'We are suffering. Nothing is changing.' Black mother's experiences, communication, and support in the neonatal intensive care unit in the United States: A Qualitative Study.

OBJECTIVES: Black mothers experience markedly disproportionate maternal morbidity and mortality in the United States, with racism often cited as the root cause manifesting through several pathways. The study examined Black mothers' perceived provider communication, support needs, and overall experiences in the neonatal intensive care unit (NICU). DESIGN: This study used grounded theory embedded in the Black feminist theoretical (BFT) framework to generate new ideas grounded in the data. Data was collected through semi-structured interviews using videoconferencing, with questions related to the mother's overall NICU experiences, communication within the NICU, and perceived support needs. Data were analyzed using thematic analysis. RESULTS: Twelve mothers participated in the study; most were married (n = 10), had a cesarean birth, had a previous pregnancy complication (e.g., diabetes, hypertension), had attained a graduate degree or more (n = 9), earned an annual household income of $75,000 or more, and were between 35-44 years of age (n = 7). Three broad domains with several accompanying themes and sub-themes were identified, explicating the mother's experiences in the NICU. Specifically, factors influencing NICU hospitalization for mothers included maternal care/nursing experiences, interactions in the NICU, and the perceived support need that might attenuate negative care and birthing experiences. . CONCLUSION: The study adds to the growing literature championing Black maternal health equity and multilevel quality improvement strategies to foster equitable maternal health. Our study reinforces the need for racially congruent interventions and policy reformations to protect Black birthing people regardless of socioeconomic factors and social class using life course, holistic approaches, and intersectionality mindset. Importantly, using the BFT, this study calls for culturally sensitive research to capture the nuances associated with the multiplicity of experiences of Black people.

Association between patient-provider communication and withholding information due to privacy concerns among women in the United States: an analysis of the 2011 to 2018 Health Information National Trends Survey.

BACKGROUND: Electronic medical record software is common in healthcare settings. However, data privacy and security challenges persist and may impede patients' willingness to disclose health information to their clinicians. Positive patient-provider communication may foster patient trust and subsequently reduce information nondisclosure. This study sought to characterize information-withholding behaviors among women and evaluate the association between positive patient-provider communication and women's health information-withholding behavior in the United States. METHODS: Data were pooled from the 2011 to 2018 Health Information National Trends Survey. We used descriptive statistics, bivariate, and logistic regression analyses to investigate whether positive patient-provider communication significantly impacted health information-withholding behaviors. Data from 7,738 women were analyzed. RESULTS: About 10.8% or 1 in 10 women endorsed withholding health information from their providers because of privacy or security concerns about their medical records. After adjusting for the covariates, higher positive patient-provider communication scores were associated with lower odds of withholding information from the provider because of privacy and security concerns (aOR 0.93; 95% CI = 0.90-0.95). Additionally, we found that age, race/ethnicity, educational status, psychological distress, and smoking status significantly predicted women's willingness to disclose health information. CONCLUSIONS: Findings suggest that improving positive patient-provider communication quality may reduce women's privacy and security concerns and encourage them to disclose sensitive medical information.

Multiple high-risk fertility behaviours and children under five mortality survivors among ever-married women of reproductive age in Nigeria.

