Medical students' perceived comfort and competence performing physical examinations on patients with obesity: A mixed-methods needs assessment.

Physicians are unsatisfied with their training in the care of patients with obesity. Physical examination is a key component of care, and modifications to techniques are often necessary for patients with obesity. To determine learning needs, we examined medical students' perceived comfort and competency in conducting physical examinations on patients with obesity. This mixed-methods study of Canadian medical students used a questionnaire and semi-structured focus groups to assess medical students' perceived comfort and competence in examining patients with obesity. Participants included 175 Canadian medical students. A minority of medical students felt comfortable (42%) or competent (14%) examining patients with obesity. Physical exam challenges included modifying exam manoeuvres, interpreting findings and communicating sensitively around weight. Lack of early exposure to patients with obesity, minimal instruction by preceptors and a lack of curricular focus on obesity were felt to be barriers to improving these skills. Students perceived their lack of confidence as negatively impacting their ability to manage patients with obesity and more training in this area was desired to prevent disparities in care. Medical students feel that adequate training on how to perform an obesity-specific physical examination is lacking. Developing curricula and including formal teaching around these key competencies within medical education is essential.

Black Appalachia's Oldest Old: Untold Stories of Experienced Racism and Coping With Religious Practices/Beliefs.

BACKGROUND AND OBJECTIVES: Racism and religion are recognized as prevailing Social Determinants of Health (SDoH). To explore ways in which racism and religion looms in the daily lives of African Americans, we analyzed the experiences of African Americans born during the Jim Crow years and living in the Southern Appalachian Region of the United States. RESEARCH DESIGN AND METHODS: Twenty-seven African Americans participated in this qualitative descriptive study that utilized criterion sampling, open-ended semistructured interviews, and content analysis to identify a typology of categories related to experienced racism and ways in which religion was used in response to those experiences. RESULTS: Participants were an average age of 82.22 years (SD = 5.07); primarily women (n = 19, 70.4%); married (n = 11, 40.7%); junior high school (n = 6, 22.2%), high school or general educational diploma (n = 7, 25.9%), completed college or professional school (n = 6, 22.2%); were retired (n = 27, 100.0%); and affiliated with Baptist churches (n = 18, 66.7%). Experiences with racism included inequities in healthcare and education, and racially motivated physical violence. Religious practices/beliefs included forgiveness, humility, and humanity. DISCUSSION AND IMPLICATIONS: Racism experienced by African American participants was likely countered by religious practices/beliefs inspired through intergenerational teachings with affiliations to the Black Church. These experiences of the oldest old ) African Americans living in communities of the Southern Appalachia, United States, illustrate the pervasive nature of racism. The religious beliefs that are frequently transmitted intergenerationally through the Black Church are relevant to understand present-day encounters with racism among African Americans and possibly other communities of color.

Assessment of maternal knowledge of infant movement and nutrition guidelines in Canada: The PREVENT survey study (Physical activity, Rest, Exercise and nutrition Values for Education of New moms with Type 2 diabetes/gestational diabetes).

Infants born to mothers with type 2 diabetes (T2D) and gestational diabetes (GDM) are at an increased risk of being overweight/obese. Modifiable lifestyle factors play a role in prevention of overweight and obesity. In 2017, the Canadian 24 h Movement Guidelines for the Early Years (CMG) were released. Alongside physical activity recommendations, sweetened beverage consumption (SBC) recommendations were also released by the American Academy of Pediatrics in 2017. The objective of this study was to determine the knowledge pregnant women with T2D and GDM have on the CMG and SBC recommendations, and to determine what factors affect this. A survey with questions regarding demographics, socioeconomic variables and the CMG and SBC recommendations was administered to pregnant women at Diabetes in Pregnancy clinics in Calgary, Alberta from July 2019 to January 2020. Surveys were analyzed utilizing the non-parametric Kruskall-Wallis Rank-Sum test, chi-square test and linear regression. A total of 79 respondents with T2D and GDM were collected. Respondents had the highest knowledge of SBC recommendations and the lowest knowledge of CMG recommendations. A bachelor's or higher degree was associated with significantly higher knowledge scores than a high-school education or less. In conclusion, pregnant women with T2D and GDM in this study had overall poor knowledge of the CMG and SBC recommendations, with less knowledge regarding the CMG. Level of education was found to be associated with knowledge regarding these recommendations. Future programs to improve education around infant and toddler physical activity and SBC recommendations may be beneficial for this patient population.

