Prevalence of different variations of non-consented care during the childbirth process in Mexico by geographical regions: comparing ENDIREH survey data from 2016 to 2021.

INTRODUCTION: Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. METHODS: We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexico's cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. RESULTS: The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. CONCLUSION: While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem.

Role of affective reactivity induced by cigarette packaging including graphic warning labels: the CASA Study.

OBJECTIVE: To identify whether three types of cigarette pack designs, including three versions of graphic warning label (GWL) plain packs, one GWL absent and branding absent pack (blank) and the smoker's own GWL absent and branding present pack (US), elicit different valence, type and levels of affect. DESIGN: US daily smokers (n=324) were asked to handle each of the five pack types and 'think aloud' their reactions. To avoid a muted familiarity response, exposure to their own US pack followed exposure to at least one GWL plain pack. Reactions were scored on a reactivity scale (-3 to +3) and the text was coded for speech polarity (-1 to +1) and emotive word frequency. RESULTS: Reactivity scores had excellent inter-rater reliability (agreement ≥86%; intraclass correlation coefficient ≥0.89) and were correlated with speech polarity (r=0.21-0.37, p<0.001). When considering their US pack, approximately two-thirds of smokers had a low (31.5%) to medium (34.6%) positive response (reactivity=1.29; polarity=0.14) with expressed feelings of joy and trust. Blank packaging prompted a largely (65.4%) neutral response (reactivity=0.03; polarity=0.00). The gangrenous foot GWL provoked mostly medium (46.9%) to high (48.1%) negative responses (reactivity=-2.44; polarity=-0.20), followed by neonatal baby (reactivity=-1.85; polarity=-0.10) and throat cancer (reactivity=-1.76; polarity=-0.08) warnings. GWLs varied in their elicitation of disgust, anger, fear and sadness. CONCLUSION: Initial reactions to GWL packs, a blank pack, and smokers' current US pack reflected negative, neutral, and positive affect, respectively. Different versions of the GWL pack elicited different levels and types of immediate negative affect.

Communication in the neonatal ICU for Spanish speaking parents: a qualitative interview study.

BACKGROUND: In the neonatal intensive care unit (NICU), health outcome disparities exist between patients with limited English proficiency (LEP) and those proficient in English. Our objective was to investigate the communication experience of parents with LEP in the NICU to learn how to mitigate such health disparities. METHODS: A certified bilingual provider conducted seventeen interviews of parents who identified Spanish as their preferred language and whose newborn was admitted to the NICU for ≥ 1 week. Interviews were conducted August 2020 - December 2021. Conventional content analysis utilizing an inductive open coding process was performed. RESULTS: The experiences of Spanish speaking parents with LEP in the NICU can be characterized by 3 main themes: 1) Information accessibility 2) Perspectives about interpreters and 3) Emotional consequences. CONCLUSIONS: Our findings can inform neonatal quality initiatives to facilitate timely and good communication for NICU families with LEP.

A remotely delivered, peer-led intervention to improve physical activity and quality of life in younger breast cancer survivors.

Younger breast cancer survivors (YBCS) consistently report poorer quality of life (QOL) than older survivors. Increasing physical activity (PA) may improve QOL, but this has been understudied in YBCS. This single arm pilot study evaluated the feasibility and acceptability of a 3-month, peer-delivered, remote intervention to increase PA and improve QOL in YBCS. Data were collected from October 2019 - July 2020. Participants (n = 34, 43.1 ± 5.5 years old, 46 ± 34.4 months post-diagnosis, BMI = 30.2 ± 7.4 kg/m2) completed six video sessions with a trained peer mentor; self-monitored PA with a Fitbit activity tracker; and interacted with a private Fitbit Community for social support. At baseline, 3-and 6-months, participants completed QOL questionnaires and PA was measured through accelerometer (moderate-to-vigorous PA [MVPA]) and self-report (strength and flexibility). A parallel mixed-methods approach (qualitative interviews and quantitative satisfaction survey at 3-months) explored intervention feasibility and acceptability. One-way repeated-measures ANOVAs examined impacts on PA and QOL at 3-and 6-months. The intervention was feasible as evidenced by efficient recruitment, high retention, and adherence to intervention components. Remote delivery, working with a peer mentor, and using Fitbit tools were highly acceptable. From baseline to 3-months, participants increased time spent in objectively measured MVPA, strength, and flexibility exercises, and reported meaningful improvements to body image, fatigue, anxiety, and emotional support. A fully remote, peer-to-peer intervention is an acceptable and promising strategy to increase PA and improve QOL in YBCS. Refinements to the intervention and its delivery should be further assessed in future studies, toward the goal of disseminating an evidence-based, scalable intervention to the growing number of YBCS.Trial registration Prospectively registered as NCT04064892.

