Feasibility and Acceptability of a Prospective Syphilis Sexual Network Study for Sexual Minority Men.

BACKGROUND: In preparation for a prospective syphilis network study of sexual minority men, we conducted a mixed-methods formative study with the following objectives: a) assess acceptability of respondent driven sampling (RDS), b) assess acceptability of study procedures, c) social network seed selection, and d) pilot an ecological momentary assessment (EMA) study to assess social networking, sexual and substance use behavior. METHODS: We conducted in-depth interviews with eight providers serving sexual minority men and five focus group discussions with 34 sexual minority men, prioritizing four target populations: young Black sexual minority men, 2) on PrEP, 3) living with HIV, 4) not engaged in care. The 4-week EMA pilot was conducted with 40 sexual minority men. EMA survey responses were analyzed to evaluate how different compensation levels influenced response rates. Brief exit surveys were used to assess EMA app acceptability. RESULTS: Primary themes identified through qualitative data collection: 1) importance of developing trust and maintaining confidentiality during proposed recruitment activities, 2) importance of compensating participants appropriately for study activities, and 3) cultural considerations for increasing visibility and participation of young Black sexual minority men. All EMA participants reported being "completely comfortable" reporting sexual behavior through the app. Most (78%) preferred the app to in-person interviews. Several participants identified technical issues with the app, including not receiving push notifications and spontaneous closure. CONCLUSIONS: This mixed-methods formative study allowed for adjustments to and tailoring of the planned network study, including recruitment protocols, compensation type and amount, and EMA survey wording and response items.

Developing Leaders in Surgical Residency: A Curriculum for Success.

OBJECTIVE: As surgical residents continue in their training, they are expected to not only take part in more complicated procedures, but to also serve as leaders in their respective care teams. While surgical skills are intensively taught in surgical residency programs, leadership is often learned informally, to the detriment of residents. Our curriculum was developed and implemented to provide foundational knowledge for surgical residents as they take on senior roles so that they may successfully act as leaders. This educational workshop was effective and efficient and can be applied at other residency programs that seek to improve the leadership skills of their residents. DESIGN: Implementation of a 3-day program focused on leadership, surgical skills, and career development to provide rising PGY-4 surgical residents with the abilities necessary for successful training. SETTING: This program was implemented at the University of Minnesota General Surgery residency program. PARTICIPANTS: Rising PGY-4 general surgery residents. RESULTS: The program consisted of a 3-day workshop which all rising PGY-4 residents participating in before transitioning into their respective roles. The program was led by the general surgery faculty. CONCLUSIONS: Curricula focused on developing leadership skills in residents can be effectively applied in a time-efficient manner that can benefit the residents as they move into official leadership roles on the care team.

Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial.

BACKGROUND: Evidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians' attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians' knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use. METHODS: Design: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians' alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI. PARTICIPANTS: ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months. OUTCOMES: We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff's alcohol use and clinic-level alcohol expectations in the EBAI arm. DISCUSSION: This trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases. TRIAL REGISTRATION: NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .

Enabled to Stand: A Single-subject Research Design Study Exploring Pediatric Power Wheelchair Standing Device Use.

PURPOSE: To investigate the influence of powered wheelchair standing device (PWSD) use on changes in activity/participation in children with neurodevelopmental conditions. METHODS: A mixed methods A-B-A single-subject research design was replicated with participants. The target behavior was parental perceptions of changes in children's performance of activity/participation goals measured via the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM with children, an interview, and a 3-measure implementation survey. COPM data related to the target behavior were analyzed using the split-middle celeration line method. RESULTS: Four child-parent dyads participated in the study. All participants achieved statistically and clinically significant increases in COPM performance ratings for the 5 parent-identified activity/participation goals. CONCLUSIONS: For the participant dyads in this study, use of the PWSD appeared to positively influence parental perceptions of improvements in their child's performance of activity/participation goals.

Crowdsourced partner services among men who have sex with men living with HIV: A pilot randomized controlled trial in China.

