Perspectives and corrective processes: Evaluating social justice in a nursing PhD program.

Efforts to integrate tenets of social justice into PhD nursing programs are long-standing but have intensified in the past few years in response to civil unrest, threats to human rights, and health inequities exacerbated during the COVID-19 pandemic. In this paper, we present an overview of our School of Nursing's efforts and processes to evaluate and ensure that social justice principles were reflected throughout the PhD program. Components of this initiative included (a) forming a Social Justice Taskforce, (b) conducting listening sessions with alumni and currently enrolled PhD students to understand student experiences, (c) surveying PhD students to aid in prioritization of recommendations for improvement, and (d) convening key stakeholders to connect student priority areas to institutional programs and practices. Lessons learned through these activities highlighted the importance of gaining the perspective of diverse constituents and stakeholders, acknowledging areas for improvement, engaging students in transformative action, and partnering with faculty, staff, and leaders in solution development as we work to eliminate systemic injustices in PhD nursing education.

School readiness and social determinants of health: A collaboration with community teachers and parents.

PURPOSE: To explore perceptions of community dwelling caregivers of preschool-aged children regarding the influence of social determinants of health (SDOH) on children's school readiness. Parents' perspectives regarding solutions to enhance school readiness in preschool-aged children are also explored. METHODS: This study employed a qualitative, descriptive design and a community based participatory research (CBPR) approach. An academic institution collaborated with parents, teachers, and administrators at a community-based preschool learning center. Ten young-adult to middle-aged mothers and caregivers attended two separate focus groups and completed open-ended questionnaires. Inductive and deductive thematic analysis of text were employed. FINDINGS: Three themes emerged 1) Families described the vast lack of appropriate community resources and inability to access those resources that are available to prepare their children for school 2). Family members need help processing information about social resources 3) Community, individual and systemic level solutions to enhance school readiness. CONCLUSIONS: Academic-Community partnerships provide an opportunity to (1) identify solutions to remove systemic barriers that impede children's readiness for school, and (2) design interventions to support families through that process. Interventions to enhance school readiness should be family-focused and can be informed by understanding the influence of SDOH during the planning stages. SDOH create barriers and prevent parents from prioritizing their children's school, health-care, and developmental needs. PRACTICE IMPLICATIONS: Interventions to enhance school readiness should be family-based and can be informed by understanding the influence of SDOH during the planning stages. Social advocacy is also needed to enhance the ability of parents to enhance their children's school readiness.

Perspectives of Pediatric Community Health Workers: Roles, Successes, and Challenges.

This multicenter qualitative study described the roles of 10 pediatric community health workers (CHWs) in their own words through exploration of the role features, successes, and challenges in pediatric health care settings across three urban U.S. cities (Philadelphia, New York City, and Cincinnati). Individual, semi-structured telephone interviews were conducted. Interviews described prominent features of the pediatric CHW role, which included taking a family-centered approach to goal setting and determining support needed, ensuring family goals stayed at the center of the work, and acting as a trusted figure for families to talk openly with. CHWs described their role as rewarding, believing in the work, and feeling a sense of fulfillment, and felt successful when families had positive outcomes, including when barriers were eliminated, resources were obtained, or independence was demonstrated by families. Challenges CHWs faced in their roles included establishing trust with families, managing the ever-changing family circumstances many families experience due to socioeconomic barriers, and managing limitations of protocol and restrictions within their roles. This study demonstrated numerous considerations for CHW practice in pediatric health care settings, in addition to considerations for pediatric-specific CHW program development and management. The primary policy implication of this study included a basis for increased funding for CHW programs in pediatric health care settings. This study also demonstrated a need for further research on the change CHWs effect within child and family systems outside of health care, such as schools and child welfare agencies.

Experiences of Adult Men Who Are Homeless Accessing Care: A Qualitative Study.

INTRODUCTION: Homeless individuals experience increased rates of chronic physical and mental health conditions. They also experience difficulty accessing care and poor health outcomes compounded by social and economic factors, such as housing insecurity, unemployment, and limited social support. The purpose of this study was to describe the perceptions of homeless individuals related to their health and experiences accessing care. METHOD: Qualitative descriptive methods and content analysis were used to gather, analyze, and interpret the data and identify themes. RESULTS: Three themes were identified: men who are homeless experience bias throughout their health care and interpersonal relationships, the best care is person-centered and considers patients' priorities, and care coordination resources are inadequate. DISCUSSION: The housing needs of homeless individuals are best contextualized by their health and social needs. In addition, their priorities must be taken into consideration to develop culturally congruent services that are appropriate and effective care for this population.