Integrating the Social Determinants of Health Into Prelicensure Nursing Pharmacology.

BACKGROUND: Nursing organizations have called for the incorporation of social determinants of health (SDOH) throughout nursing school curricula. Guidance is needed regarding best practices to integrate SDOH into pharmacology courses in prelicensure nursing programs. METHOD: Using Emory University's School of Nursing SDOH framework to guide curriculum innovation, pharmacology faculty identified three pharmacology-centric SDOH topics: race-based medicine and pharmacogenomics, pharmacy deserts, and lack of diversity in clinical trials. These three SDOH topics were incorporated into preestablished pharmacology content. RESULTS: Faculty integrated SDOH into pharmacology courses with heavy science content, and students were receptive to open discussion of SDOH topics. CONCLUSION: The integration of SDOH into a prelicensure nursing pharmacology course across multiple cohorts of students was feasible, and student feedback was positive. Faculty faced several challenges, including time constraints. Additional and ongoing training is needed to support the integration of SDOH into nursing curricula. [J Nurs Educ. 2023;62(3):175-179.].

Strategies to Integrate the Practice of Social Emergency Medicine Into Routine Patient Care.

The Research to Practice column focuses on improving the research critique skills of advanced practice providers and to assist with the translation of research into practice. In this issue, we discuss the findings of a 2-phase, mixed-methods feasibility investigation conducted by A. S. Wallace et al. (2020) that developed and evaluated a screening process to identify social needs/risks for emergency department (ED) patients and connect them to community-based resources upon discharge. The results revealed that patients with identified social needs and referred to community resources tended to utilize the ED more than those without needs. This suggests the need for EDs to implement a standardized screening tool for social determinants of health (SDOH) on all ED patients for improved patient outcomes. Findings also highlighted a need for EDs to provide staff training and competence in the areas of patient communication and SDOH.

The impact of COVID-19 among Black women: evaluating perspectives and sources of information.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has burgeoned into a pandemic that highlights the countless social and health disparities that have existed in Black communities within the United States for centuries. Recent epidemiological data show that Black communities are being disproportionately impacted by COVID-19, resulting in higher morbidity and mortality rates compared to other racial and ethnic groups. For Black women in particular, a long-standing history of systemic racism and marginalization has resulted in increased vulnerability and susceptibility to certain adverse health outcomes. Recent data show that COVID-19 knowledge rates among Black participants are low, and that Black women who become infected with COVID-19 have higher risks of complications and mortality compared to their non-Black counterparts. Given this data, there is a need to explore where and how Black women are obtaining information that pertains to COVID-19, along with the impacts that COVID-19 may be having on their daily lives. DESIGN: We conducted interviews with 15 Black women who are clients at a community-based family service center to assess their understanding of COVID-19, determine how they were obtaining COVID-19 information, and evaluate the various impacts that COVID-19 was having on their lives. An initial codebook was developed based on the recorded interviews which included deductive and inductive codes. A thematic analysis of the data was then conducted using MaxQDA (Verbi Software), focusing on Black women's experiences related to COVID-19. RESULTS: The majority of participants were using a combination of social media platforms and news sources to obtain information about COVID-19. Most participants (79%) expressed confusion, misunderstanding, and mistrust of the information that they were receiving about COVID-19. CONCLUSION: In addressing COVID-19-related health disparities within Black communities, it is imperative for trusted entities and organizations within Black communities to provide accurate and tailored information regarding this novel virus.

Greater Nutritional Risk Scores in 2-Year-Old Children Exposed to Gestational Diabetes Mellitus In Utero and Their Relationship to Homeostasis Model Assessment for Insulin Resistance at Age 5 Years.