BACKGROUND: This study aimed to assess the acceptability, feasibility, and preliminary effectiveness of a crowdsourced HIV partner services (PS) intervention among men who have sex with men living with HIV (MLWH) in China. METHODS: A pilot two-arm randomized controlled trial (RCT) was conducted in three HIV testing clinics in China. The control arm received conventional HIV PS while the intervention arm received a crowdsourced intervention, including HIV self-testing kits for secondary distribution (HIVST-SD), digital education materials, and assisted PS. The intervention was developed through two-phase crowdsourcing events including an open call and a Designathon. The primary outcomes were measured by the 3-month follow-up rate (i.e., the proportion of participants who completed the follow-up survey to report HIV PS outcomes three months after enrollment) and the frequency of using intervention components (feasibility), index evaluation of intervention components (acceptability), and the proportion of partners getting HIV testing (preliminary effectiveness). RESULTS: The study enrolled 121 newly diagnosed MLWH between July 2021 and May 2022. The 3-month follow-up rates were 93% (75/81) and 83% (33/40) in the intervention and control arms, respectively. Crowdsourced intervention components demonstrated feasibility, with all indexes utilizing digital educational materials, 23 successfully using HIVST-SD, and six employing provider-referral to notify nine sexual partners. Acceptability was high, with HIVST-SD and digital educational materials rated 4·4 and 4.1 out of 5. The proportion of partners receiving HIV testing was 11% higher in the intervention arm than in the control arm (marginal significance with 95% CI = [-2%, 24%], 38% vs. 27%). CONCLUSION: The crowdsourced HIV PS intervention was acceptable and feasible, suggesting the potential to facilitate partner HIV testing among Chinese MLWH. Further implementation research is recommended to expand HIV PS among key populations in low- and middle-income countries.Clinical trial registration ID: NCT04971967 (Protocol ID: 19-0496).

The relationship between felt stigma and non-fatal overdose among rural people who use drugs.

BACKGROUND: Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. METHODS: Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. RESULTS: 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). CONCLUSIONS: Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.

Evaluation of respondent-driven sampling in seven studies of people who use drugs from rural populations: findings from the Rural Opioid Initiative.

BACKGROUND: Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. METHODS: RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. RESULTS: Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. CONCLUSIONS: RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.

Forecasting Hepatitis C Virus Status for Children in the United States: A Modeling Study.

BACKGROUND: Virtually all cases of hepatitis C virus (HCV) infection in children in the United States occur through vertical transmission, but it is unknown how many children are infected. Cases of maternal HCV infection have increased in the United States, which may increase the number of children vertically infected with HCV. Infection has long-term consequences for a child's health, but treatment options are now available for children ≥3 years old. Reducing HCV infections in adults could decrease HCV infections in children. METHODS: Using a stochastic compartmental model, we forecasted incidence of HCV infections in children in the United States from 2022 through 2027. The model considered vertical transmission to children <13 years old and horizontal transmission among individuals 13-49 years old. We obtained model parameters and initial conditions from the literature and the Centers for Disease Control and Prevention's 2021 Viral Hepatitis Surveillance Report. RESULTS: Model simulations assuming direct-acting antiviral treatment for children forecasted that the number of acutely infected children would decrease slightly and the number of chronically infected children would decrease even more. Alone, treatment and early screening in individuals 13-49 years old reduced the number of forecasted cases in children and, together, these policy interventions were even more effective. CONCLUSIONS: Based on our simulations, acute and chronic cases of HCV infection are remaining constant or slightly decreasing in the United States. Improving early screening and increasing access to treatment in adults may be an effective strategy for reducing the number of HCV infected children in the United States.

Methods for Decreasing Preweaning Mortality in a Fragile Mouse Model of Hypomorphic Collagen VII Deficiency.

Preweaning mortality is a widespread problem in laboratory mouse breeding, particularly in the case of fragile mouse models. While numerous studies explore alternative care methods to increase the survivability of common mouse strains, there remains a paucity of research into the care of mice with fragile health conditions that result from induced or natural genetic mutations. In this study, standard husbandry practices were enhanced by the addition of a softened diet, a nutritionally fortified dietary supplement, soft bedding, gentle handling techniques, decreased handling, lengthened weaning age, and dam productivity tracking. This alternative care plan was shown to increase the survival of a fragile recessive dystrophic epidermolysis bullosa mouse model, and some aspects could be used in developing a care plan for other fragile mouse strains.