Forming Habits, Overcoming Obstacles, and Setting Realistic Goals: A Qualitative Study of Physical Activity Maintenance Among Latinas.

BACKGROUND: The impact of physical activity interventions for Latina women can be enhanced by identifying and implementing strategies to achieve long-term physical activity maintenance. Physical activity promotion research has mainly focused on physical activity initiation and we know little regarding individual, interpersonal, or environmental factors that influence maintenance of physical activity. This study aimed to qualitatively explore and understand factors associated with maintenance and non-maintenance of physical activity among Latinas. METHODS: Semi-structured individual interviews were conducted with 21 Latinas who increased their physical activity as a result of an intervention, and who completed a 3-month maintenance period without contact from research staff. Data were analyzed using thematic analysis. RESULTS: Important facilitators of physical activity maintenance described by participants included having made physical activity a habit; the ability to proactively overcome obstacles to engaging in physical activity, and satisfaction with outcomes obtained from engaging in physical activity. Additional facilitators mentioned by both maintainers and non-maintainers included having motivation, social support, and opportunities to be active. Both maintainers and non-maintainers reported high self-efficacy for PA maintenance in the future. CONCLUSIONS: Guiding intervention participants to form habits and to set realistic expectations could help them to independently continue engaging in physical activity upon completion of physical activity interventions. Teaching them skills to proactively overcome obstacles may also be important for physical activity maintenance.

Pilot Study of Compassion Meditation Training to Improve Well-being Among Older Adults.

OBJECTIVES: Compassion meditation (CM) training has demonstrated potential in improving well-being and psychosocial functioning. However, most prior studies of CM training have focused on younger adults. The generalizability of the effectiveness of CM training with older adults requires further study. This pilot study was intended to inform future randomized controlled studies of CM training in older adults. METHODS: Participants included 24 older adults who attended a 10-week group CM training. Exploratory outcome measures were administered prior to, during, and after the intervention. Participants also completed logs of mood and meditation practice, and provided descriptive comments in response to open-ended questions administered at the end of treatment. RESULTS: High treatment completion rates (87.5%) and reported adherence (85.7% of assigned meditation) were observed. Descriptive feedback from participants indicated older adults are interested in and capable of learning and applying new concepts and skills in support of their well-being. Pre- to post-intervention changes were explored with a variety of self-report measures. Weekly journals suggested increased feelings of love, closeness, or trust, and decreased feelings of stress, nervousness, or being overwhelmed. CONCLUSIONS: These findings provide preliminary support for the feasibility of CM training in community-dwelling older adults, and suggest the need for future efficacy and effectiveness clinical trials. CLINICAL IMPLICATIONS: CM training offers potential benefits for improving well-being among older adults, and, as an example of a strengths-based approach, can be tailored to the specific needs of older adults.

Lapse, Relapse, and Recovery in Physical Activity Interventions for Latinas: a Survival Analysis.

BACKGROUND: Physical activity (PA) research extensively focuses on initiation of PA, yet lapse and relapse among PA intervention participants are less well understood, particularly among minority populations such as Latinas in the USA. This study aimed to (1) determine the probability of lapse during two PA interventions for Latinas; (2) assess demographic, psychosocial, and environmental predictors of the amount of time until first lapse; and (3) identify factors predictive of lapse recovery. METHODS: Data from 176 Latina intervention participants were pooled. Survival functions and Kaplan-Meier curves were used to illustrate probability of lapse. Cox proportional hazard models assessed predictors of time to lapse. Logistic regressions identified predictors of lapse recovery. RESULTS: The probability of lapse after 1 month of starting to exercise was 18%, escalating to 34% after 4 months. Predictors of earlier lapse included various psychosocial constructs (i.e., self-efficacy and various processes of change), but none of the measured environmental factors, and only one demographic factor (≥ 2 children under 18). Increased use of consciousness raising at 2 months was associated with lower likelihood of lapse recovery, yet use of behavioral processes of change at 6 months was associated with higher likelihood of recovery. CONCLUSIONS: Lapsing may not be pre-determined by demographic and environmental characteristics. On the other hand, skills that can be learned through interventions, such as skills to improve self-efficacy, seem important in the delay or prevention of lapses. Results pertaining to lapse recovery are less clear.