BACKGROUND: Multiple high-risk fertility behaviours (MHRFBs), including maternal age < 18 or > 34 years old, a birth order 4+, and birth spacing < 24 months, can directly or indirectly affect survival outcomes among under-five children. There is a dearth of available information and data about these two phenomena in Nigeria. Thus, this study evaluates the prevalence of MHRFBs and examines the association between MHRFBs and under-five mortality survival (U5M) outcomes among ever-married women of reproductive age in Nigeria. METHODS: This study used the recent secondary datasets from the Nigerian Demographic Health Surveys conducted in 2018, with a total sample size of 10,304 women of reproductive age. The outcome variable was MHRFBs. Multivariable logistic regression analysis was employed to examine the association between U5M and MHRFBs. Odds ratios with a p-value of less than 0.05 were considered significant. RESULTS: It was found that among women who had MHRFBs, U5M was prevalent, particularly in young maternal age (< 18 years) and within short birth intervals (< 24 months). The adjusted odds ratio of the association between MHRFBs and U5M shows the experience of MHRFBs, in addition to other factors such as household wealth index, type of marriage, and sex of child, to be significant predictors for U5M. The odds were higher for U5M to occur among women who had experienced MHRFBs compared to those who have not had an experience of MHRFBs [aOR = 1.48; 95%CI: 1.02-2.17 ]. Similarly, the odds of U5M occurrence among women in polygamous marriages are higher compared to those in monogamous unions [aOR = 1.35; 95% CI: 1.10-1.65]. While under-five children born in the richest households (wealth quintiles) are less likely to die compared to those born in the poorest households [aOR = 0.64; 95% CI: 0.41-1.01]. CONCLUSION: This study concludes that women in Nigeria who engaged in MHRFBs, particularly maternal ages < 18 years and short birth intervals (< 24 months), were more likely to experience U5M. Furthermore, children born to women who received post-natal care after delivery were more likely to survive U5M, as were children born to women with educated partners. We recommend strengthening educational opportunities and creating adaptive reproductive health education programs for ever-married women of reproductive age in Nigeria.

Investigating the Role of Race and Stressful Life Events on the Smoking Patterns of Pregnant and Postpartum Women in the United States: A Multistate Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) Analysis.

OBJECTIVE: To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. METHODS: The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted. RESULTS: A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking. CONCLUSIONS FOR PRACTICE: Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support.

The Development of a Systems-Level Approach to Address Adolescent Access to Health Care: A Novel Confidentiality Policy Intervention.

Most evidence-based interventions in adolescent sexual and reproductive health and mental health remain largely aimed at individual-level outcomes and do not conceptualize adolescent health within a social-ecological model. Interventions to affect policy, systems, and environmental change offer potential for sustained population impact. The current initiative used an innovation framework to develop a novel systems-level approach to address adolescent access to health care. The Framework for Public Health Innovation provided an approach to develop a novel intervention. Confident Teen is a systems-level intervention that creates the opportunity, through organizational policy change, to increase adolescents' access to confidential sexual and reproductive health services through organizational policies. Gaps in adolescents' access to health care services allowed for a systems-level approach to be designed through an adolescent pregnancy prevention innovation initiative. Confidentiality is a right and critical component to their health care; therefore, a policy and conversation between provider and patient is a prioritized component of the novel intervention.

Spatial distribution and multilevel analysis of factors associated with long-acting reversible contraceptive use among sexually active women of reproductive age in Nigeria.

BACKGROUND: Long-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria. METHODS: This is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15-49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample. RESULTS: The spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48-0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30-2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45-0.97)] compared to women with lower socioeconomic status. CONCLUSIONS: This study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.

A multi-level analysis of prevalence and factors associated with caesarean section in Nigeria.

The choice of caesarean section (CS) plays a significant role in maternal and neonatal health. However, suboptimal CS uptake suggests unmet obstetric care leading to adverse maternal and neonatal health. Considering that maternal health problems in Nigeria remain a public health problem, this present study aims to assess the prevalence and multilevel factors associated with caesarean section among women of reproductive age in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey were analysed. Our analyses included 19,964 women of reproductive age, with their last birth within five years preceding the survey. Multilevel logistic regression analysis was carried out to examine the predictors of the caesarean section in Nigeria. The prevalence of CS among women of reproductive age in Nigeria was 3.11%. Women from the Yoruba ethnic group [aOR = 0.52; 95%(CI = (0.32-0.84)], with two children [aOR = 0.67; 95%(CI = 0.52-0.88)], three children [aOR = 0.49; 95%(CI = 0.36-0.66)], four children and above [aOR = 0.34; 95%(CI = 0.26-0.46)], those who practised Islam [aOR = 0.74; 95%(CI = (0.56-0.99)], and those that had a normal weighted baby [aOR = 0.73; 95%(CI = 0.60-0.99)] were less likely to report having a CS in Nigeria compared to those from Hausa/Fulani ethnic group, those who had one child, those who practised Christianity, and those who had a high weighted baby. Also, women residing in rural areas [aOR = 0.79; 95% (CI = (0.63-0.99)] and the South-South [aOR = 0.65; 95%(CI = (0.46-0.92)] were less likely to have CS compared to those residing in urban areas and North Central. The study concluded that several individual and community-level factors, such as religious belief, number of children, ethnicity, place of residence, and region of residence, were associated with CS utilisation in Nigeria. Our study highlights the need for different regional, local, and cultural contexts for evidence-based policy and programmatic efforts to facilitate equitable access to a caesarean section in Nigeria.

