Rural young males' acceptance & receptiveness to technology-based interventions for dating violence prevention: A qualitative descriptive study.

INTRODUCTION: Rural youth are twice as likely as urban youth to experience some forms of teen dating violence (TDV), and significant barriers to accessing support services for physical, psychological, sexual violence. However, rural youth remain understudied and undersampled. Rural young men, in particular, are at risk for experiencing or perpetrating dating violence influenced by regional and sociocultural risk factors that promote male supremacy ideals while also impeding male help-seeking. Technology-based interventions circumvent some of these risk factors by offering confidential and reliable support. This study investigates rural young males' acceptability of technology-based interventions for fostering healthy relationships and preventing dating abuse, including their preferences for intervention content and features. METHODS: Three online focus groups (n = 14) and phone interviews (n = 13) were conducted with rural young males. Participants were stratified by age (15-17 and 18-24 year-olds). Most were White (81%) from the United States Midwest (65%). Semi-structured interview data were analyzed using Qualitative Description (QD), guided by the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS: Three themes identified were (1) Scarcity of Useful Resources, (2) Socio-Structural Challenges for Intervention Uptake, with two subthemes (2a) Rural-Specific Structural Barriers and (2b) Rural Masculinity Disrupting Help-seeking; (3) Finally, participants discussed Functionality and Design Needs, itemizing their intervention "must-have" in terms of content, resources, and features. CONCLUSION: This qualitative study identified obstacles and facilitators to using technology-based interventions for dating violence prevention among young rural males and offers pragmatic "ready-to-use" recommendations for the development of technology-based anti-dating violence interventions for rural youth.

Impact of a community-based approach to patient engagement in rural, low-income adults with type 2 diabetes.

OBJECTIVE: This secondary analysis examined the relationships between Patient Activation Measure (PAM) scores, use of health services, and HgA1C. DESIGN: A feasibility study was conducted for a community-based intervention for high-risk adults with uncontrolled diabetes. Data were collected at baseline and monthly, including PAM and modified Diabetes Self-Management Assessment Report Tool. INTERVENTION: Participants (n = 58) were randomized to a 3-month nurse (RN) telephone management or community health worker (CHW) in-home intervention, focusing on medication adherence, timely follow-up, diabetes self-management coaching, and linkage to resources. RESULTS: Sample was mostly female (73%), African-American (90%), low income (75%), high school education or less (80%), and mean age of 59 years. A positive association between PAM score and self-reported diabetes care recommendations was found (r = .356, p = .014) and significant correlation between baseline PAM score and HgA1C levels (r = -.306, p = .029). A paired samples t test showed statistically significant increases in PAM scores in the CHW intervention group (mean increase +8.5, CI [+2.49 to +14.65]); baseline (M = 60.31, SD = 13.3) to end of study ([M = 68.89, SD = 16.39], t(22) = 2.924, p = .008 [two-tailed]). CONCLUSION: A community-based approach to diabetes management demonstrated a positive effect on patient activation. Although disparities in health care access among rural, low-income populations exist, community-based interventions show potential for improving patient engagement in diabetes management and recommended health services.

Foot Health Assessment and Problem Identification in a Dominican Batey Community: A Descriptive Study.

PURPOSE: Foot problems can adversely impact foot function and quality of life. Foot problems are often overlooked, particularly in populations with limited health care access. Little is known about the foot health of Haitian immigrants who live and work in the bateyes (rural sugarcane villages) of the Dominican Republic. These immigrant workers may experience foot problems that could affect foot function and the ability to work and provide for their families. DESIGN: Cross-sectional, exploratory, descriptive study design. SUBJECTS AND SETTING: A convenience sample of adults was recruited from an ongoing community-based participatory research project evaluating a mobile hypertension screening and treatment clinic program in 11 Dominican batey communities. METHODS: Foot health was assessed using the Foot Problems Checklist, a 24-item survey instrument developed for this study based on a review of the literature and foot clinician expertise. A certified foot care nurse recorded foot health data on the Foot Problems Checklist via visual and physical inspection. RESULTS: Study participants were 25 females and 16 males, aged 18 to 90 years, and all had at least one foot health problem. The most common foot problems were calluses (78%), dry skin (76%), thick nails (59%), jagged nails (29%), long/overgrown nails (17%), and skin fissures (12%). CONCLUSIONS: While the foot problems we observed were not considered serious, they could become progressively debilitating and be prevented with proper self-management guided by appropriate knowledge and skills and available supplies. We recommend the development and testing of foot care self-management interventions deliverable via mobile clinics to increase access and improve foot health outcomes.

The Role of Policy on Sexual Health Education in Schools: Review.