OBJECTIVES: Exposure to gestational diabetes mellitus (GDM) in utero may impact nutritional intake and lifestyle habits in early childhood. However, it is unclear whether nutritional status predicts greater risk for metabolic disturbances, such as insulin resistance (IR). The primary objectives were: 1) to determine parent-reported nutritional risk scores in 2-year-old children born to women with and without GDM and 2) to assess whether these scores predict IR in 5-year-old children. METHODS: Children exposed (n=34) and unexposed (n=46) to GDM were screened at 2 years of age using the Toddler version of the Nutrition Screening Tool for Every Preschooler (NutriSTEP). At a 5-year follow up, IR was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). RESULTS: Total NutriSTEP scores ranged from 6 to 33, with higher scores indicating greater risk. After controlling for infant birthweight, sex of the child, child ethnicity, maternal age at time of pregnancy, breastfeeding status and maternal prepregnancy body mass index, average NutriSTEP scores were higher in children exposed to GDM compared with those unexposed (13.8±1.1 vs 11.2±1.1, p=0.03). NutriSTEP scores at 2 years emerged as a positive independent predictor of HOMA-IR at 5 years. For each unit increase in NutriSTEP score, suggesting greater nutritional risk, we saw a 0.48 (95% confidence interval, 0.17 to 0.80; p=0.003) increase in score on the HOMA-IR. CONCLUSIONS: Parent-reported nutritional risk is greater in GDM-exposed children, and these nutritional behaviours developed during the first years of life may predispose to metabolic disturbance in early childhood.

Evaluation of anthropometric measures for assessment of cardiometabolic risk in early childhood.

OBJECTIVE: Waist-to-height ratio has been shown to be an important indicator of cardiometabolic risk. There are few studies evaluating this measure against existing measures of adiposity and cardiometabolic markers in early childhood. The objectives were: (i) to determine in young children the ability of waist-to-height ratio, BMI z-score, weight for length, and sum of skin fold thickness to predict cardiometabolic risk and (ii) to examine this association at ages 1, 3 and 5 years. DESIGN: Prospective cohort study. SETTING: A university hospital in Toronto, Ontario. PARTICIPANTS: Infants at 1 (n 406), 3 (n 112) and 5 years of age (n 94) born to mothers with and without gestational diabetes mellitus. RESULTS: Weight for length and BMI z-score demonstrated the strongest correlations with biochemical measures compared to waist-to-height ratio, including leptin (at 5 years, weight for length z-score: ρ = 0·65, P < 0·001; BMI z-score: ρ = 0·67, P < 0·001) and measures of insulin resistance (at 3 years, weight for length z-score: ρ = 0·25, P = 0·02; BMI z-score: ρ = 0·24, P = 0·02). The magnitude of associations between anthropometric measures and biochemical measures strengthened over time. Weight for length and BMI z-scores were moderately correlated with overall measures of fat mass as measured by dual-energy X-ray absorptiometry (ρ = 0·65, P = 0·00; ρ = 0·61, P = 0·01). CONCLUSIONS: Waist-to-height ratio was not superior to existing measures in predicting cardiometabolic risk in young children. BMI z-score is a preferred measure of adiposity between birth and 5 years of age.

Resting Energy Expenditure and Metabolic Adaptation in Adolescents at 12 Months After Bariatric Surgery.

BACKGROUND: Evidence suggests that metabolic adaptation occurs after bariatric surgery such that resting energy expenditure (REE) declines more than accounted for by body weight or body composition changes in adults. Little is known about REE and metabolic adaptation among adolescents after bariatric surgery. OBJECTIVE: To examine changes in REE and metabolic adaptation among adolescents at 12 months (12M) after bariatric surgery. SETTING: Pediatric hospital, Canada. METHODS: Adolescents undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were followed. Bioelectrical impedance analysis and indirect calorimetry were completed to measure body composition and REE, respectively. Predicted REE was calculated using the Mifflin equation before and after bariatric surgery and a predictive equation using preoperative data. RESULTS: Among 20 patients (15 girls), the mean age and body mass index at surgery were 17.2 ± 0.8 years and 48.7 ± 7.4 kg/m2, respectively. REE had decreased by 548.3 kcal/d at 12M postoperatively (P < 0.001). Metabolic adaptation, determined by two procedures, was negative and significantly different from baseline (P < 0.05). When stratified by surgery type, REE change at 12M was not significantly different (RYGB, -494.0 ± 260.9 kcal/d, n = 11; SG, -614.6 ± 344.4 kcal/d, n = 9; P = 0.384). Among 13 patients with REE data at 6 and 12M, no statistically significant difference was found (P = 0.368). CONCLUSIONS: Predicted and measured REE was 19% and 25% lower at 12M, respectively, irrespective of bariatric surgery type. Metabolic adaptation might predispose adolescents to weight regain after bariatric surgery and warrants careful nutritional management and counseling.

