Perceived Benefits and Barriers of mHealth Mindfulness Use for Caregivers of Older Adults with Cognitive Impairment: A Qualitative Exploration.

OBJECTIVES: Mobile (mHealth) mindfulness-based interventions have the potential to be feasible, acceptable, effective, and scalable interventions for caregivers of people living with cognitive impairment. This qualitative study of caregivers of older adults with cognitive impairment explored caregivers' experiences using a mindfulness therapy mobile application. METHODS: Fifteen caregivers were interviewed using a semi-structured interview guide. Analysis was guided by the phenomenological approach and inductive-deductive analysis. RESULTS: Six themes were generated from the data: convenience, barriers, perceived helpfulness, useful features, suggested app improvements, and skill transfer. Caregivers reported that the app was easy to use with many perceived benefits. Caregivers also noted some barriers to using the app. CONCLUSIONS: This study revealed that self-directed mHealth delivered mindfulness therapy may be a promising intervention for the caregivers involved in the study. Having the ability to use the app anywhere and at any time was a prominent reason for continued regular use for the participants. This was especially important to some caregivers during the COVID-19 pandemic. The barriers discussed by the caregivers are important considerations for future app-based interventions for caregivers. CLINICAL IMPLICATIONS: Clinicians can consider recommending mHealth mindfulness therapy to caregivers as a tool to provide caregivers with additional support.

Oral Health Workforce and American Indian and Alaska Native Communities: a Systematic Review.

OBJECTIVE: Understanding the oral health workforce representing and serving American Indian and Alaska Native (AI/AN) communities is vital to improving community dental health outcomes. No systematic review of recent published literature on the oral health workforce among this population has been completed. METHODS: We conducted a systematic review of published literature examining the oral health workforce representing and serving AI/AN communities in the USA. We analyzed 12 articles according to the PRISMA Statement. RESULTS: The studies suggested that AI/AN identity is an important aspect of routine and accessible oral healthcare. There are unique barriers and motivations that personnel in the oral health workforce face, let alone the distinctiveness of serving AI/AN communities. CONCLUSIONS: This review provides evidence that expanded oral health positions aid in community members receiving more routine and preventative care and is an upstream public health approach that has diversified the dental workforce.

Assessment of Racial Misclassification Among American Indian and Alaska Native Identity in Cancer Surveillance Data in the United States and Considerations for Oral Health: A Systematic Review.

Introduction: Misclassification of American Indian and Alaska Native (AI/AN) peoples exists across various databases in research and clinical practice. Oral health is associated with cancer incidence and survival; however, misclassification adds another layer of complexity to understanding the impact of poor oral health. The objective of this literature review was to systematically evaluate and analyze publications focused on racial misclassification of AI/AN racial identities among cancer surveillance data. Methods: The PRISMA Statement and the CONSIDER Statement were used for this systematic literature review. Studies involving the racial misclassification of AI/AN identity among cancer surveillance data were screened for eligibility. Data were analyzed in terms of the discussion of racial misclassification, methods to reduce this error, and the reporting of research involving Indigenous peoples. Results: A total of 66 articles were included with publication years ranging from 1972 to 2022. A total of 55 (83%) of the 66 articles discussed racial misclassification. The most common method of addressing racial misclassification among these articles was linkage with the Indian Health Service or tribal clinic records (45 articles or 82%). The average number of CONSIDER checklist domains was three, with a range of zero to eight domains included. The domain most often identified was Prioritization (60), followed by Governance (47), Methodologies (31), Dissemination (27), Relationships (22), Participation (9), Capacity (9), and Analysis and Findings (8). Conclusion: To ensure equitable representation of AI/AN communities, and thwart further oppression of minorities, specifically AI/AN peoples, is through accurate data collection and reporting processes.

Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality.

PURPOSE: Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population. METHODS: A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma. RESULTS: A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions. CONCLUSIONS: AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.

Health following recovery from immune thrombotic thrombocytopenic purpura: the patient's perspective.

The impact of residual symptoms following recovery from immune-mediated thrombotic thrombocytopenic purpura (iTTP) on activities of daily living during remission is not routinely discussed or evaluated by hematologists. This study used qualitative methodology to understand 3 issues from the patient's perspective: the most important symptoms during remission, the impact of these symptoms on their daily activities, and the effectiveness of communication with hematologists. Oklahoma and Ohio patients participated in either focus groups or individual interviews. Eligibility included age ≥18 years, ADAMTS13 deficiency (<10% activity) at diagnosis or relapse, and in clinical remission (≥1 year from episode). A nonprobabilistic purposive sampling approach was used. The most important symptoms were defined as symptoms mentioned across all 7 focus groups. The interviews supplemented focus group data. The analysis focused on describing the impact of symptoms and barriers to communicating with hematologists. A total of 44 patients participated (focus groups, N = 25; interviews, N = 19). The most important symptoms affecting the patients' daily activities were cognitive issues, anxiety, depression, and fatigue. These symptoms affected patients' ability to return to their previous level of functioning and created difficulties in relationships. A key communication barrier with their hematologists was forgetting to mention these symptoms. Although hematologists pronounce patients as recovered, iTTP remains a life-changing event. Patients often did not return to their previous functioning; relationships and careers were affected. However, patients may forget to discuss these concerns with their hematologist. To improve remission care, hematologists should incorporate patient-reported outcome measures evaluating these symptoms in remission visits.