Out-of-clinic and self-managed abortion in Bangladesh: menstrual regulation provider perspectives.

BACKGROUND: In Bangladesh, abortion is illegal except to save a woman's life, though menstrual regulation (MR) is permitted. MR involves the use of manual uterine aspiration or Misoprostol (with or without Mifepristone) to induce menstruation up to 10-12 weeks from the last menstrual period. Despite the availability of safe and legal MR services, abortions still occur in informal setttings and are associated with high complication rates, causing women to then seek post abortion care (PAC). The objective of this study is to contextualize MR in Bangladesh and understand systemic barriers to seeking care in formal settings and faciltators to seeking care in informal settings via the perspective of MR providers in an effort to inform interventions to improve MR safety. METHODS: Qualitative individual semi-structured interviews were conducted with 25 trained MR providers (doctors and nurses) from urban tertiary care facilities in six different cities in Bangladesh from April to July, 2018. Interviews explored providers' knowledge of MR and abortion in Bangladesh, knowledge/experience with informal MR providers, knowledge/experience with patients attempting self-managed abortion, personal attitudes and moral perspectives of MR/abortion in general, and barriers to formal MR. Team based coding and a directed content analysis approach was performed by three researchers. RESULTS: There were three predominant yet overlapping themes: (i) logistics of obtaining MR/PAC/abortion, (ii) provider attitudes, and (iii) overcoming barriers to safe MR. With regards to logistics, lack of consensus among providers revealed challenges with defining MR/abortion gestational age cutoffs. Increasing PAC services may be due to patients purchasing Mifepristone/Misoprostol from pharmacists who do not provide adequate instruction about use, but are logistically easier to access. Patients may be directed to untrained providers by brokers, who intercept patients entering the hospitals/clinics and receive a commission from informal clinics for bringing patients. Provider attitudes and biases about MR can impact who receives care, creating barriers to formal MR for certain patients. Attitudes to MR in informal settings was overwhelmingly negative, which may contribute to delays in care-seeking and complications which endanger patients. Perceived barriers to accessing formal MR include distance, family influence, brokers, and lack of knowledge. CONCLUSIONS: Lack of standardization among providers of MR gestational age cutoffs may affect patient care and MR access, causing some patients to be inappropriately turned away. Providers in urban tertiary care facilities in Bangladesh see primarily the complicated MR/PAC cases, which may impact their negative attitude, and the safety of out-of-clinic/self-managed abortion is unknown. MR safety may be improved by eliminating brokers. A harm reduction approach to improve counseling about MR/abortion care in pharmacies may improve safety and access. Policy makers should consider increasing training of frontline health workers, such as Family Welfare Visitors to provide evidence-based information about Mifepristone/Misoprostol.

Health Outcomes and Costs Associated with the Provision of Culturally Competent Services for Underrepresented Ethnic Populations with Severe Mental Illness.

Underrepresented racial/ethnic populations (UREPs) face disparities in their use of behavioral health services for multiple reasons including lack of culturally competent services and stigma. This paper employs mixed methods to compare health outcomes and costs among clients in 14 culturally competent behavioral health programs targeting specific UREPs to five programs without a specific racial or ethnic focus. We found that UREP-focused programs were associated with similar improvements in health outcomes, but greater costs relative to the comparison programs. Main themes from the qualitative analysis included: addressing stigma, building trust and understanding confidentiality, looking for a cure, and moving beyond linguistic competency.

Ethical issues in using Twitter for population-level depression monitoring: a qualitative study.

BACKGROUND: Recently, significant research effort has focused on using Twitter (and other social media) to investigate mental health at the population-level. While there has been influential work in developing ethical guidelines for Internet discussion forum-based research in public health, there is currently limited work focused on addressing ethical problems in Twitter-based public health research, and less still that considers these issues from users' own perspectives. In this work, we aim to investigate public attitudes towards utilizing public domain Twitter data for population-level mental health monitoring using a qualitative methodology. METHODS: The study explores user perspectives in a series of five, 2-h focus group interviews. Following a semi-structured protocol, 26 Twitter users with and without a diagnosed history of depression discussed general Twitter use, along with privacy expectations, and ethical issues in using social media for health monitoring, with a particular focus on mental health monitoring. Transcripts were then transcribed, redacted, and coded using a constant comparative approach. RESULTS: While participants expressed a wide range of opinions, there was an overall trend towards a relatively positive view of using public domain Twitter data as a resource for population level mental health monitoring, provided that results are appropriately aggregated. Results are divided into five sections: (1) a profile of respondents' Twitter use patterns and use variability; (2) users' privacy expectations, including expectations regarding data reach and permanence; (3) attitudes towards social media based population-level health monitoring in general, and attitudes towards mental health monitoring in particular; (4) attitudes towards individual versus population-level health monitoring; and (5) users' own recommendations for the appropriate regulation of population-level mental health monitoring. CONCLUSIONS: Focus group data reveal a wide range of attitudes towards the use of public-domain social media "big data" in population health research, from enthusiasm, through acceptance, to opposition. Study results highlight new perspectives in the discussion of ethical use of public data, particularly with respect to consent, privacy, and oversight.

