Pride Camp: Pilot study of an intervention to develop resilience and self-esteem among LGBTQ youth.

BACKGROUND: Many LGBTQ youth experience rejection and discrimination in their families and schools, and the range of interventions for improving their resilience and well-being is limited. We developed and piloted an LGBTQ-youth-focused intervention to build resilience and promote health equity, called Pride Camp, in an urban environment in the Midwest. METHODS: Using a mixed-method approach we examined the impact of Pride Camp on resilience and other measures of well-being among LGBTQ high school students who attended camp on a college campus in 2015, 2016, and 2017. Camp attendees and the research sample included a majority proportion of transgender and gender nonbinary (TGN) youth. RESULTS: Pre- and post-test data from our quantitative surveys (n = 28), indicated significant increases in resilience, self-esteem, and quality of life in LGBTQ youth who attended camp. Similar results were found among the TGN participants (n = 19). Qualitative data from focus groups indicated that specifically for TGN youth, the affirming environment at the camp provided social opportunities that they had not found elsewhere. CONCLUSIONS: Findings suggest that the Pride Camp intervention provides a platform for LGBTQ youth to meet peers and engage in LGBTQ communities, improving their resilience and outlook on the future. A larger controlled study of the Pride Camp intervention including measurement of additional specific health outcomes over a longer follow-up period is warranted to examine the impact of this program on health equity.

Rural Malawian Women's Resistance to Systematic Oppression, Violence, and Abuse by Their Husbands.

In Malawi, 41% of women aged 15 to 49 report ever experiencing intimate partner violence (IPV). Although there is evidence of the pervasiveness of IPV in Malawian society, the context in which it occurs and how women respond is not well described. The purpose of this study was to describe experiences of IPV of rural Malawian women. In-depth interviews were conducted with 55 rural Malawian women aged 21 to 75 years (M = 39) as part of a larger, mixed-methods study. This qualitative thematic analysis highlights husbands' IPV against wives and women's actions to protect themselves and their children, and to thrive despite the violence. Our use of a postcolonial feminist perspective led us to acknowledge Malawian women's acts of resistance in the midst of the harsh realities of IPV and gender inequality. We contend women's resilience and resistance against oppression within intimate relationships are critical tools in the process of reducing IPV. Structural interventions that (a) address the multiple distal and proximal factors affecting IPV, (b) are tailored to and owned by local populations, and (c) involve both men and women as architects and active participants, we believe, hold the greatest promise for reducing IPV in Malawi.

Culture, identity, strength and spirituality: A qualitative study to understand experiences of African American women breast cancer survivors and recommendations for intervention development.

OBJECTIVE: Despite advancements in cancer treatment, racial disparities in breast cancer survival persist, with African American women experiencing lower survival rates and poorer quality of life than non-Hispanic White women. Using a social cognitive model of restorative well-being as a framework, this qualitative study sought: (a) to examine strength- and culture-related factors associated with African American female breast cancer survivors' cancer coping and post-treatment experiences and (b) to make recommendations for culturally sensitive intervention. METHODS: Eight focus groups occurred with a total of 40 local African American breast cancer survivors. Focus groups were audiotaped and transcribed verbatim. Framework analyses were used to identify themes. NVivo qualitative analysis software-managed data. RESULTS: Two major themes emerged from the focus group discussions: (a) God enables breast cancer survivorship and works every day in our lives and (b) the healthiest thing about us is that we are strong African American women. Recommendations for intervention planning and implementation were made towards intervention structure, content development and language framing in a local context. CONCLUSION: Findings suggest a need for community-based participatory survivorship interventions that are culturally and spiritually consonant and peer-based. Such interventions may respond to the cancer-related and personal needs of the target population.

Enhancing cultural safety among undergraduate nursing students through watching documentaries.

The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students' written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and determine how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students' understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care.

Preparing culturally safe student nurses: An analysis of undergraduate cultural diversity course reflections.

This descriptive, qualitative study was conducted to gain insight into how pre-clinical nursing students' worldviews about people different from themselves are formed, changed, and expanded. 90 mid-term and 87 end- of-term reflection papers in a cultural diversity course were analyzed. Krathwohl's taxonomy of learning guided the evaluation of students' development. Our findings showed that the course content supported most students' in their affective development. It was also evident that students' perspectives, which were influenced by past experiences, changed as the course progressed. However, while a positive change in perspective towards providing culturally safe care was evident, this was not the case for all students. Our findings have implications for informing the development of undergraduate nursing courses that prepare future nurses for their professional role in providing culturally safe care.