Barriers and facilitators to accessing and using sexual and reproductive health services during the COVID-19 pandemic outbreak in Africa: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Access and utilisation of sexual and reproductive health services remain an important component in averting adverse sexual and reproductive health outcomes. However, the unprecedented emergence of the 2019 coronavirus disease (COVID-19) left most of these services disrupted in Africa. Thus, this protocol study seeks to conduct a systematic review and meta-analysis of barriers and facilitators to accessing and using sexual and reproductive health services during the COVID-19 pandemic outbreak in Africa. METHOD AND ANALYSIS: An open electronic database search will be conducted in African journals online, PubMed, CINAHL, EMBASE and PsycINFO to identify potentially eligible studies published between January 2020 and December 2022. Two authors from the research team will screen the title and abstract of the potential studies, and another two authors will independently assess the full articles based on the inclusion or exclusion criteria. Studies will be selected if they examine barriers and facilitators to accessing and using sexual and reproductive health services, including family planning counselling and services, sexually transmitted infections (STIs)/HIV testing, consultation, and treatment, and provision of abortion services during the COVID-19 pandemic outbreak in Africa. The data extracted from the included studies will be analysed using Review Manager (RevMan V.5) and Meta-Analysis software V.3. Each outcome measure will be analysed separately against barriers and facilitators; the dichotomous data will be presented in odd ratios with a 95% CI, while mean and standardised mean differences will be employed to present the continuous data. We envisage that the potential results of this study will identify the barriers and facilitators to family planning counselling and services, STIs/HIV testing, consultation, and treatment, and provision of abortion services during the COVID-19 pandemic outbreak in Africa, which can be used to develop required interventions and policies to curb identified barriers. ETHICS AND DISSEMINATION: Ethical approval is not required for a systematic review and meta-analysis. Findings from this study will be disseminated through conferences and peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42022373335.

"I am not really into the government telling me what I need to eat": exploring dietary beliefs, knowledge, and practices among ethnically diverse communities in England.

BACKGROUND: Communities with diverse ethnicity in high-income countries are disproportionately affected by poor diet-related health outcomes. In England, the United Kingdom's government's healthy eating dietary resources are not well accepted and are underutilised among this population. Thus, this study explored perceptions, beliefs, knowledge, and practices around dietary intake among communities with African and South Asian ethnicity residing in Medway, England. METHODS: This qualitative study generated data from 18 adults aged 18 and above using a semi-structured interview guide. These participants were sampled using purposive and convenience sampling strategies. All the interviews were conducted in English over the telephone, and responses were thematically analysed. RESULTS: Six overarching themes were generated from the interview transcripts: eating patterns, social and cultural factors, food preferences and routines, accessibility and availability, health and healthy eating, and perceptions about the United Kingdom government's healthy eating resources. CONCLUSION: The results of this study indicate that strategies to improve access to healthy foods are required to improve healthy dietary practices among the study population. Such strategies could help address this group's structural and individual barriers to healthy dietary practices. In addition, developing a culturally responsive eating guide could also enhance the acceptability and utilisation of such resources among communities with ethnic diversity in England.

Prevalence, correlates, and sources of women's health information-seeking behaviors in the United States.

