy of the Cuídalos Web-based format and provide insight into future Web-based sexual health interventions for this population.

Use of Web-Based Parent-Adolescent Health Promotion Program Among Puerto Ricans.

BACKGROUND: Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information. OBJECTIVE: The aim of this study was to examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent-adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents. METHODS: This study uses data from a randomized controlled trial designed to examine the long-term effectiveness of Cuídalos. Parents were recruited from community-based and school sites throughout Puerto Rico and randomly assigned to a web-based, parent-adolescent sexual communication (n = 245) or a physical activity (n = 247) program. Parents were instructed to complete the two-session program within 1 week and had access to the program for a period of 3 months. Outcomes in this secondary analysis were the number of log-ins and self-reported access during the 3-month period. Reasons for not accessing the program after the 3-month period were assessed. RESULTS: Self-reported access after completion of the Cuídalos program and the actual number of log-ins over the intervention period were low. There were no statistically significant differences in the number of log-ins between parents who accessed Cuídalos during the 3-month time frame and those who did not (p = .28). Logistic regression analyses demonstrated that the odds of accessing Cuídalos during the 3-month period was 72% higher (OR = 1.72, 95% CI [1.08, 2.75]) among parents with a high school education or less, as compared to parents with a college education (p = .02). Similarly, Poisson regression model results indicated that, with every year increase in age, the expected number of log-ins increased by 1% (RR = 1.01, 95% CI [1.00, 1.02]); compared to those who accessed the program at home, the expected number of log-ins ranged from 10% to 27% lower for parents accessing elsewhere. Reasons for not accessing the program during the 3-month period included not having easy access to a computer (n = 134, 48.6%), or they did not know how to access the program again (n = 56, 20.3%). DISCUSSION: Despite the availability of web-based and e-health resources, further research is needed to identify how to facilitate greater access and actual use of digital health resources by Latinos. This is an important effort in order to prevent a widening health equity gap caused by a lack of access and use of digital health resources.

Building Innovation and Sustainability in Programs of Research.

PURPOSE: Innovation and sustainability are two important concepts of impactful programs of research. While at first glance these concepts and approaches may seem at odds, they are synergistic. APPROACH: We examine the social, political, and policy context as it relates to innovation and sustainability. We present an exemplar of a program of research and discuss factors to consider in developing innovative and sustainable programs of research. CONCLUSIONS: Innovation is an important component of sustainable programs of research. Understanding the social and political context and addressing relevant policy issues are factors to be considered in both innovation and sustainability. CLINICAL RELEVANCE: Innovation and sustainability, important components of research, are also central to clinical practice. Open communication between researchers and clinicians can support the acceleration of innovations and the integration of evidence-based findings in practice.

A Reflection on Claire Fagin.

Honoring the life and work of this visionary leader.

Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19.

BACKGROUND: Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake. METHODS: The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted. RESULTS: Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents. CONCLUSIONS: Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.

Engaging Trusted Messengers to Increase COVID-19 Pediatric Vaccine Uptake in Philadelphia: Lessons from the VaxUpPhillyFamilies program.

INTRODUCTION: Communities of color had higher rates of Coronavirus (COVID-19) infection and lower rates of COVID-19 vaccination during the pandemic. Parental concern about the safety and necessity of pediatric COVID-19 vaccines contribute to low childhood vaccination. Enlisting parents and caregivers as trusted messengers is an evidence-based approach to mitigate this challenge. VaxUpPhillyFamilies was formed to engage parents and caregivers as vaccine ambassadors to increase vaccination rates in children of color. This study aimed to understand the key benefits, challenges, and lessons learned from the VaxUpPhillyFamilies program. METHODS: Three online debriefing sessions with ambassadors were conducted between September 7 and October 24, 2022, to share best practices, address challenges, receive emerging vaccine information, and provide support. Thematic analysis was utilized to develop broad themes and subthemes. RESULTS: Four themes with corresponding subthemes were identified: 1) Motivations to Become an Ambassador: a) improving the health of the community and b) personal satisfaction; 2) Defining Success: a) community interactions and b) influencing opinions; 3) Best Approaches: a) being mentally prepared with facts, b) addressing community health needs beyond COVID-19, c) demonstrating empathy, d) "meeting them where they're at" by motivational interviewing, and e) building trust and connection; 4) Challenges: a) changes in vaccine guidelines, b) vaccine misinformation, c) varied perceptions of severity of COVID-19 illness and benefits of the vaccine, d) breakdown of communication from trusted sources, and e) structural barriers to engagement. CONCLUSION: Parents and caregivers were a resource for delivering evidence-based messaging about COVID-19 and other health challenges. To effectively equip parents and caregivers as public health ambassadors, it is critical to offer training in engagement strategies, to identify and combat misinformation, and to provide support in navigating challenges. VaxUpPhillyFamilies program is a model for future public health campaigns.

Patient-centered communication and health assessment with youth.

BACKGROUND: Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. OBJECTIVES: The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. METHODS: This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). RESULTS: Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. DISCUSSION: EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Creating an innovation infrastructure in academic nursing.

As interest in nurse-led health and health care innovation grows, we must prepare nurses with the skills, knowledge, and experiences necessary to lead in these areas. In this article we describe how schools of nursing can integrate innovation in their mission, describe actionable steps to position nurses as leaders in this space, and provide a case study example of how to infuse innovation into a school of nursing. CLINICAL RELEVANCE: In order for nurses to lead in health and healthcare innovation, schools of nursing and nursing programs must think strategically about the knowledge and skills the next generation of nurses will need and then support those innovation needs at all levels of research, education, and practice.

From vision to action: Next steps in designing PhD programs of the future.

Declines in PhD enrollment, funding and support for PhD students, and the quality and quantity of the nursing research pipeline has fueled the concern about providing high-quality education in research-focused nursing doctoral programs. To address the challenges and opportunities facing research focused PhD education, the University of Pennsylvania School of Nursing convened an invitational summit, Re-Envisioning Research-Focused PhD Programs of the Future, of research-intensive institutions. Both as a dissemination strategy and as an effort to engage perspectives from other Schools with PhD programs, we presented a summary of the Penn Summit discussion at the AACN Doctoral Education Conference (AACN Doctoral Conference). Focused discussions at both events further identified opportunities for research focused PhD programs, including recruiting undergraduate students, establishing research-focused partnerships, creating clear evaluation methods. AACN Doctoral conference participants also discussed the need to discuss and identify competencies, common subject areas, and financial resources for PhD students and graduates. This synthesis of discussions, considerations, and challenges affecting research-focused doctoral programs of nursing serve as a basis and catalyst for further discussion and action to ensure PhD research focused programs are preparing successful nurse scientists of the future.

Innovations in Ph.D. education to prepare nurse scientists for the future.

The University of Pennsylvania sponsored a PhD summit in October 2019 to bring together faculty and leaders in PhD education as well as professional associations in nursing to discuss the state of PhD education. Participants were divided into groups and asked to address specific questions. This paper presents the discussion points and recommendations from the group focusing on innovation in PhD education. Innovations such as team mentoring models, design thinking courses, and structures that support students to progress from BSN through PhD programs are discussed. Recommendations include a need to intentionally structure faculty development earlier in their professorial careers, develop team models of advisement and longitudinal follow-up of alumni graduates form Ph.D. programs to examine the effectiveness of innovations.