Implementing Tobacco Control Programs in Homeless Shelters: A Mixed-Methods Study.

Background Tobacco-related chronic diseases contribute significantly to the increased morbidity and mortality observed in the homeless population. Few homeless service settings address tobacco use among their clients. Method Directors and staff from emergency and transitional shelters in San Diego County completed a questionnaire on no-smoking policies and smoking cessation services and participated in in-depth, semistructured interviews to examine the barriers to and facilitators of implementing smoke-free policies and cessation services in their facilities. Results Facilities differed in outdoor restrictions around smoking: 61.5% reported having an outdoor designated smoking zone, and 25% reported having a campus-wide ban on smoking. About one-third of the facilities offered on-site resources for smoking cessation. Although directors and staff supported smoke-free policies, they reported that the increased resources needed to "police" the policy created barriers to implementation. Almost all directors and staff expressed interest in developing an on-site tobacco control program, but they reported that lack of expertise among staff posed challenges to implementing such a program. Conclusion Our findings suggest that for a tobacco control program to be effective in homeless shelters, it should include training and incentives for staff to implement smoke-free policies and cessation services.

An Exercise-Based Program for Veterans with Substance Use Disorders: Formative Research.

Substance use disorders (SUDs) are prevalent among veteran populations. Adjunctive treatments for SUDs are warranted for many reasons, including high relapse rates. Physical exercise has broad health benefits as well as mood-enhancing, anxiolytic, and withdrawal-reducing effects, but veterans with SUDs report low rates of regular exercise. Evaluating exercise-based interventions that incorporate evidence-based behavior change strategies tailored to meet the unique needs of veterans with SUDs is warranted. This article describes the formative research conducted to evaluate the following information among veterans receiving treatment for SUDs: (1) interest in an adjunctive exercise program to supplement their current SUD treatment; and (2) exercise program design considerations. A survey and small group interviews were conducted to obtain both quantitative and qualitative data. Results suggested that veterans with SUDs are interested in exercise, and participants provided perceptive suggestions for modifying an existing evidence-based program. These findings will be used to design an exercise-based treatment program tailored specifically for veterans with SUDs.

Protocol for the development of a vaping cessation intervention for young adult veterans.

The use of e-cigarettes ("vaping") by young adults has increased substantially in the past decade. Although health risks of long-term e-cigarette use remain unknown, there is evidence of acute physiological harms. Most young adults who vape report intent to quit, but little is known about effective interventions. This protocol paper reports on the development and design of a pilot trial of a vaping intervention for young military Veterans. Young adult Veterans accessing VA healthcare (n = 20) who vape daily and have been referred for cessation services will be enrolled. To maximize accessibility the intervention will be delivered virtually; participants will be randomized to receive behavioral counseling by telephone or by video telehealth. The intervention was adapted from an existing program targeting young adult cigarette smokers and will include 6 individual counseling sessions delivered over 8 weeks. Assessment visits will occur at baseline, at end-of-treatment, and 4 weeks later. Analyses will evaluate feasibility and acceptability of the intervention overall, and will compare telephone and video telehealth modalities. Longitudinal regression will be used to evaluate changes in vaping behavior and in nicotine dependence over time. This study will provide assessment of a novel intervention adapted for Veterans who vape nicotine. The comparison of two modalities of virtual intervention delivery will increase knowledge and the potential to disseminate across VA and other healthcare systems. Findings from this pilot trial will inform the design of future, larger studies of vaping cessation interventions for younger Veterans.

Assessing microplastics contamination in unviable loggerhead sea turtle eggs.