A Text Messaging Intervention With Financial Incentive for Adolescents With Type 1 Diabetes.

BACKGROUND: Adolescents with type 1 diabetes (T1D) have higher hemoglobin A1C (HbA1c) levels than others. In general, adolescents engage with text messaging (TM) and financial incentives, both associated with improved diabetes outcomes. This study aimed to assess the impact of a TM intervention with financial incentives on self-care behaviors and HbA1c. METHODS: A six-month randomized controlled trial compared MyDiaText™, a TM education and support application, with standard care. The sample included 166 teens with T1D, 12-18 years old, attending a diabetes clinic. The intervention group received one daily TM and were instructed to respond. Participants who responded to TMs for the most consecutive days were eligible for a financial reward biweekly via lottery. All participants received prompts to complete the self-care inventory (SCI) at baseline, 90, and 180 days. HbA1c was collected at clinic visits. Changes in SCI and HbA1c were analyzed using a multilevel mixed-effects linear regression model. Intention-to-treat and per-protocol analyses were performed. RESULTS: The median TM response rate was 59% (interquartile range 40.1%-85.2%) and decreased over time. After adjustment for baseline characteristics, in per-protocol analysis, there was a statistically significant difference in SCI score increase in those receiving one TM per day vs control (P = .035). HbA1c decreased overall, without significant difference between groups (P = .786). CONCLUSIONS: A TM intervention with financial incentives for adolescents with T1D in suboptimal control was associated with increasing self-care report; however, glycemic control did not differ from controls. Further research is needed to develop digital health interventions that will impact glycemic control.

Racial disparities in treatment and outcomes of children with type 1 diabetes.

OBJECTIVE: The aim of this study was to assess racial disparities in treatments and outcomes between Non-Hispanic black (NHB), Hispanic and Non-Hispanic white (NHW) children with type 1 diabetes (T1D). METHODS: We reviewed electronic health records of children (<18 years) attending a large, pediatric tertiary care diabetes center in the United States between October 1, 2018, and December 31, 2019. Health care utilization (appointment attendance, ED visits, hospitalizations), technology use (insulin pumps, continuous glucose monitors [CGM]) and hemoglobin A1c (HbA1c) were examined for each race/ethnicity and stratified by insurance type (private/government) as a proxy for socioeconomic status (SES). RESULTS: Of 1331 children (47% female) with a median (IQR) age of 14.2 (11.5, 16.3) years and T1D duration of 5.8 (3.8, 9) years; 1026 (77%) were NHW, 198 (15%) NHB, and 107 (8%) Hispanic. Government insurance was used by 358 (27%) children, representing 60% of NHB and 53% of Hispanic, but only 18% of NHW children. NHB children had higher HbA1c, more ED visits and hospitalizations, and were less likely to be treated with insulin pumps or CGM than NHW children (P < .001 for all). There were no racial disparities with regard to the number of appointments attended. CONCLUSIONS: Racial disparities in technology use and diabetes outcomes persist in children with T1D, regardless of insurance status. To ensure equitable care, pediatric healthcare providers should remain cognizant of racial disparities in diabetes treatment. The impact of provider and patient factors should be explored when studying the etiology of these health disparities.

Contributors to Depressed Mood in Black Single Mothers.

Participants: A convenience sample of 210 community dwelling Black single mothers ages 18 to 45, who reside in U.S. urban communities.Methods: A descriptive, cross-sectional design was employed. Participants responded to an open-ended question that asked about reasons for depressed mood. A directed approach to content analysis was used to categorize the responses based on existing theoretical formulations and empirical findings about the causes of depression in women. Percentages and frequencies were used to describe the results of the analysis.Findings: A total of 319 usable responses were provided. Collectively and individually the most frequent responses were consistent with Social/Environmental factors such as lack of financial resources (n = 115; 36.05%), followed by Psychological factors such as general cognitive/emotional feelings of stress (n = 60; 18.81%), and parenting stressors or daily hassles (n = 40; 12.54%). Physiologic factors such as a having physiologic or medical conditions were reported less often (n = 14; 4.39%).Conclusions/Implications: Social/Environmental and Psychological factors contribute to depressed mood more often than Physiological factors in Black single mothers. Depression prevention efforts should target the social determinants of mental health in Black single mothers who should be connected with appropriate financial, psychological, educational and social service resources in the community.