HPV vaccine acceptance among African-American mothers and their daughters: an inquiry grounded in culture.

BACKGROUND: Much of the research on African-Americans' HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture. OBJECTIVE: To explore the influence of culture on African-American mothers' and daughters' HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework. METHODS: Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n = 28) and their daughters (n = 34). RESULTS: Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance. CONCLUSION: Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.

User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study.

BACKGROUND: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. OBJECTIVE: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. METHODS: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. RESULTS: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents' views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. CONCLUSIONS: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.

Determining the accuracy of predictive energy expenditure (PREE) equations in severely obese adolescents.

BACKGROUND & AIMS: Severe obesity in children and adolescents is now a serious global health concern. Accurate measurements of resting energy expenditure (REE) is a key foundation for successful obesity treatment. Clinical dietitians rely heavily on measured or calculated REE to tailor dietary interventions. Indirect calorimetry (IC) is the gold standard for measuring REE. However, predictive resting energy expenditure (PREE) equations are commonly used when IC is unavailable due to cost or practicality. PREE equations differ based on variables such as age, gender, weight, and height and selecting the most accurate PREE for an individual is crucial to avoid over or underestimation of energy requirements. Published studies investigating the accuracy of PREE equations in obese children and adolescents have reported inconsistent findings, which likely result from heterogeneity in the patient populations studied. Accordingly, this study aimed to (a) assess the accuracy of the published PREE equations in a group of severely obese (SO) adolescents using IC measurement, and (b) determine if there is a BMI threshold at which the PREE equations become less accurate. METHODS: SO adolescents were studied using IC. REE was calculated using nine commonly used PREE equations. Generalized linear regression equations were used to compare absolute and relative differences between calculated and measured REE (MREE) for each PREE equation. Accuracy was calculated as the percentage of subjects with PREE values within 10 percent of MREE. RESULTS: 226 SO adolescents (mean ± SD age: 15.9 ± 1.9 years; weight: 126.9 ± 24.5 kg; BMI: 44.9 ± 8.1 kg/m2) participated. Mean MREE was 2163 ± 443 kcal/d. PREE calculated by the Mifflin equation was the only equation without a statistically significant bias compared to MREE (mean bias of -23 ± 307 kcal/d; p = 0.26). Mifflin was also the most accurate with 61% of individuals within ±10% of MREE. PREE equations accuracy was not associated with degree of BMI elevation (31-69 kg/m2). CONCLUSIONS: In adolescents with severe obesity, the Mifflin equation best predicts REE. This should be the equation applied when using PREE to optimize nutritional care in this population.

Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review.

BACKGROUND: African-Americans and Latinos suffer the highest cervical cancer burden compared to other populations and have sub-optimal HPV vaccination rates. OBJECTIVE: To condense research findings of studies conducted with African-Americans and Latinos on factors associated with HPV vaccine acceptability and uptake. METHODS: Standards for conducting an integrative review were used. PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases were searched. RESULTS: Awareness about HPV and the HPV vaccine varied by demographics of parents. For Latino parents, acculturation and awareness were associated. However, findings were mixed regarding the association between acculturation and knowledge. Among African-Americans, higher socioeconomic status (SES) and awareness were associated. Sexuality-related concerns, concerns about safety and low perceived risk of daughter's acquiring HPV emerged as barriers to vaccination among Latinos and African-Americans. Among Latinos, vaccine acceptability was associated with the vaccine's cancer prevention benefits and a provider's recommendation. Among African-Americans, acceptability was associated with awareness, perceived risk of acquiring HPV, religion, and a provider's recommendation. Few interventions have been developed to increase HPV vaccine acceptance. Importantly, few studies assessed the influence of culture on vaccine acceptance and uptake. CONCLUSIONS: Future research should be informed by culture-centered theories as this is the first step to inform the development of culturally-grounded interventions.