OBJECTIVE: To investigate the prevalence, correlates, and sources of women's health information-seeking behaviors in the United States using the Andersen Behavioral Model. METHODS: The 2012-2019 Health Information National Trends Survey data were used to analyze how and where women seek health theoretically. Weighted prevalence, descriptive analysis, and separate multivariable logistic regression models were computed to test the argument. RESULTS: The overall prevalence of seeking health information from any source was (83%, 95% CI: 0.82-0.84). Between 2012 and 2019, the analysis revealed a downward trend in health information seeking from any source (85.2-82.4%), health care provider (19.0-14.8%), family/friends (10.4-6.6%), and traditional channels (5.4-4.8%). Interestingly, there was an increase in Internet usage from 65.4% to 73.8%. CONCLUSIONS: We found statistically significant relationships between the predisposing, enabling, and need factors of the Andersen Behavioral Model. Specifically, age, race/ethnicity, income levels, educational status, perceived health status, having a regular provider, and smoking status predicted women's health information-seeking behaviors. PRACTICE IMPLICATIONS: Our study concludes that several factors influence health information-seeking behaviors, and disparities exist in the channels through which women seek care. The implications for health communication strategies, practitioners, and policymakers are also discussed.

What Black Mothers with Preterm Infants Want for Their Mental Health Care: A Qualitative Study.

Title: "I think that some culturally sensitive mental health information could have been provided": What Black mothers with preterm infants want for their mental health care: A qualitative study. Background: In the United States, preterm birth (PTB) rates in Black women are 50% higher than in non-Hispanic White and Hispanic mothers. Existing discriminatory sociohistorical and contemporary health care practices have been linked to the alarmingly higher rates of PTB among Black families. While it is well-known that PTB is associated with increased mental health (MH) problems, Black women experience elevated MH burdens due to inequities along the care continuum in the neonatal intensive care unit (NICU). Consequently, culturally responsive MH care holds promises to achieve maternal MH equity. This study aimed to explore the available MH services and resources in the NICU for Black mothers with preterm infants. We also sought to discover potential recommendations and strategies for MH programs through a cultural lens. Materials and Methods: Semistructured interviews were conducted with Black mothers with preterm infants using a Grounded Theory approach embedded in the Black feminist theory. Results: Eleven mothers who gave birth to a preterm infant between 2008 and 2021 participated in this study. Eight women reported not receiving MH services or resources in the NICU. Interestingly, of the three mothers who received MH referrals/services, two did so one-year postbirth and did not utilize the services. Three main themes emerged: stress and the NICU experience, coping mechanisms, and culturally appropriate MH care with diverse providers are needed. Overall, our finds suggest that MH care is not prioritized in the NICU. Conclusion: Black mothers with preterm infants encounter numerous negative and stressful experiences that exacerbate their MH during and beyond the NICU. However, MH services in the NICU and follow-up services are scarce. Mothers in this study endorsed creating culturally appropriate MH programs that addresses their unique intersections.

The Role of Health Information Technology in Improving Awareness of Human Papillomavirus and Human Papillomavirus Vaccine Among U.S. Adults.

Objective: Although human papillomavirus (HPV) vaccines prevent cancer-causing HPV infections and cervical precancers, there is suboptimal awareness and limited global accessibility of HPV and HPV vaccine. Emerging evidence suggests that health information technology (HIT) may influence HPV-related awareness and improve vaccine adoption. The objective of this study was to evaluate the link between HIT and HPV-related awareness Methods: Data were obtained from 1,866 U.S. adults aged 18-45 years who completed the 2017 and 2018 Health Information National Trends Survey. We conducted multivariable logistic regression to analyze the association between HIT utilization and HPV-related awareness. Results: Awareness of HPV and HPV vaccine were 72.7% and 67.5%, respectively. Participants who used electronic means to look up health information (adjusted odds ratio [aOR] = 3.05; p = 0.001), communicate with health care provider (aOR = 1.68; p = 0.026), look up test results (aOR = 1.94; p = 0.005), and track health costs (aOR = 1.65; p = 0.04) were more likely to report HPV awareness than those who did not. Participants who used an electronic device to look up health information (aOR = 3.10; p = 0.003), communicate with clinicians (aOR = 1.72; p = 0.008), look up test results (aOR = 1.63; p = 0.021), and track health care charges (aOR = 1.90; p = 0.006) were more likely to report HPV vaccine awareness than those who did not. Discussion and Conclusion: Our findings suggest a positive association between HIT utilization and HPV-related awareness. Given the rapid and exponential increase in mobile technology access globally, these results are encouraging and offer a potential opportunity to leverage digital technology in primary cancer prevention for HPV-related cancers, especially in low- and middle-income countries with unsophisticated health infrastructures.

