Pre-implementation determinants for digital mental health integration in Chicago pediatric primary care.

OBJECTIVE: Pediatric primary care (PPC) is a common treatment site for pediatric mental health, but it is currently unable to meet the needs of all teen patients, particularly those with minoritized identities and/or marginalized experiences. Digital mental health (DMH) low-intensity treatments (LITs) can increase mental health screening and care capacity in PPC, but how this is done successfully without burdening providers, patients, or families is unclear. This paper presents a pre-implementation study aimed at understanding the implementation context (PPCs in Chicago, IL) for a specific DMH LIT. METHOD: Using a mixed-methods design, quantitative data from an online survey of providers assessed current DMH practices in PPC, and qualitative interviews with Pediatricians and Pediatric Psychologists examined implementation determinants for a specific DMH LIT. Quantitative data were analyzed using descriptive statistics, and interviews were analyzed using rapid qualitative assessment. RESULTS: Survey reports (n = 105) and interviews (n = 6) indicated low current use of DMH. Providers in PPC clinics voiced multiple reasons for low usage and low perceived feasibility, including: Consolidated Framework for Implementation Research (CFIR) Inner Setting Domain (PPC clinic workflow, responsibility and ethical considerations, patient privacy and confidentiality), CFIR Outer Setting Domain (hospital and healthcare system factors), CFIR Innovation Domain (DMH design), and a cross-cutting theme of safety. CONCLUSIONS: Provider-reported low feasibility for integrating DMH in PPC is a call to action to partner with interdisciplinary colleagues and identify how such settings can ethically and seamlessly deliver digital evidence-based and accessible screening and care prior to implementation.

The human gut microbiome and health inequities.

Individuals who are minoritized as a result of race, sexual identity, gender, or socioeconomic status experience a higher prevalence of many diseases. Understanding the biological processes that cause and maintain these socially driven health inequities is essential for addressing them. The gut microbiome is strongly shaped by host environments and affects host metabolic, immune, and neuroendocrine functions, making it an important pathway by which differences in experiences caused by social, political, and economic forces could contribute to health inequities. Nevertheless, few studies have directly integrated the gut microbiome into investigations of health inequities. Here, we argue that accounting for host-gut microbe interactions will improve understanding and management of health inequities, and that health policy must begin to consider the microbiome as an important pathway linking environments to population health.

Community Teens' COVID-19 Experience: Implications for Engagement Moving Forward.

Data collected from pediatric primary care settings during the pandemic suggest an increase in internalizing symptoms and disparities in care based upon minoritized identity status(es). To inform care moving forward, the current study characterized the pandemic and related technology usage experiences of teenaged pediatric patients from communities with high hardship indexes. As part of a larger mixed-methods study, 17 teens (Mean age = 15.99 ± .99) and 10 caregivers independently voiced experiences related to the pandemic during remote focus group and interview sessions. Thematic analyses were used to assess qualitative data; descriptive analyses were used to characterize qualitative data. Despite no direct queries about the pandemic, 41% of teens and 40% of caregivers described their lived experiences during the pandemic. Two subthemes emerged within the primary theme of COVID-19: (1) Wellness/Mental Health and (2) Smartphone Use and Utility. Although distress and negative effects were voiced, questionnaire data indicated normative psychosocial functioning for both teen self-report and caregiver proxy report. Informed by the voiced experiences of teens and their caregivers from communities with high hardship indexes, methods for better assessing and managing internalizing symptoms in teen patients are presented. A multi-modal and multi-informant approach that leverages technology to garner information about teens' experiences and deliver care may help improve the well-being of teens in communities systemically burdened with disparities.

Leading through difficult times: The oral histories of Drs. Barbara Nichols, Beverly Malone, and Ernest Grant.

BACKGROUND: The nursing profession, along with its respective professional organizations, has transcended through the vicissitudes of time. This includes, but is not limited to, the evolution of the profession and integration of African American nurses into nursing organizations and leadership roles. PURPOSE: The three past African American presidents of the American Nurses Association (ANA) were invited to participate in an oral history about their leadership and presidencies. METHODS: The interviews were visual/audio-recorded, digitally taped, and transcribed. DISCUSSION: The oral histories centered on their journeys to becoming the president of the ANA, experiences being the president, leading beyond their presidency, and respective insights about their presidency.

From group mentoring to collective liberation: The imperative to decolonize nursing academia.