Patients Provide Recommendations for Improving Patient Satisfaction.

National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction.

Strategies African-American Cancer Survivors Use to Overcome Fears and Fatalistic Attitudes.

This qualitative study explored strategies African-American cancer survivors use to overcome their fears and fatalistic attitudes toward cancer at the point of diagnosis through completion of treatment. Thirty-one African-American cancer survivors who had completed or nearly completed treatment were recruited through criterion purposeful sampling. In-depth, open-ended interviews were used to collect data. The data were analyzed using thematic analysis. Of the 31 survivors interviewed, 26 reported being fearful of cancer and believed that cancer would result in death. These cancer survivors were particularly fearful of having a cancer had spread, of being isolated, and performing less effectively at work. Strategies used to overcome these fears included increasing their own awareness about cancer, using positive self-talk, and avoiding negative people. The findings suggest that past experiences continue to influence fears and fatalistic perspectives about cancer and that educational resources to inform the public about cancer may be ignored until there is a confirmed diagnosis of cancer. Televised news broadcasts of high-profile personalities who had died from cancer were also anxiety provoking, particularly if the cancer survivor died of a recurrence from cancer. Prevalent sources of information and support for these survivors were family members or close friends they trusted with personal information, perceived as strong, or experienced in the care of other cancer survivors.

The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

INTRODUCTION: The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. METHODS: In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). RESULTS: A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. DISCUSSION: In a health equity system of care such as the military health care system, active duty soldiers and their family members did not experience disparities in access to care or in important health outcomes of patient satisfaction, physical health status, or mental health status.

Vitamin D status and cardiometabolic assessment in infancy.

BACKGROUND: Infants are at risk of vitamin D insufficiency, owing to their limited exposure to direct sunlight and the low levels of vitamin D in breast milk. Although vitamin D insufficiency has been associated with cardiometabolic risk factors in children, these associations have not been studied in infants, despite their unique risks. Therefore, we sought to determine whether vitamin D status was associated with cardiometabolic measures in infants. METHODS: Ninety-nine full-term infants were evaluated at the age of 1 y with measurement of 25-hydroxy vitamin D (25-OH-D) and an array of traditional (fasting glucose, insulin, low-density-lipoprotein cholesterol, high-density-lipoprotein cholesterol, triglycerides) and emerging (C-reactive protein, adiponectin, leptin) cardiometabolic risk factors. On the basis of 25-OH-D levels, infants were classified as vitamin D sufficient (n = 59), vitamin D insufficient (n = 29), or vitamin D deficient (n = 11). RESULTS: Duration of exclusive breastfeeding and prevalence of nonwhite ethnicity were highest in the vitamin D-deficient group (P = 0.05 and 0.03, respectively). Current use of vitamin D supplementation was highest in the sufficient group (P = 0.02). Of note, however, there were no significant differences among the three groups in any of the cardiometabolic risk factors, on both unadjusted and covariate-adjusted analyses. CONCLUSION: Vitamin D insufficiency/deficiency is not associated with an adverse cardiometabolic risk factor profile in 1-y-old infants.

Women's experiences in a community-based participatory research randomized controlled trial.

Integrating community-based participatory research (CBPR) into traditional study designs can enhance outcomes in studies with disadvantaged groups. Little is known, however, about study participants' experiences with these approaches, the underlying processes involved in creating more positive outcomes, and whether undesirable effects on study outcomes occur simultaneously. We conducted focus group interviews with 31 disadvantaged women who participated in a CBPR-driven randomized controlled trial (RCT) both to explore their study experiences and to obtain their interpretations of select study findings. Using dimensional analysis, we found the tailored health questionnaire, treatment by study staff members, and RCT participants' understandings of and responses to randomization were salient to what women described as transformative experiences that occurred over the course of the RCT. These findings have implications for understanding how CBPR and non-CBPR aspects of interventions and study designs have the potential to affect both process and endpoint study outcomes.