Using a Community Workgroup Approach to Increase Access to Physical Activity in an Underresourced Urban Community.

Background. Regular physical activity is associated with improved physical and psychosocial well-being. Increasing access to physical activity in underresourced communities requires collaborative, community-engaged methods. One such method is community workgroups. Purpose. The purpose of this article is to describe implementation, strengths, challenges, and results of the workgroup approach as applied to increasing access to physical activity, using our recent study as an illustrative example. Method. A 1-day conference was held in April 2017 for community leaders. The first half of the conference focused on disseminating results of a multifaceted community assessment. The second half entailed community workgroups. Workgroups focused on applying community assessment results to develop strategies for increasing access to physical activity, with plans for ongoing workgroup involvement for strategy refinement and implementation. A professional artist documented the workgroup process and recommendations via graphic recording. Results. Sixty-three community leaders attended the conference and participated in the workgroups. Workgroup participants reported that greater macrosystem collaboration was critical for sustainability of physical activity programming and that, particularly in underresourced urban communities, re-imagining existing spaces (rather than building new spaces) may be a promising strategy for increasing access to physical activity. Discussion. Considered collectively, the community workgroup approach provided unique insight and rich data around increasing access to physical activity. It also facilitated stakeholder engagement with and ownership of community health goals. With careful implementation that includes attention to strengths, challenges, and planning for long-term follow-up, the community workgroup approach can be used to develop health promotion strategies in underresourced communities.

Addressing Social Determinants of Health Through Community Engagement: An Undergraduate Nursing Course.

BACKGROUND: Community engagement is a promising method for teaching about social determinants of health (SDOH) through experiential learning. The purpose of this article is to report the implementation and evaluation of a baccalaureate nursing degree course focused on addressing social determinants of health through community engagement. METHOD: The class was structured as a flipped classroom, during which students spent the majority of the time engaged with a community site. Students were required to attend two in-class seminars. Course evaluations were used to provide feedback to refine course delivery and assess course impact. RESULTS: Thirty-six students enrolled in the course over two semesters. Knowledge and self-reported competencies in addressing SDOH in under-resourced populations increased. Course evaluations demonstrated an increase in students' knowledge and clinical skills related to SDOH. CONCLUSION: A course focused on addressing SDOH through community engagement provided a promising approach for preparing nursing students to provide care to underresourced populations. [J Nurs Educ. 2019;58(7):423-426.].

Reconciling opposing perceptions of access to physical activity in a gentrifying urban neighborhood.

OBJECTIVE: We sought to understand perspectives on access to physical activity in a gentrifying neighborhood. DESIGN: This qualitative descriptive study used street intercept interviews and photo documentation. SAMPLE: Participants included members (n = 19) of a gentrifying neighborhood in a northeastern city. RESULTS: Participants held markedly different perceptions of opportunities for physical activity. Some participants, particularly area university students or those who are identified as White, perceived the neighborhood as favorable to physical activity, with high walkability and abundant resources. Other participants, particularly those who identified as Black or African-American, felt it was difficult to be physically active because neighborhood recreation facilities are scarce or unaffordable and parks are poorly maintained or unsafe. Multiple participants noted strategies to overcome neighborhood barriers to physical activity. Regardless of neighborhood perceptions, family and friends played an important role in influencing physical activity. CONCLUSIONS: Nurses must consider how disparities in actual and perceived access to neighborhood resources influence participation in physical activity, particularly in gentrifying neighborhood. Public health nurses are embedded in the neighborhoods that they serve, providing a unique opportunity to understand and address the impact of neighborhood on health.

Engaging With the Community to Promote Physical Activity in Urban Neighborhoods.