BACKGROUND: Four Black early-career faculty members, one Black doctoral student, and a Black senior faculty member, (herein referred to as scholars), previously engaged in cross-cultural mentoring with a White senior researcher to bolster their scholarship. PURPOSE: In the years following the 2020 racial reckoning, the scholars were motivated to reconvene by the realization that traditional scholarship activities of academia ignore historical educational oppression and fail to account for the contemporary effects of racism and discrimination rooted in American colonialism. METHODS: Collaborative autoethnography, a decolonizing qualitative approach to research, was used to explicate our journeys in academia. The tenets of Freire's critical pedagogy (conscientização, scholarship, praxis) framed our collective experiences. DISCUSSION: We describe resisting academic structures of power, discrimination, and disadvantage through reformation, crafting a vision statement, and utilizing positions of influence. CONCLUSION: To decolonize nursing academia, we implore the scholarly community to pursue liberation and contest structures that center Whiteness and marginalize collectivism and collaboration.

Perceptions of Caring Recruitment Among Older Adults: African Americans and Non-Latinx Whites.

BACKGROUND: African Americans (AAs) are underrepresented in health-related research studies. Few studies have investigated how behaviors of study recruiters affect recruitment of older AAs versus non-Latinx Whites (NLWs). OBJECTIVES: The aim of this study was to explore whether caring behaviors influence AA and NLW older adults' decision to participate in hypothetical, high-commitment, health-related research studies and differences in participants' enrollment decisions by race. METHODS: Using a descriptive, cross-sectional study design, guided by Kristen Swanson's middle-range theory of caring, a research-savvy sample of 60 AA and 60 NLW adults (age > 65 years) were randomly assigned one of two written vignettes. The concept of caring behaviors was manipulated and illustrated in a hypothetical recruitment scenario. A participant feedback survey was used to assess (a) participants' perceptions of caring and uncaring behaviors exhibited by the fictitious research recruiter, (b) differences in their willingness to participate based on vignette type, and (c) participants' judgment of the research recruiter as being caring or uncaring. A chi-square test assessed the association among categorical variables (caring behavior and participants' race). RESULTS: Participants who received the vignette with the high caring recruiter were more than twice as likely to agree to participate in the study than those who received the vignette with the low caring recruiter. AA and NLW participants did not differ in their likelihood to agree to participate. Participants who received the caring vignette and judged the recruiter as caring were 5 times as likely to agree to participate in the high-commitment study than those who received the uncaring vignette ( p < .001). Associations did not vary by race. DISCUSSION: This experimental study of equally recruited older adults from an existing longitudinal study revealed that caring behaviors in recruitment strategies are associated with an increased likelihood of participation in high-commitment research with older adults. The research-savvy AA participants were just as likely to participate in the hypothetical high-commitment research as their NLW peers when the fictional research recruiter was perceived as having caring behaviors. When targeting specific populations, it is essential to employ nuanced recruitment approaches where the study recruiters are attuned to caring behaviors.

Grandmothers residing with grandchildren: Social determinants of health, health behaviors, and health outcomes.

The purpose of this study was to explore the associations between social determinants of health, health behaviors, and physical and mental health among African American and Hispanic caregiving grandmothers. We use cross-sectional secondary data from the Chicago Community Adult Health Study, originally designed to understand the health of individual households based on residential context. In a multivariate regression model, discrimination, parental stress, and physical health problems were significantly associated with depressive symptoms in caregiving grandmothers. Considering the multiple sources of stress experienced by this grandmother sample, researchers should develop and strengthen contextually relevant interventions for improving the health of caregiving grandmothers. Healthcare providers must be equipped with skills to address caregiving grandmothers' unique needs related to stress. Finally, policy makers should promote the development of legislation that can positively influence caregiving grandmothers and their families. Expanding the lens through which caregiving grandmothers living in minoritized communities are viewed can catalyze meaningful change.

Parent education programs for children assisted by invasive mechanical ventilation: A scoping review.

PROBLEM: The population of children assisted by invasive mechanical ventilation (IMV) and living at home is growing. Although parent education is essential for safe transitions from hospital-to-home, little is known about how this education is delivered. The aim of this review is to identify existing literature about parent education programs, synthesize the evidence, and identify gaps in the literature for future inquiry. ELIGIBILITY CRITERIA: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology. Full-text publications in the English language focused on describing parent education programs for children assisted by IMV, indexed in CINAHL, PubMed, OVID, and PsycINFO and published from 2010 to 2021 were included. Reference lists of relevant articles were reviewed, and a hand search was completed to locate any additional literature outside the original search. SAMPLE: A total of 2472 citations were identified. After screening titles and abstracts, 37 full-text articles were retrieved and assessed for eligibility. Two independent reviewers completed the screening process. A hand search located one additional article. A final sample of 18 articles were included in the review. RESULTS: The parent education programs described in the final sample included standardized discharge education programs, simulation training, resourcefulness training, patient-specific action plans, disaster preparedness, and symptom and technology management. CONCLUSION: Although most parent education programs identified in this review focused on teaching caregiver skills, program characteristics and outcome measures varied widely. IMPLICATIONS: This review recommends directions for future research to optimize parent education for children assisted by IMV.