Understanding the Domains of Experiences of Black Mothers with Preterm Infants in the United States: A Systematic Literature Review.

OBJECTIVE: To report the domains of Black mothers' experiences with preterm infants in the neonatal intensive care unit (NICU) and to determine the frameworks used. METHODS: A systematic review of the literature using the PRISMA guideline was performed. An electronic database search of published literature between 2000 and 2022 was conducted based on predetermined search terms and parameters. RESULTS: Twenty-seven articles met the inclusion and exclusion criteria. Eleven articles focused on feeding practices, ten reported on nursing/maternal care experiences, five reported mental health/social support, and only one focused on mother-infant relationships. Only five papers reported using any frameworks, comprising grounded theory framework (n = 2), theory of planned behavior (n = 1), research justice framework (n = 1), and the patient and public engagement protocol (n = 1). DISCUSSION: A holistic approach to understanding the multifactorial experiences of Black mothers with preterm infants needs to be socio-culturally competent to ensure their diverse intersections and identities are accurately represented and understood. Rigorous research at the intersection of Black maternal health and the NICU hold promises for advancing maternal health equity in the United States.

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa.

BACKGROUND: The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA. METHODS: Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05. RESULTS: The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03-1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41-1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure. CONCLUSION: The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA.

Health insurance coverage and modern contraceptive use among sexually active women in Nigeria: Further analysis of 2018 Nigeria Demographic Health Survey.

BACKGROUND: Studies have shown that affordable health insurance can influence healthcare visits and increase the choice of medication uptake in sub-Saharan Africa. However, there is a need to document the influence of health insurance coverage and modern contraceptive use in order to encourage its uptake. Thus, this study examined the influence of health insurance coverage on modern contraceptive use among sexually active women in Nigeria. METHODS: The secondary dataset utilised in this study were derived from the 2018 Nigeria Demographic and Health Survey (NDHS). Data analyses were restricted to 24,280 women of reproductive age 15-49 years who were sexually active in the survey dataset. Weighted bivariate and multivariable logistic regression models were used to examine the influence of health insurance coverage on modern contraceptive use while controlling for possible confounders. A Significant level of alpha was determined at p < 0.05 using STATA 16.0. RESULTS: The prevalence of health insurance coverage and modern contraceptive use among sexually active women in Nigeria were 25.47% and 13.82%, respectively. About 1 out of every 4 sexually active women covered by health insurance were using a modern contraceptive, while 86.50% of the women not covered by health insurance were not using any modern contraceptive method. After adjusting for socio-demographic characteristics, the odds of using any modern contraceptive were significantly higher for sexually active women who were covered by any health insurance [aOR = 1.28; 95% (CI = 1.01-1.62)] compared to sexually active women not covered by health insurance in Nigeria. CONCLUSION: The study demonstrated that health insurance coverage is a significant driver of health service utilization, including modern contraceptive use. Health insurance benefits are recommended to be expanded to cover a broader spectrum of family planning services in Nigeria. More research is required to understand the influence of different health insurance schemes and the use of modern family planning methods in Nigeria.

The Use of Digital Health Tools for Health Promotion Among Women With and Without Chronic Diseases: Insights From the 2017-2020 Health Information National Trends Survey.