PURPOSE: To describe perceptions of physical activity, opinions, on intergenerational approaches to physical activity and a vision for increasing physical activity in an underresourced urban community. APPROACH: Focus groups embedded in a large Community-Based Participatory Research Project. SETTING: West and Southwest Philadelphia. PARTICIPANTS: 15 parents, 16 youth, and 14 athletic coaches; youth were 13 to 18 years old and attended West Philadelphia schools; parents' children attended West Philadelphia schools; and coaches worked in West Philadelphia schools. METHODS: Six focus groups (2 youth, 2 parent, and 2 coach) were conducted guided by the Socio-Ecological Model; transcriptions were analyzed using a rigorous process of directed content analysis. RESULTS: Factors on all levels of the Socio-Ecological Model influence the perception of and engagement in physical activity for youth and their families. Future strategies to increase engagement in physical activity need to be collaborative and multifaceted. CONCLUSION: When physical activity is reframed as a broad goal that is normative and gender-neutral, a potential exists to engage youth and their families over their lifetimes; with attention to cross-sector collaboration and resource sharing, engaging and sustainable intergenerational physical activity interventions can be developed to promote health in underresourced urban communities.

University⁻Community Partnerships Using a Participatory Action Research Model to Evaluate the Impact of Dance for Health.

Little is known about fostering sustainable, collaborative community-academic partnerships that effectively improve physical activity and health in residents of under resourced communities using Participatory Action Research (PAR) driven models. The purpose of this PAR study was to evaluate the impact of an urban, intergenerational, and physical activity dance program by identifying community preferred measurable outcomes that promote program participation and sustainability. A descriptive, qualitative design was employed using semi-structured interview guides to facilitate discussions for two adult focus groups and one youth focus group. Exactly 19 community-residing adults and six youth who lived in urban neighborhoods in West Philadelphia participated in the discussions. The audiotapes were transcribed and analyzed using directed content analysis. Five outcome themes emerged and included: (1). Enhancing the psychological and emotional well-being of the individual, (2). Enhancement of social well-being and management of interpersonal relationships and responsibilities (3). Enhancing and promoting physiologic well-being (4). Changes in health promoting behaviors and skill acquisition, and (5). Concerns about accessibility of dance for health and other physical activity programs in the community. Focused attention to measuring community preferred outcomes can promote sustainability of Dance for Health and possibly other urban-based physical activity dance programs.

Dance for Health: An Intergenerational Program to Increase Access to Physical Activity.

PURPOSE: The purpose of this study was to evaluate Dance for Health, an intergenerational program to increase access to physical activity in an underserved, high risk urban community. DESIGN AND METHODS: Dance for Health was developed using community-based participatory research methods and evaluated using an observational study design. The program entailed two hour line dancing sessions delivered by trained dance instructors in the neighborhood recreation center. The weekly sessions were delivered for one month in the spring and one month in the fall from 2012-2016. Nurse practitioner students mentored local high school students to assess outcomes: achievement of target heart rate, Borg Rating of Perceived Exertion, number of pedometer steps during dance session, Physical Activity Enjoyment Scale, and adiposity. Analytic methods included descriptive statistics and mixed effects models. RESULTS: From 2012-2016, 521 participants ranging from 2-79 years attended Dance for Health. Approximately 50% of children and 80% of adults achieved target heart rate. Achievement of target heart rate was not related to perceived exertion, though it was related to pedometer steps in adults. All participants rated the program highly for enjoyment. There was no change in adiposity. CONCLUSIONS: Dance for Health demonstrated high levels of community engagement and enjoyment. It led to adequate levels of exertion, particularly for adults. Our evaluation can inform program refinement and future intergenerational physical activity programs. PRACTICE IMPLICATIONS: Dance is an enjoyable, culturally appropriate, low cost method for increasing access to physical activity for children and families.

Children with Short Stature and Growth Failure: Heightism, Gender and Racial Disparities.

Growth is the single most important indication of the health of a child. Identification of growth disorders in all children is crucial as growth failure can be the first sign of a number of acute and chronic conditions. However, gender and racial biases have resulted in inequities in the identification, referral and treatment of children with growth disorders. In addition, short children have been impacted by a number of psychosocial issues. Heightism is prejudice or discrimination against individuals based on height, and refers to discrimination against individuals whose height is not within the normal acceptable range. Studies have shown that short children have been affected by juvenilization, teasing, bullying, victimization, loss of independence/ overprotection, and exclusion. The role of the advanced practice nurse is critical in addressing heightism and racial and gender disparities in children with growth failure/short stature.

