App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy.

BACKGROUND: Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. OBJECTIVE: This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. METHODS: This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. RESULTS: Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. CONCLUSIONS: The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication.

Urban, Low-Income, African American Well-Child Care: Comparison of Parent and Healthcare Provider Experiences and Expectations.

OBJECTIVES: Urban, low-income, African American children and parents report lower quality primary care and face negative social determinants of health. High-quality well-child care is critical for this population. The purpose of this qualitative study was to compare and contrast parent and health care provider experiences of well-child care for urban, low-income, African American families to better understand the complex factors involved in care quality and health outcomes. METHODS: Two data sets were analyzed using conventional content analysis, parent focus group data, and provider interviews. After analysis, results were sorted into similar categories, and convergence coding was completed to identify areas of agreement, partial agreement, dissonance, and silence. RESULTS: Thirty-five parents took part in four focus groups, and nine providers were interviewed. Following convergence coding, five categories and 31 subcategories were identified. The five categories included: social determinants of health, sources of advice and support, challenges with the healthcare system, parent-provider relationships, and anticipatory guidance topics. CONCLUSIONS FOR PRACTICE: Triangulation demonstrated convergence between parents and providers understanding of the concepts and functions of well-child care, however the prominence and meaning varied within each category and sub-category. The variance in agreement, areas of silence, and dissonance shed light on why the population reports lower overall quality primary care.

Urban, Low-Income, African American Parents' Experiences and Expectations of Well-Child Care.

PURPOSE: Well-child care is the foundation of pediatric health promotion and disease prevention. Primary care quality is lower for low-income and African American children compared to white children, and social determinants have an increasingly acknowledged impact on child health. Ensuring that high-quality well-child care fulfills its potential to mitigate the negative effects of social determinants on African American children is imperative. This study provides an understanding of urban, low-income, African American well-child care experiences and expectations. DESIGN AND METHODS: A qualitative, focus group method was used. A purposive, volunteer sample of low-income, African American parents with children birth to age five was recruited from St. Louis and Milwaukee. Focus groups were held in convenient, community sites. Data was audio-digitally recorded. Transcribed data were coded and analyzed through inductive content analysis. RESULTS: Thirty-five caregivers, 86% females, participated in four focus groups. Categories (and sub-categories) identified include: Community factors (We want better schools, It's getting more rough where I live); Sources of parenting advice (Google it, Call your parent, Older remedies); System challenges (Cost, Frequent new faces, Politics); Challenges with providers (Couldn't help me, Missed something important, Treated differently, Are you really listening?); Anticipatory guidance (Breastfeeding, Discipline, Vaccines, Development); and What parents desire (Know them, trust). CONCLUSIONS: This study reveals the contexts that give rise to health care disparities and provides insight into parent's healthcare behaviors. PRACTICE IMPLICATIONS: Results offer providers guidance in providing well-child care for this population to improve pediatric care quality and child health.

Theory and Theorizing in Nursing Science: Commentary from the Nursing Research Special Issue Editorial Team.

BACKGROUND: Articles from three landmark symposia on theory for nursing-published in Nursing Research in 1968-1969-served as a key underpinning for the development of nursing as an academic discipline. The current special issue on Theory and Theorizing in Nursing Science celebrates the 50th anniversary of publication of these seminal works in nursing theory. OBJECTIVE: The purpose of this commentary is to consider the future of nursing theory development in light of articles published in the anniversary issue. APPROACH: The Editorial Team for the special issue identified core questions about continued nursing theory development, as related to the nursing metaparadigm, practice theory, big data, and doctoral education. Using a dialogue format, the editors discussed these core questions. DISCUSSION: The classic nursing metaparadigm (health, person, environment, nursing) was viewed as a continuing unifying element for the discipline but is in need of revision in today's scientific and practice climates. Practice theory and precision healthcare jointly arise from an emphasis on individualization. Big data and the methods of e-science are challenging the assumptions on which nursing theory development was originally based. Doctoral education for nursing scholarship requires changes to ensure that tomorrow's scholars are prepared to steward the discipline by advancing (not reifying) past approaches to nursing theory. CONCLUSION: Ongoing reexamination of theory is needed to clarify the domain of nursing, guide nursing science and practice, and direct and communicate the unique and essential contributions of nursing science to the broader health research effort and of nursing to healthcare.

Advancing adolescent maternal development: a grounded theory.

OBJECTIVES: This paper reports a substantive grounded theory called the theory of Advancing Adolescent Maternal Development. DESIGN: A grounded theory approach was used. SAMPLE: Thirty public health nurses working with adolescent clients in a state public health nurse home visiting program volunteered to participate in this study. RESULTS: The basic social psychological problem that emerged from the data was incomplete and at risk adolescent maternal development. Social support and public health nursing interventions are central in the problem resolution process which occurs in stages. CONCLUSIONS: Study results can be used to inform the nursing care of pregnant and parenting adolescents.

Photovoice in the Red River Basin of the north: a systematic evaluation of a community-academic partnership.

A community-academic partnership was formed in Minnesota's Red River Basin for a 1-year planning grant preceding a larger intervention to reduce pesticide exposure among children. Photovoice, developed by Dr. Caroline Wang, was used by mothers to document pathways to pesticide exposure for their children along with other health and safety concerns. An evaluation of the partnership was conducted for mothers, and for the research team of local stakeholders and academics. Surveys consisting of structured and open-ended questions elicited information on the perception of the process and short-term outcomes. Questions were created based on objectives of the Photovoice project, satisfaction, and principles of community-based participatory research (CBPR). A high percentage of study participants and researchers indicated that the objectives of the effort had been met, the principles of CBPR had been realized and they were satisfied with the benefits of participation. A need for more thorough planning was identified related to long-term dissemination of knowledge generated. The evaluation provides insight on the strengths and weaknesses of the project, demonstrates to team members and funders that formative and summative outcomes were met, and serves as a model for community-academic partnerships utilizing Photovoice as one CBPR method.

Contextual learning: a reflective learning intervention for nursing education.

Nursing educators need to continue to explore ways that new pedagogies such as narrative pedagogy and reflective practice inform and extend students' thinking in classroom and clinical situations. The goal of instruction becomes creating an opportunity for learning that integrates content knowledge with knowledge of the context. Educational methodologies that incorporate the use of context in a reflective, dialogical approach over time hold much promise in developing a dynamic process of thinking in practice. Contextual learning is a reflective learning intervention that offers new possibilities for nurse educators to prepare nurses to think critically in practice. In this expository paper the design and instructional methodology of contextual learning is discussed, beginning with a brief overview of the nature of critical thinking and the use of narrative as major underpinnings in the development of this intervention. Examples of how the intervention was implemented with novice nurses in practice is provided. Finally, reflections on how the intervention could be refined for nursing students is offered.