BACKGROUND: In the United States, almost 90% of women are at risk of at least one chronic condition. However, the awareness, management, and monitoring of these conditions are low and present a substantial public health problem. Digital health tools can be leveraged to reduce the alarmingly high rates of chronic condition-related mortality and morbidity in women. OBJECTIVE: This study aimed to investigate the 4-year trend of digital health use for health promotion among women with chronic conditions in the United States. METHODS: Data for this study were obtained from the 2017 to 2020 iterations of the Health Information Trends Survey 5. Separate weighted logistic regression models were conducted to test the unadjusted and adjusted association of the study variables and each digital health use. The 95% CI, adjusted odds ratio (aOR), and P value (.05) were reported. Analysis was conducted using Stata 17 software. RESULTS: In total, 8573 women were included in this study. The weighted prevalence of the use of a smartphone or tablet for various activities were as follows: track health goals, 50.3% (95% CI 48.4%-52.2%; 3279/7122); make a health decision, 43.6% (95% CI 41.9%-45.3%; 2998/7101); and discuss with a provider, 40% (95% CI 38.2%-41.8%; 2834/7099). In the preceding 12 months, 33% (95% CI 30.9%-35.2%; 1395/4826) of women used an electronic wearable device, 18.7% (95% CI 17.3%-20.2%; 1532/7653) shared health information, and 35.2% (95% CI 33.2%-37.3%; 2262/6349) sent or received an SMS text message with a health professional. Between 2017 and 2020, the weighted prevalence of having 0, 1, and multiple chronic conditions were 37.4% (2718/8564), 33.4% (2776/8564), and 29.3% (3070/8564), respectively. However, slightly above half (52.2%, 95% CI 0.50%-0.53%; 4756/8564) of US women reported having at least one chronic disease. Women with multiple chronic conditions had higher odds of using their tablet or smartphone to achieve a health-related goal (aOR 1.43, 95% CI 1.16-1.77; P=.001) and discuss with their provider (aOR 1.55 95% CI 1.20-2.00; P=.001) than those without any chronic conditions. Correspondingly, in the past 12 months, the odds of using an electronic wearable device (aOR 1.40, 95% CI 1.00-1.96; P=.04), sharing health information (aOR 1.91, 95% CI 1.46-2.51; P<.001), and communicating via SMS text messaging with a provider (aOR 1.31, 95% CI 1.02-1.68; P=.03) were significantly higher among women with chronic conditions than those without a chronic condition. CONCLUSIONS: This study suggests that women with chronic conditions accept and integrate digital health tools to manage their care. However, certain subpopulations experience a digital disconnect that may exacerbate existing health inequities. Implications for research and opportunities to leverage and integrate digital health tools to prevent, monitor, manage, and treat chronic conditions in women are discussed.

Supporting and Enabling the Process of Innovation in Public Health: The Framework for Public Health Innovation.

This manuscript introduces a new framework for creating innovations in public health-the Framework for Public Health Innovation. The framework was developed through a longitudinal qualitative research study that investigated the process of creating innovative adolescent health programs. Interviews were conducted with a national sample of 26 organizations over two time points. Data collection focused on the process of innovative program development; organizational capacity; training; and technical assistance needs, successes, and barriers. The framework was developed and modified based on interview findings and expert advice; then, the final framework was validated with content experts. The framework illustrates a dynamic process of innovation that begins with dissatisfaction with the status quo, and then, illustrates three necessary components for innovation-space, process, and partnerships. Four categories of innovation, which range in complexity, are proposed: (1) creating a new component to an existing program, (2) adapting an existing program to meet new needs, (3) taking an alternative approach to addressing an existing program, and (4) reframing a health problem from a new perspective. As illustrated by a feedback loop, the resulting innovations disrupt the status quo. This model can be applied to any content area in public health and is useful for both research and practitioners.

Network analysis of a community-wide teenage pregnancy prevention initiative.

Although US teenage birth rates substantially decreased over the past two decades, it still remains the highest in the developed world. More innovative, community-wide initiatives are needed to combat the issue. In Oklahoma County, Oklahoma, the Central Oklahoma Teen Pregnancy Prevention Collaboration is utilizing the collective impact model to convene multiple organizations with the goal of making systems-level changes related to teenage pregnancy within the community. This study used an interorganizational network analysis to evaluate the current strength of relationships between organizations in the Collaboration. An interorganizational network survey assessed collaborative relationships (e.g. information sharing and joint planning) within the network. Using R software, network diagrams were developed to depict partner relationships, and network measures, including node-, group- and network-level measures, were calculated. The network depiction (n = 23) revealed that the network core was composed of organizations from multiple sectors, and the backbone organization served as the most central organization for most centrality measures. This study provides insight into how organizational relationships can be assessed in order to increase community capacity to address teenage pregnancy. Continuous monitoring of the strength of relationships is important to ensure success in achieving goals as well as collective impact.