Sea turtles, in comparison with marine mammals, sea birds, and fishes, are the most affected by microplastics in terms of number of individuals impacted and concentration within each organism. The ubiquitous nature and persistence of microplastics in the environment further compromises sea turtles as many species are currently vulnerable, endangered, or critically endangered. The objective of this study was to quantify microplastic contamination in unviable loggerhead sea turtle eggs (Caretta caretta). Eggs were collected from seven locations along the northwest coast of Florida. A total of 70 nests and 350 eggs were examined. Microplastics (n = 510) were found in undeveloped loggerhead sea turtle eggs across all seven sites, suggesting that maternal transference and/or exchange between the internal and external environment were possible. The frequency found was 7.29 ± 1.83 microplastic pieces per nest and 1.46 ± 0.01 per egg. Microplastics were categorized based on color, shape, size, and type of polymer. The predominant color of microplastics were blue/green (n = 236), shape was fibers (n = 369), and length was 10-300 µm (n = 191). Identified fragments, films, beads and one foam (n = 187) had the most common area of 1-10 µm2 (n = 45). Micro-Fourier Transform Infrared (µ-FTIR) spectroscopy analysis demonstrated that polyethylene (11 %) and polystyrene (7 %) were the main polymer types. For the first time microplastics were found in unviable, undeveloped loggerhead sea turtle eggs collected in northwest Florida. This work provides insight into the distribution patterns of microplastic pollutants in loggerhead sea turtle eggs and may extend to other species worldwide.

vTrain: a novel curriculum for patient surge training in a multi-user virtual environment (MUVE).

INTRODUCTION: During a pandemic influenza, emergency departments will be overwhelmed with a large influx of patients seeking care. Although all hospitals should have a written plan for dealing with this surge of health care utilization, most hospitals struggle with ways to educate the staff and practice for potentially catastrophic events. Hypothesis/Problem To better prepare hospital staff for a patient surge, a novel educational curriculum was developed utilizing an emergency department for a patient surge functional drill. METHODS: A multidisciplinary team of medical educators, evaluators, emergency preparedness experts, and technology specialists developed a curriculum to: (1) train novice users to function in their job class in a multi-user virtual environment (MUVE); (2) obtain appropriate pre-drill disaster preparedness training; (3) perform functional team exercises in a MUVE; and (4) reflect on their performance after the drill. RESULTS: A total of 14 students participated in one of two iterations of the pilot training program; seven nurses completed the emergency department triage course, and seven hospital administrators completed the Command Post (CP) course. All participants reported positive experiences in written course evaluations and structured verbal debriefings, and self-reported increase in disaster preparedness knowledge. Students also reported improved team communication, planning, team decision making, and the ability to visualize and reflect on their performance. CONCLUSION: Data from this pilot program suggest that the immersive, virtual teaching method is well suited to team-based, reflective practice and learning of disaster management skills.

Lipoprotein(a) Testing Trends in a Large Academic Health System in the United States.

Background Despite its high prevalence and clinical significance, clinical measurement of lipoprotein(a) is rare but has not been systematically quantified. We assessed the prevalence of lipoprotein(a) testing overall, in those with various cardiovascular disease (CVD) conditions and in those undergoing cardiac testing across 6 academic medical centers associated with the University of California, in total and by year from 2012 to 2021. Methods and Results In this observational study, data from the University of California Health Data Warehouse on the number of individuals with unique lipoprotein(a) testing, unique CVD diagnoses (using International Classification of Diseases, Tenth Revision [ICD-10], codes), and other unique cardiac testing were collected. The proportion of total individuals, the proportion of individuals with a given CVD diagnosis, and the proportion of individuals with a given cardiac test and lipoprotein(a) testing any time during the study period were calculated. From 2012 to 2021, there were 5 553 654 unique adults evaluated in the University of California health system, of whom 18 972 (0.3%) had lipoprotein(a) testing. In general, those with lipoprotein(a) testing were more likely to be older, men, and White race, with a greater burden of CVD. Lipoprotein(a) testing was performed in 6469 individuals with ischemic heart disease (2.9%), 836 with aortic stenosis (3.1%), 4623 with family history of CVD (3.3%), 1202 with stroke (1.7%), and 612 with coronary artery calcification (6.1%). For most conditions, the prevalence of testing in the same year as the diagnosis of CVD was relatively stable, with a small upward trend over time. Lipoprotein(a) testing was performed in 10 753 individuals (1.8%) who had lipid panels, with higher rates with more specialized testing, including coronary computed tomography angiography (6.8%) and apolipoprotein B (63.0%). Conclusions Lipoprotein(a) testing persists at low rates, even among those with diagnosed CVD, and remained relatively stable over the study period.