Transgender and Gender Nonconforming Youths' Public Facilities Use and Psychological Well-Being: A Mixed-Method Study.

Purpose: In this study, we explored experiences and feelings of safety in public facilities in relation to psychological well-being among transgender and gender nonconforming (TGNC) youth in the Midwest in the summer of 2016, in the context of ongoing legislative proposals and regulations regarding school and public bathroom use in the United States. Methods: We used a mixed-method approach, with (1) a self-administered, paper-and-pencil survey of 120 TGNC youth, focusing on differences of self-esteem, resilience, quality of life (QoL), perceived stigma, feelings of safety, and experiences of public facility use and (2) two focus group interviews (n=9) in which TGNC youth discussed individual perceptions, attitudes, and experiences of bathroom use outside participants' homes. The samples consisted predominantly of individuals assigned female at birth and currently of trans-masculine identity. Results: TGNC youth in our sample who reported that they had felt unsafe in bathrooms due to appearance or gender identity had significantly lower levels of resilience (mean(felt safe)=125.7 vs. mean(felt unsafe)=116.1; p=0.03, Cohen's d=0.44) and QoL (mean(felt safe)=59.1 vs. mean(felt unsafe)=51.9; p=0.04, Cohen's d=0.39), compared to those who felt safe. Meanwhile, feeling unsafe in bathrooms was associated with a greater level of perceived LGBT stigma (mean(felt safe)=2.3 vs. mean(felt unsafe)=2.6; p=0.03, Cohen's d=0.41) and problematic anxiety in the past year (χ2 (1)=4.06; p=0.04). Individuals in the focus groups provided specific examples of their experiences of and concerns about locker room or bathroom use in public facilities, and on the impact of school bathroom-related policies and legislation on them. Conclusion: Perceptions of safety related to bathroom use are related to psychological well-being among TGNC youth. Our predominantly trans-masculine youth sample indicated that choice of bathroom and locker room use is important and that antiharassment policies need to support students' use of their choice of bathrooms. This is particularly important information given debate of so-called bathroom bills, which attempt to restrict public bathroom use for TGNC youth, creating less choice and more stress and fear among these individuals.

Women's narratives of living in polygamous marriages: Rural Malawian experience distilled and preserved in poetic constructions.

Polygamy in sub-Saharan Africa has been linked to poverty, infant mortality, and HIV; however, it is unknown how interpersonal dynamics within polygamous households may influence population health outcomes. Findings from this postcolonial feminist study derive from interview data in a larger mixed-methods study in rural Malawi. We used thematic narrative analysis to probe 25 women's stories and applied an arts-based research technique, poetic construction, to present the results. Participants' evocative expressions, distilled and preserved in poetic form, illustrate themes of perseverance, grief, agency, and reflection. We discuss how gender relations, childrearing, tradition, economics, and health intersect in polygamous households.

Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi.

The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18-, and 36-months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29-2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07-4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63-0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants' outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.

Embracing an "African Ethos" to facilitate African immigrants participation in medical genetics and genomics research.

BACKGROUND: Limited published research exists on perceptions and potentials for black African immigrants' participation in medical genetics and genomics research. PURPOSE: This study explores the inclination and disinclination of African immigrants to be involved in genetics and genomics research. METHODS: In-depth qualitative interviews were employed in which a sample of black African immigrants 18 years and older (n = 34) were interviewed. DISCUSSION: Barriers included contrary beliefs and customs about disease and the human body that differs from Western conceptions, and lack of genuine connection to the health care system. Facilitators included promotion of an "African ethos," wherein Africans unite with one another in a communal extension of self and robust community involvement across the life span of genetic studies. CONCLUSION: It is important for researchers and genetic counselors to understand the sociocultural underpinnings of African immigrants about genetics and genomics research as an initial step to encouraging their participation.

Raising Questions About Capitalist Globalization and Universalizing Views on Women: A Transnational Feminist Critique of the World Development Report: Gender Equality and Development.

Nursing in the United States has embraced global health primarily from a clinical perspective, with emphasis on care delivery to populations in underserved, resource-poor settings. Less attention has been devoted to developing expertise about social, economic, and political contexts that produce ill health around the world. The purpose of this article is to offer a transnational feminist critique of the World Development Report: Gender Equality and Development and to illuminate implications such reports may have in the lives of the world's most marginalized women and girls. We examine the political economy idealized in the report, raising questions about the capitalist framework underpinning its agenda. Second, we examine the assumptive language used in the report, suggesting that it discursively constructs a problematic representation of women in low-income countries. We contend that the report perpetuates a hegemonic discourse of patriarchy and inequality for women in the Global South through the use of an uncontested economic framework and universalist reasoning. We conclude the article with discussion about a transformative policy making that could be more inclusive of the wisdoms, values, and everyday experiences of women living in the Global South and about the vital role nurses can play in advancing gender equity through their active collaboration in policy critique and policy formulation.