Association between knowledge of Human Immunodeficiency Virus transmission and consistent condom use among sexually active men in Nigeria: An analysis of 2018 Nigeria Demographic Health Survey.

An estimated 1.7 million people were living with HIV in Nigeria in 2020, with over 86,000 people newly infected. Although the global rates of HIV have remained consistent over time, Nigeria has the second-highest number of people living with HIV and contributes to 9% of the global burden of HIV/AIDS. This is due to several structural and individual-level factors that limit knowledge of HIV and condom utilization. In this context, this study examines the association between knowledge about HIV transmission and consistent condom use among sexually active men in Nigeria. The data utilised in this study was sourced from the latest Nigeria Demographic and Health Survey conducted in 2018. The sample included a total of 9,346 men between the ages of 15-59 years who were sexually active at the time of data collection. Frequency distribution, univariate and multivariable analyses were performed at 95% confidence interval and p-value less than 0.05 to determine the association between the key independent variables and covariates. The results showed that 85.03% of sexually active men who had no knowledge of HIV engaged in inconsistent condom use. The key independent variable showed that sexually active men who had knowledge of HIV had higher odds [AOR = 1.37; 95%(CI = 1.10-1.72)] of consistent condom use compared to those without knowledge of HIV. However, sexually active men who were previously married [AOR = 0.38; 95%(CI = 0.24-0.61)], and those residing in the South Eastern region of Nigeria [AOR = 0.62; 95%(CI = 0.44-0.96)] had lower odds of consistent condom use. This study established the association between HIV knowledge and consistent condom use among sexually active males in Nigeria even after controlling for confounders. Educational level, wealth index, and ethnicity are also associated with condom use. This calls for the consideration of social determinants of health, localised and cultural health promotion and targeted public health strategies at all governmental levels to combat the HIV/AIDS epidemic in Nigeria.

Sociodemographic factors and perceived patient-provider communication associated with healthcare avoidance among women with psychological distress.

Objective: To establish the extent to which psychological distress influences health avoidance behavior among women, controlling for patient provider communication and sociodemographic characteristics. Methods: Data from the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3) was analyzed to obtain healthcare avoidance behavior among women aged 18 and older (n = 2788). Weighted descriptive, bivariate, and multivariable logistic regression models were conducted. Results: Approximately 649 women or 1 in 4 women (26.7% weighted prevalence; 95% Confidence Interval [CI] 0.23%-0.29%) avoided healthcare in the past 12 months. Non-Hispanic white (62.8%) and married (55.4%) women represented a higher proportion of the sample. Bivariate analysis revealed that the odds of reporting healthcare avoidance among women with mild, moderate, and severe psychological distress (Odds Ratio [OR]: 2.26, 95% CI: 1.45-3.53, p = 0.001; OR: 3.88, 95% CI: 2.29-6.56, p < 0.001; OR: 3.08, 95% CI: 1.81-5.23, p < 0.001) was significantly higher compared to those with none-minimal psychological distress. In the adjusted model, women with moderate and severe psychological distress (Adjusted OR [AOR]:3.15, 95% CI: 1.55-6.38, p = 0.002; AOR: 2.24, 95% CI: 1.10-4.92, p = 0.044) were more likely to report healthcare avoidance than those experiencing none-minimal psychological distress. Furthermore, increasing patient-provider communication score (AOR: 0.91, 95% CI: 0.87-0.96, p < 0.001) reduced the likelihood of healthcare avoidance. Among the sociodemographic variables assessed, being younger (18-49 years) and having less than a high school degree significantly increased the chances of avoiding healthcare. Conclusion: A high proportion of women with psychological distress avoid necessary healthcare. Patient-provider communication quality, increasing age, and being a high school student contribute to healthcare avoidance in women. Innovation: Strategies to improve health service utilization must address healthcare avoidance by developing effective health communication targeted at women with psychological distress.