Mothers' Perspectives on Co-Parenting with African American Non-Resident Fathers.

Over half of African American (AA) children grow up in single-mother headed households. Strained relationships between co-parents can complicate and potentially thwart efforts for father engagement. Twelve mothers who served as data informants in a randomized control trial of a fatherhood intervention were recruited to describe their experiences co-parenting with nonresident AA fathers in semi-structured interviews. Qualitative descriptive content analysis of the data revealed three major themes that are used to identify innovative ways for researchers, policy makers, and mental health practitioners to support co-parents as they strive to engage in equitable shared parenting.

Using Vignette-Based Methodology to Examine Study Recruitment in Older African American Adults: A Methods Paper.

This study's objective was to assess which caring recruitment behaviors correlate with the successful recruitment of older African-American adults-a two-step cross-sectional design employing a vignette-based survey methodology. Kristen Swanson's middle-range theory of caring was used to guide the examination of African-American adults' (65 years of age and older) perceptions of research-study-recruiter recruitment behaviors. This study's main findings are twofold: Step 1: Seven of ten invited experts identified major revisions of the two core vignettes, written at an eighth-grade reading level and high school comprehension. Step 2: A 51% response rate yielded findings that this methodology successfully captured older African-American adults' perception of research study recruiters' behavioral characteristics during the recruitment process. Older African-Americans who received the hypothetical caring vignette were twice as likely to indicate their willingness to enroll in a research study with a high commitment (i.e., brain donation) compared to their counterparts who received the hypothetical uncaring recruitment scenario. Vignette-based survey methodology holds promise as a tool for informing the recruitment of older African-American adults and other minorities into federally funded health-related research studies.

Recruitment, Retention, and Intervention Outcomes from the Dedicated African American Dad (DAAD) Study.

A significant proportion of African American (AA) fathers live in households apart from their young children. This living arrangement can have detrimental effects for children, families, and fathers. One hundred seventy-eight (n = 178) AA fathers, not residing with their 2-6-year-old children, were enrolled in a randomized trial to test the Building Bridges to Fatherhood (BBTF) program against a financial literacy comparison condition. BBTF is an intervention that was developed collaboratively with a fathers' advisory council of AA fathers who oversaw all aspects of program development. Based upon advisory council feedback, short video scenes captured fathers interacting with their children, their children's mothers, and other fathers. These video scenes were used to jump start the discussion around fatherhood, parenting, communication, and problem solving during the intervention group meetings. The actors in the video scenes were recruited from the community. Two trained group leaders, using a standardized group leader manual, delivered the intervention. The Money Smart Financial Literacy Program (MSFLP), which served as the comparator, was also delivered by AA men. Program satisfaction was high in both conditions. Even so recruitment and retention challenges influenced the ability to detect father and child outcomes. This study informs the participation of vulnerable urban AA fathers in community-based fatherhood intervention research and provides insight into bolstering engagement in studies focused on this population.

Fatherhood Matters: An Integrative Review of Fatherhood Intervention Research.

Positive father involvement is critical to the healthy social, emotional, and academic outcomes of children at all stages of development. The purpose of this integrative review was to identify, categorize, and evaluate the potential impact of fatherhood interventions on father and child outcomes. A systematic search of four major research databases yielded 44 studies published between 1988 and 2018 that met study inclusion criteria. The most effective interventions were delivered in the community, with fathers convened in groups. Content focused on promoting positive parenting, co-parenting, and father/child relationships. Consequently, father involvement and child cognitive and socioemotional development were improved. Academic settings were underutilized in the fatherhood interventions in this review. We conclude that in order to optimize healthy child development, school officials must adopt a more inclusive stance toward the involvement of fathers in their children's education. Future randomized trials of fatherhood interventions delivered within school-based settings are warranted.

A group think tank as a discourse coalition to promote minority nursing faculty retention.

BACKGROUND: The nursing profession will need one million more nurses by 2024, yet nursing schools are turning away applicants due to insufficient numbers of nursing faculty. Likewise, minority nursing faculty are needed in order to attract diverse nursing students who can then address health care disparities. PURPOSE: The purpose of this paper is to describe the use of a group think tank (GTT) as a mentoring strategy for supporting the recruitment and retention of minority nursing faculty. METHOD: Guided by Kotter's theory of change, this paper describes the application of the GTT approach with 5 African American (AA) faculty, one AA doctoral student and a cross-cultural mentor. FINDINGS: Results are presented based upon the metrics typically used to support career advancement, promotion and/or tenure. DISCUSSION: The GTT is a promising mentoring model that can be used to integrate cross-cultural and peer mentoring into academic communities to support diversity in academia.

A tripartite model for recruiting African-Americans into fatherhood intervention research.