A multi-substrate approach for functional metagenomics-based screening for (hemi)cellulases in two wheat straw-degrading microbial consortia unveils novel thermoalkaliphilic enzymes.

BACKGROUND: Functional metagenomics is a promising strategy for the exploration of the biocatalytic potential of microbiomes in order to uncover novel enzymes for industrial processes (e.g. biorefining or bleaching pulp). Most current methodologies used to screen for enzymes involved in plant biomass degradation are based on the use of single substrates. Moreover, highly diverse environments are used as metagenomic sources. However, such methods suffer from low hit rates of positive clones and hence the discovery of novel enzymatic activities from metagenomes has been hampered. RESULTS: Here, we constructed fosmid libraries from two wheat straw-degrading microbial consortia, denoted RWS (bred on untreated wheat straw) and TWS (bred on heat-treated wheat straw). Approximately 22,000 clones from each library were screened for (hemi)cellulose-degrading enzymes using a multi-chromogenic substrate approach. The screens yielded 71 positive clones for both libraries, giving hit rates of 1:440 and 1:1,047 for RWS and TWS, respectively. Seven clones (NT2-2, T5-5, NT18-17, T4-1, 10BT, NT18-21 and T17-2) were selected for sequence analyses. Their inserts revealed the presence of 18 genes encoding enzymes belonging to twelve different glycosyl hydrolase families (GH2, GH3, GH13, GH17, GH20, GH27, GH32, GH39, GH53, GH58, GH65 and GH109). These encompassed several carbohydrate-active gene clusters traceable mainly to Klebsiella related species. Detailed functional analyses showed that clone NT2-2 (containing a beta-galactosidase of ~116 kDa) had highest enzymatic activity at 55 °C and pH 9.0. Additionally, clone T5-5 (containing a beta-xylosidase of ~86 kDa) showed > 90% of enzymatic activity at 55 °C and pH 10.0. CONCLUSIONS: This study employed a high-throughput method for rapid screening of fosmid metagenomic libraries for (hemi)cellulose-degrading enzymes. The approach, consisting of screens on multi-substrates coupled to further analyses, revealed high hit rates, as compared with recent other studies. Two clones, 10BT and T4-1, required the presence of multiple substrates for detectable activity, indicating a new avenue in library activity screening. Finally, clones NT2-2, T5-5 and NT18-17 were found to encode putative novel thermo-alkaline enzymes, which could represent a starting point for further biotechnological applications.

Contending with Psychological Distress in Contexts with Limited Mental Health Resources: HIV-Positive Kenyan Women's Experiences.

This study describes the psychosocial distress experiences of HIV-positive women in Kenya. In-depth narrative interviews were conducted three times over six months between 2009 and 2010 with 54 HIV-positive women living in Kenya to explore how the women perceived psychological distress and the steps they took to find support to cope with their HIV-positive diagnosis. Thematic analysis revealed that the women described psychological distress as: physical and emotional shock, worry, and hopelessness and suicidality. The women reported receiving support to cope through spiritual connections, family and friends, others coping with HIV/AIDS, and health care agencies. This study heightens awareness of the critical value of understanding culturally relevant mental health evaluations in a limited mental health access context.

An examination of actor-partner social support effects on HIV-related problems and interpersonal outcomes among a sample of HIV-positive African American dyads.

OBJECTIVES: Social support is an important resource that has been associated with better mental and physical health outcomes among HIV-positive people. However, researchers have not adequately explored how social support functions among HIV-positive African Americans. The purpose of the current study was to understand whether HIV-related support resources are associated with relational functioning and HIV-related problems among a sample of HIV-infected African American dyads. METHOD: Exactly 34 HIV-infected (i.e., seroconcordant) dyads compromised of HIV-positive African American adults and their HIV-positive adult "informal supporters" from 3 Midwestern urban cities completed psychosocial questionnaires and a communication task. Using the actor-partner interdependence model, we analyzed dyadic data to determine whether there were actor and/or partner effects within dyadic relationships on measures of conflict and HIV-related problems, communication about these problems, and health symptoms. RESULTS: We found significant negative relationships between perceived support and HIV-related problems and perceptions of problem inequity within dyads and a positive relationship between perceived support and communication about these problems within dyads. Contrary to our expectations, we found no relationship between social support and HIV symptoms, relational conflict, or perceptions about dyadic partners' HIV-related problems. CONCLUSIONS: Although our study precludes drawing causal conclusions, we found evidence of a relationship between the personal experience of HIV-related problems, communication about these problems, and perceptions of social support among a small sample of HIV-infected African American dyads. These findings suggest the need to consider how support-related communication within HIV-infected dyads might influence and be influenced by problem perceptions.