Veterans' reasons for dropping out of prolonged exposure therapy across three delivery modalities: A qualitative examination.

Premature dropout from posttraumatic stress disorder treatment (PTSD) hinders treatment response. Studies have primarily used quantitative methodology to identify factors that contribute to Veterans' premature dropout, which has yielded mixed results. Qualitative methods provide rich data and generate additional hypotheses about why Veterans discontinue PTSD treatment. This study aimed to understand Veterans' reasons for dropping out of prolonged exposure therapy (PE) and to examine if there are differences in reasons for dropout between three delivery modalities: in-home, in-person (IHIP), office-based telehealth (OBT), or home-based telehealth (HBT). Twenty-two Veterans who dropped out of PE from a parent randomized clinical trial participated in individual qualitative interviews about potential contextual and individual factors related to discontinuation. Team-based coding was used to conduct open and focused coding. Themes were generated that described factors that influenced Veterans' dropout from PE and constant comparison was used to explore differences in reasons between the three modalities. Most Veterans had multiple reasons for dropping out and reasons were similar across delivery modalities with few differences. Practical barriers (e.g., scheduling difficulties), attitudes toward mental health providers and therapy (e.g., stigma), psychological and physical health factors (e.g., perceived worsening of symptoms, pain), and the therapeutic context (e.g., disliking aspects of PE) contributed to Veterans' decisions to drop out from PE. Veterans in OBT reported more types of practical barriers than Veterans in HBT and IHIP. These findings can help generate hypotheses about interventions that may promote engagement and future studies should continue to study how to reduce dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Qualitative Analysis of the Content Validity of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) in Schizophrenia: A Multi-Stakeholder Perspective.

The US Food and Drug Agency (FDA) requires clinical trials targeting cognitive impairment associated with schizophrenia (CIAS) to demonstrate the functional relevance of cognitive improvements by employing a functional co-primary measure. Although quantitative evidence supports the suitability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for this purpose, FDA guidelines for qualification of clinical outcome assessments require evidence of content validity, defined as qualitative evidence that key stakeholders view the measure as relevant and important. To collect this important qualitative data, semi-structured interviews were conducted with outpatients with schizophrenia (n = 24), caregivers (n = 12), and professional peer support specialists (n = 12) to elicit their views about the definition and importance of functional independence, the importance of the functional domains assessed by the VRFCAT (meal planning, using transportation, handling money, shopping), and the relevance of the VRFCAT tasks to these domains. Qualitative thematic analyses revealed consistent themes across groups in defining functional independence, including performing instrumental self-care, financial, and social tasks; making decisions autonomously; and not depending on others to carry out daily activities. There were, however, notable differences in their views regarding the importance of and barriers to functional independence. All groups viewed the VRFCAT as assessing skill domains that are central to independent functioning and, with some minor differences, the VRFCAT tasks were viewed as relevant and meaningful examples of the domains. These qualitative results provide converging evidence that key stakeholders view the VRFCAT as a content-valid measure.

Regular and App-enhanced Maintenance of Physical Activity among Latinas: A Feasibility Study.

Introduction: Few studies have focused on physical activity (PA) maintenance, particularly among minority populations; smartphone apps could provide valuable tools. This study aimed to 1) assess and understand PA maintenance among Latinas who completed a PA intervention; and 2) evaluate the feasibility, acceptability and preliminary efficacy of commercial smartphone apps as tools for PA maintenance. Methods: For this feasibility study, 27 Latinas who completed a PA intervention and increased their PA were randomly assigned to enhanced maintenance (i.e., taught to use commercial smartphone apps, N=14), or regular maintenance (i.e., no additional treatment, N=13). After 3-months, the feasibility and acceptability of using apps for PA maintenance was assessed via survey questions, analyzed using descriptive statistics. PA was reassessed via the 7-day PA Recall and analyzed using longitudinal mixed effects regression models. Qualitative data were collected via open-ended interview questions and analyzed using thematic analysis. Results: 43% of enhanced maintenance participants reported using study apps at least "a little" and 21% using them "a lot." Although not statistically significant, enhanced maintenance participants reported a smaller drop in PA from post-intervention to post-maintenance, compared to regular maintenance participants. Several participants expressed approval of the apps, while others reported on factors that kept them from using the apps for PA maintenance. Conclusion: Incorporating lessons learned from this study, larger randomized trials are warranted to evaluate the efficacy of using smartphone apps to support PA maintenance. The widespread use of apps could make them ideal tools to support PA maintenance after interventions in different settings.