Many studies have examined factors influencing African-American (AA) participation in research studies. But none inform the recruitment of AA men into fatherhood intervention research. Our purpose is to describe the recruitment and enrollment framework of the Dedicated African American Dad (DAAD) Study, a randomized controlled trial (RCT) designed to test a fatherhood intervention against a financial literacy comparison condition. AA nonresident (AANR) fathers are fathers who do not reside with their child on a full-time basis. Fathers attended 10 group-based sessions; and father and mother informants completed research interviews at baseline, postintervention, and 12 weeks postintervention. The DAAD Study tripartite model is a system of strategies that address three factors that individually and cooperatively affect recruitment of AANR fathers into research: community partnerships; study infrastructure; and recruitment personnel. The intersection of these three components forms a recruitment nexus that can be used to guide community-based research. The DAAD study serves as an exemplar of recruitment challenges, strategies, and lessons learned.

Preferred intervention strategies to improve dietary and physical activity behaviors among African-American mothers and daughters.

OBJECTIVE: The objective of this study was to identify cultural- and age-appropriate intervention strategies to improve dietary and physical activity (PA) behaviors in African-American adolescent daughters and their mothers. DESIGN AND SAMPLE: A convergent parallel mixed methods design with interactive quantitative and qualitative measures was used. Twenty-four 9th- and 10th-grade African-American daughters from a large urban high school and their mothers participated. MEASURES: Measures included the 2013 Youth Risk Behavior Surveillance System dietary and PA questions, 2013 Behavioral Risk Factor Surveillance System dietary and PA questions, and BMI. Focus group questions covered preferred intervention formats and strategies for delivering a dietary and PA intervention. RESULTS: Fifty-five percent of daughters and 92% of mothers were overweight/obese. Mothers tended to prefer the group format (mothers/daughters together or mothers together) for delivering a dietary and PA intervention, while the daughters' delivery preferences were mixed. Top mother/daughter dyad strategy preferences for both dietary and PA were goal setting and use of rewards/prizes. CONCLUSIONS: These findings suggest several dietary and PA obesity intervention strategies that can guide obesity prevention efforts for African-American daughters and their mothers.

Hunter-Prey Discourse: A Critical Discourse Analysis of the Online Posts of Men Who Buy Sex.

BACKGROUND: The Internet has emerged as a major expediter of the commercial sex (CS) industry. While use of web-based CS industry sites is brisk, the full extent of their impact remains unclear particularly how they influence users' views of the CS industry. OBJECTIVE: This research study sought to uncover the nuances of buyers' interactions on an online CS website. DESIGN: Six hundred sixty-six online posts from 363 unique members were collected and analyzed using critical discourse analysis. RESULTS: Via the use of language and dialogue, particular ways of thinking about and talking about buying sex are normalized and reinforced. Evident within these discursive patterns are mechanisms by which assumptions are forwarded, perceptions shaped, and authority established. CONCLUSIONS: Information about how CS industry websites establish beliefs, relationships, and practices among its users may increase understanding of how the CS industry seeks to gain acceptance in the American culture and normalize its activities.

Does race still matter in nursing? The narratives of African-American nursing faculty members.

BACKGROUND: The rise in undergraduate enrollment of African-American students has not translated into more African-American faculty members, although they could mentor minority students and promote an ethos that encourages their academic success. Discrimination against African-American faculty members continues, which could lessen their presence. PURPOSE: This study explored the narratives of 23 African-American faculty members to determine if race still matters in nursing. METHODS: A narrative approach grounded in social constructionism and critical race theory was used to illustrate the journey of African-American faculty into and throughout academia and to reveal factors related to decisions to enter and remain in academia. DISCUSSION: Most of the participants stated that they faced racial discrimination that tested their resilience and reinforced their commitment to the academy. CONCLUSION: Intentional actions and open discourse could strengthen institutional commitments to racial diversity and facilitate the recruitment and retention of racially diverse nursing faculties.

A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth.

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent-youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Rationales for Support That African American Grandmothers Provide to Their Children Who Are Parenting Adolescents.

African American grandmothers are known to be a major source of support for their children who are parenting adolescents, but little is known about why they provide support. The purpose of this study was to describe the kinds of support provided by African American maternal and paternal grandmothers to their parenting adolescents and the reasons for giving support. In all, 10 maternal and 10 paternal grandmothers were recruited from one low-income African American community to participate in this cross-sectional, qualitative, descriptive study. Grandmothers provided support due to love and concern for their adolescent parenting children and their grandchildren. Grandmothers were influenced by their own past experiences and by the adolescent's personality and behavior. School nurses and school health clinic personnel are tactically positioned within the lives of families with parenting adolescents and can help facilitate the provision of support that allows adolescent parents to successfully transition to adulthood and assume adult roles.