Shared Illness and Social Support Within Two HIV-Affected African American Communities.

A key source of resiliency within HIV-affected African American communities is informal social support. Data from dyadic conversations and focus groups were used to address the following research question: What are HIV-positive African Americans' social support experiences within their informal social networks in response to HIV-related problems? Circumstances that exacerbated HIV-related problems included others' fear of contagion, reticence to be involved, judgment and rejection, and disregard for privacy Support from HIV-negative others buffered the impact of problems when others communicate interest, take the initiative to help, or make a long-term investment in their success. Support from other HIV-positive persons was helpful given the shared connection because of HIV, the opportunity to commiserate about what is mutually understood, and the fight for mutual survival Based on these findings, we offer suggestions for future research and social network interventions aimed at bolstering connections between HIV-positive peers, reducing stigma, and improving family support.

mHealth text messaging for physical activity promotion in college students: a formative participatory approach.

OBJECTIVES: To develop mobile-based physical activity promotion text messages, understand users' preferences, and assess feasibility and acceptability in a college student sample. METHODS: Five focus groups (N = 33) were conducted using a participatory approach. An Audience Response System was adopted for data collection to ensure confidentiality and for directing the discussion foci. A framework analysis of transcribed focus group discussions was conducted. Atlas. ti qualitative analysis software was used to manage the data. RESULTS: Participants were uniformly enthusiastic about a text message-based intervention to encourage regular physical activity. They also preferred positive, supportive personally tailored messages. Participants placed a high value on messages related to establishing and monitoring realistic and achievable goals. CONCLUSIONS: mHealth text messaging was well received. The results support the feasibility and acceptance of such an intervention.

The Ebola epidemic in West Africa: challenges, opportunities, and policy priority areas.

The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in particular the inadequacies of health care systems in sub-Saharan African countries for appropriately managing and containing infectious diseases. The purpose of this article is to examine the sociopolitical and economic conditions that created the environment for the Ebola epidemic to occur, identify challenges to and opportunities for the prevention and control of Ebola and future outbreaks, and discuss policy recommendations and priority areas for addressing the Ebola epidemic and future outbreaks in West Africa. Articles in peer-reviewed journals on health system reforms in developing countries and periodicals of international organizations were used to gather the overview reported in this article. We identify individual, structural, and community challenges that must be addressed in an effort to reduce the spread of Ebola in West Africa. The Ebola epidemic in West Africa underscores the need for the overhaul and transformation of African health care systems to build the capacity in these countries to address infectious diseases. Public-private partnerships for investment in developing countries' health care systems that involve the international community are critical in addressing the current Ebola epidemic and future outbreaks.

Methods and protocol of a mixed method quasi-experiment to evaluate the effects of a structural economic and food security intervention on HIV vulnerability in rural Malawi: The SAGE4Health Study.

BACKGROUND: Poverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people's economic status and food security translate into changes in HIV vulnerability. METHODS: In this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18- and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants. DISCUSSION: In addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.

Enhancing the participation of african americans in health-related genetic research: findings of a collaborative academic and community-based research study.

The involvement of African Americans in research has long been expressed as a concern by the scientific community. While efforts have been undertaken to identify factors inhibiting the participation of African Americans in health-related research, few efforts have been undertaken to have highlight factors associated with their engagement of health-related research. An exploratory study of factors presumed to be associated with participation in health-related research was conducted among a nonprobability sample of African Americans (n = 212) from a large urban community in the Midwest. The study was guided by a framework that hypothesized the influence of knowledge, beliefs, and perceptions about genetics and the involvement of providers in decision-making on willingness to participate in health-related genetic research. The results revealed that knowledge, beliefs, and perceptions about genetics and the involvement of providers were associated with willingness to engage in health-related genetic research (P < .05). The most interesting, however, was that 88.7% of the participants who had not previously been involved in a health-related study who expressed a willingness to participate reported that they "had never been asked." Study findings suggest the need for research that further examines factors associated with the involvement of African Americans in health-related genetic research.