Teen pregnancy and sexually transmitted infections are leading public health problems in the United States. While abstaining from sexual intercourse is the best way to avoid these conditions, abstinence only education (AOE) programs in schools have been shown ineffective in delaying sexual initiation or decreasing the teen pregnancy rate. Conversely, comprehensive sex education (CSE) programs have demonstrated the ability to decrease teen pregnancy and delay initiation into sex. However, federal funding continues to primarily support AOE programs, and a majority of states favor AOE in schools, rather than CSE. The purpose of this review was to examine the role of policy on sexual health education, which can have an impact on the health and well-being of adolescents. The review provides school nurses with information to help them educate parents and administrators to the negative repercussions of AOE, so they can advocate for policy change.

Development and feasibility of a community-partnered nutrition intervention targeting rural migrant communities in the Dominican Republic.

OBJECTIVE: Research on health initiatives for rural batey communities in the Dominican Republic is needed. DESIGN AND SAMPLE: This study utilized a pretest-posttest design to examine the feasibility and acceptability of a nutritional intervention targeting rural migrant sugarcane families. Participants (N = 310) were primarily female (61%) and ranged in age from 13 to 64 years (M = 25.9; SD = 10.4). A convenience sample was recruited from six rural bateyes in the southern region of the Dominican Republic. INTERVENTION: The intervention was developed for the target population in partnership with a grass-roots organization. The intervention consisted of a short video in the participant's preferred language (Spanish or Creole) describing the importance of consuming a diverse diet. Participants then completed an interactive meal-planning activity to enhance skills learned in the video. The main outcome variable was knowledge and a secondary outcome was participants' performance on the interactive activity. RESULTS: Results showed that the intervention was well received by the target population and participants demonstrated a significant increase in nutrition knowledge (p < .001). Higher postintervention knowledge scores were positively correlated with higher activity skills scores. CONCLUSION: This novel intervention may have promise as a practical program to enhance the nutritional status of a vulnerable population of migrant sugarcane workers.

Patient-Centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis.

OBJECTIVE: Using meta-analytic procedures to synthesize changes in patient-centered outcomes after medication adherence interventions. METHODS: Strategies to locate studies included online searches of 13 databases and 19 research registries, hand searches of 57 journals, and author and ancestry searches of all eligible studies. Search terms included patient compliance, medication adherence, and related terms. Searches were conducted for all studies published since 1960. Eligible published or unpublished primary studies tested medication adherence interventions and reported medication knowledge, quality of life, physical function, and symptom outcomes. Primary study attributes and outcome data were reliably coded. Overall standardized mean differences (SMDs) were analyzed using random-effects models. Dichotomous and continuous moderator analyses and funnel plots were used to explore risks of bias. RESULTS: Thorough searching located 141 eligible reports. The reports included 176 eligible comparisons between treatment and control subjects across 23,318 subjects. Synthesis across all comparisons yielded statistically significant SMDs for medication knowledge (d = 0.449), quality of life (d = 0.127), physical function (d = 0.142), and symptoms (d = 0.182). The overall SMDs for studies focusing on subsamples of patients with specific illnesses were more modest but also statistically significant. Of specific symptoms analyzed (depression, anxiety, pain, energy/vitality, cardiovascular, and respiratory), only anxiety failed to show a significant improvement after medication adherence interventions. Most SMDs were significantly heterogeneous, and risk of bias analyses suggested links between study quality and SMDs. CONCLUSIONS: Modest but significant improvements in patient-centered outcomes were observed after medication adherence interventions.

Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis.

This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

Cultural relevance in medication adherence interventions with underrepresented adults: systematic review and meta-analysis of outcomes.

OBJECTIVE: This meta-analysis systematically compiles intervention research designed to increase medication adherence among underrepresented adults. METHOD: Comprehensive searching located published and unpublished studies with medication adherence behavior outcomes. Studies were included if samples were adults living in North America who had any of the following backgrounds or identities: African American, Native American, Latino, Latino American, Asian, Asian American, Pacific Islander, Native Alaskan, or Native Hawaiian. Random-effect analyses synthesized data to calculate effect sizes as a standardized mean difference and variability measures. Exploratory moderator analyses examined the association between specific efforts to increase the cultural relevance of medication adherence studies and behavior outcomes. RESULTS: Data were synthesized across 5559 subjects in 55 eligible samples. Interventions significantly improved medication adherence behavior of treatment subjects compared to control subjects (standardized mean difference=0.211). Primary studies infrequently reported strategies to enhance cultural relevance. Exploratory moderator analyses found no evidence that associated cultural relevance strategies with better medication adherence outcomes. CONCLUSION: The modest magnitude of improvements in medication adherence behavior documents the need for further research with clear testing of cultural relevance features.

Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study.

This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.

Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes.

PURPOSE: The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS: A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS: Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS: NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.

The management of chronic diseases in rural Missouri practices.

This qualitative study describes the challenges of managing chronic diseases in small, rural, health care practices in Missouri. Four recurrent themes were identified from each of the nine focus groups: the similarity of their patient population and community characteristics, their unfamiliarity with aspects of the chronic care model, the consistent problem of poverty as a barrier to health care access for patients, and the uncertainty about what health care reform will mean for rural practice settings.

The "Ups and Downs" of Living With Type 2 Diabetes Among Working Adults in the Rural South.

The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults.

We Are Our Sister's Keeper: The Experience of Black Female Clergy Responding to Intimate Partner Violence.

Intimate partner violence (IPV) affects all populations, regardless of race, education, or socioeconomic status, but Black women experience higher rates of IPV (43.7%) in comparison with White women (34.6%). Although evidence indicates that faith-based organizations and clergy play key roles in preventing and responding to IPV among Black women, limited research has been conducted in this area, and existing studies have focused on Black male clergy leaders' response to IPV. Using transcendental phenomenology, we interviewed 12 Black female clergy regarding their role as responders to IPV among Black women in their congregation. Each clergy leader participated in a face-to-face interview. Data analysis followed the modified Van Kaam seven-step process. One overarching theme emerged-We Are Our Sister's Keeper, as well as three primary themes: Support Advocate, Spiritual Advisor, and Roadblocked Leader. The themes indicated that Black female clergy respond to the emotional and spiritual needs of Black women despite barriers (e.g., few outside resources, limited support from the Black church). The themes also suggested that clergy lack knowledge and training for responding to IPV. However, Black female clergy are passionate about providing holistic, culturally centered care by bridging the gap between the church and the community to better serve Black women who have experienced IPV. Findings support the importance of incorporating spiritual and emotional healing among this population when providing care and services. Further research is needed to develop interventions, such as a faith-based toolkit that incorporates community resources and guidance to better support Black female clergy leaders' ability to respond to IPV.

Perceptions of Risk for Dating Violence Among Rural Adolescent Males: An Interpretive Analysis.

About one in eight U.S. high school students in Grades 9 to 12 report experiencing teen dating violence (TDV) in the form of physical, sexual, or psychological dating violence in the past year in person, on school grounds, and online. Compared with their urban counterparts, rural teens face nearly double the rate of physical dating abuse and an elevated risk of experiencing multiple forms of violence. Rural young males are exposed to regional masculinities and gender norms that may simultaneously promote female subordination (a prelude to dating violence) while impeding help-seeking intentions. We used an interpretive and dialectical approach grounded in Relational Dialectics Theory to explore how rural young males perceive and describe their own risk of experiencing and perpetrating dating violence and the factors contributing to their help-seeking intentions and behaviors. Data from three focus groups and individual interviews with 27 rural young males (ages 15-24) were collated. We identified two central dialectical themes described as (a) Social Tension Dialectics (subthemes include: Abusive vs. Unhealthy Relationships: A Dialectic of Language; #MeToo vs. #WeToo: A Dialectic of Victimhood; "It's All Country Boys": A Dialectic of Masculinity) and (b) Help-Seeking Dialectics demonstrating the dual roles Religion, School Guidance Counselors, Peer Mentors, and Social Cohesion play in promoting or preventing dating violence. Overall, we found dialectic tensions in rural youth risk perceptions about dating violence. These findings bear implications for advocates and practitioners working with rural youth in planning developmentally and culturally appropriate TDV prevention programs, offering policy and research-relevant insight.

A Systematic Review of Nurse-Led Antiretroviral Medication Adherence Intervention Trials: How Nurses Have Advanced the Science.

ABSTRACT: Antiretroviral therapy (ART) is essential to achieving viral suppression and improving health and clinical outcomes in persons living with HIV. Despite the effectiveness of ART and many promising evidence-based ART adherence interventions, viral suppression rates continue to be less than optimal. Nurses play pivotal roles in HIV care management, yet their role in the development and delivery of evidence-based adherence interventions has received little attention. Therefore, this review examined the contributions of nurses to ART adherence research and delivery. We found that nurse-led and nurse-facilitated interventions can be effective in fostering ART adherence in persons living with HIV. Considering the role nurses play in HIV care management and the effectiveness of interventions involving nurses, more nurse-led and nurse-facilitated interventions to address ART adherence are indicated. However, there is a need for further research to examine multilevel interventions and comparative cost and effectiveness of nurse-delivered ART interventions with other forms of delivery.