Racial and Ethnic Disparities in the Incidence, Treatment, and Outcomes of Youth with Type 1 Diabetes.

Type 1 diabetes mellitus (T1DM) is the third most common chronic childhood disease in the United States. As more Hispanic and non-Hispanic black children are diagnosed with T1DM, racial and ethnic disparities in the treatment and outcomes of T1DM are increasing. This article reviews the increasing incidence and prevalence of T1DM in non-Hispanic white, non-Hispanic black, and Hispanic children. In addition, the racial and ethnic disparities in diabetes treatment, such as blood glucose monitoring, insulin therapy, and continuous glucose monitoring, and outcomes, including glycemic control, diabetic ketoacidosis, severe hypoglycemia, retinopathy, nephropathy, neuropathy, and diabetes-related mortality, are highlighted.

Electronic Health Record Mid-Parental Height Auto-Calculator for Growth Assessment in Primary Care.

Primary care providers are charged with distinguishing children with an underlying growth problem from those with healthy variant short stature. Knowing the heights of the biological parents aids in making that decision. This study sought to determine the feasibility and functionality of an electronic mid-parental height (MPH) auto-calculator in the clinical assessment of child growth in a pediatric primary care setting. Clinicians completed surveys for 62% of 6803 children (mean height 13 ± 7 percentile) with recorded parent heights. Collecting parent height data required <30 seconds in 91% of encounters. The MPH tool confirmed clinicians' initial growth assessment in 79% of cases and changed it in 4%; the remainder did not use the tool. Clinicians who changed assessment were more likely (P < .0001) to pursue more comprehensive evaluation. The MPH tool was a quick, functional resource as a component of an electronic health record system in actual, busy, pediatric primary care practices.

Parental Concerns Influencing Decisions to Seek Medical Care for a Child's Short Stature.

AIMS: To examine parental concerns about child growth and factors that drive parents' decisions whether to intervene medically with their child's height. METHODS: Parents of 9- to 14-year-old pediatric primary care patients of various heights, oversampled for those with short stature, participated in exploratory focus groups and nominal group technique sessions. Growth concerns expressed by the groups were incorporated into a survey, completed by 1,820 parents, and rated for their degree of impact on medical decision-making. Ordinal logistic regression modeled concern scores against parent traits. Explanatory focus groups clarified the survey results. RESULTS: Research team consensus and factor analysis organized the 22 distinct concerns expressed by the parent groups into 7 categories. Categories rated as having the greatest influence on parental decision-making involved: treatment efficacy and side effects, child health and psychosocial function. Level of concern was highly associated with parental education and parenting style. CONCLUSION: Psychosocial issues are influential, but parental decision-making is most impacted by concerns about treatment and child health. By discussing the real risks and benefits of hormone treatment and addressing parents' perceptions of what is needed for physical and psychosocial health, clinicians can be highly effective educators to assure that treatment is used only as medically indicated.

Internet informs parents about growth hormone.

BACKGROUND: Parents' knowledge influences decisions regarding medical care for their children. METHODS: Parents of pediatric primary care patients aged 9-14 years, irrespective of height, participated in open focus groups (OFGs). Moderators asked the question, 'How do people find out about growth hormone (GH)?' Because many parents cited the Internet, the top 10 results from the Google searches of 'growth hormone children' and 'parents of children who take growth hormone' were examined. Three investigators independently performed content analysis and then reached a consensus. The results were tabulated via summary statistics. RESULTS: Eighteen websites were reviewed, most with the purpose of education (56%) and many funded by commercial sources (44%). GH treatment information varied, with 33% of the sites containing content only about US FDA-approved indications. Fifty-six percent of the sites included information about psychosocial benefits from treatment, with 44% acknowledging them as controversial. Although important to OFG participants, risks and costs were each omitted from 39% of the websites. CONCLUSION: Parents often turn to the Internet for GH-related information for their children, although its content may be incomplete and/or biased. Clinicians may want to provide parents with tools for critically evaluating Internet-based information, a list of prereviewed websites, or their own educational materials.