What are relevant predictors of physical activity in older adults with lower limb loss (LLL)? Results of a retrospective analysis.

BACKGROUND: People with lower limb loss (LLL) have reduced physical activity (PA). There is evidence of physical and psychosocial predictors of PA in older adults with limb loss. However, these 2 areas (physical/psychosocial) have not been evaluated in the same analysis. OBJECTIVES: To describe and identify predictors of PA in individuals with LLL. STUDY DESIGN: Cross-sectional study. METHODS: Secondary analysis of data from a multisite Canadian randomized control trial involving community-dwelling prosthetic ambulators with unilateral transtibial or transfemoral amputation (N = 72). The dependent variable was the Physical Activity Scale for the Elderly. Potential predictors were four step square test, 2-minute walk test, Short Physical Performance Battery, Life Space Assessment, walking while talking test, and Activities-specific Balance Confidence scale. RESULTS: Seventy-two community-dwelling lower limb prosthesis users were enrolled. The sample included 62 male participants (86%), and 58 participants (81%) had transtibial amputation. The average age of participants was 65 (8.9) years, and for 49 participants (70%), the amputation was over 24 months ago. The total mean Standard Deviation (SD) Physical Activity Scale for the Elderly score was 153.2 (88.3), with scores of 148.1 (11.4) and 184.5 (24.7) for male and female participants, respectively. Regression analysis identified Life Space Assessment (ß = 1.15, p = 0.007) and Short Physical Performance Battery (ß = 3.51, p = 0.043) as statistically significant predictors accounting for 25% of the variance in PA. CONCLUSIONS: Community mobility and physical performance are the most meaningful predictors of PA. Future research should examine additional factors (e.g., environment, motivation). Understanding the predictors for PA after LLL would improve clinical practice as clinicians would have increased knowledge to modify and improve training.

Changes in functioning and health during the first 6-months of the COVID-19 pandemic among individuals with a spinal cord injury.

STUDY DESIGN: Single-cohort longitudinal survey design. OBJECTIVES: To identify what ongoing impact the COVID-19 pandemic has on functioning and health in individuals with SCI. Using the ICF model as a guide, outcome measures were chosen to explore potential constructs and aspects of health and functioning which may have been affected by regulations. SETTING: Online, Canada. METHODS: Participants provided demographic and clinical characteristics at baseline. They completed standardized online measures at three time points, each roughly one month apart (June, July, and August of 2020). The measures assessed mental health, resilience, boredom, social support, technology use, life space, and participation. Repeated measures ANOVAs were used to identify longitudinal changes for each measure. RESULTS: We collected data from 21 participants with SCI (mean age 54 years, 12 male). We found a large effect size for participation (η2 = 0.20), which increased over time. We also found medium effect sizes in both anxiety (η2 = 0.12) and social network usage (η2 = 0.12). Anxiety decreased over time and social networking usage fluctuated slightly but with an increase from time point one to time point two. CONCLUSION: The results indicate that individuals with spinal cord injury appear to be staying relatively stable during the pandemic with improvements in a few key aspects, such as potentially increased participation and decreased anxiety. The results also suggest that it is important to continue fostering ways for individuals with spinal cord injury to stay connected, engaged, and informed.

A qualitative study of clinicians' and individuals' with lower limb loss perspectives on the development of a novel online self-management program.

PURPOSE: To explore the rehabilitation preferences and experiences of clinicians and patients for education after lower limb loss to facilitate the development of an online self-management program. METHODS: A qualitative descriptive approach was used. Thirty-one clinicians (physiotherapists, occupational therapists, and prosthetists), and 26 patients with lower limb loss (transtibial and transfemoral amputation; mean age (SD) of 63.3 (9.1), years) were recruited. We used semi-structured focus groups and one-on-one interviews, and audio recorded the interviews. Data were analyzed using conventional content analysis. RESULTS: Three themes were identified: (1) Needing education in rehabilitation described the education in current practice as one-on-one discussion and booklets and highlighted the limitations of education such as its length, static nature, and inaccessible for patients living in remote areas. (2) Getting back to activities prior to amputation emphasized how goal setting and social support could assist patients and facilitate self-management. (3) Augmenting learning highlighted the need for an accessible complementary source for education and potential solutions to overcome the barriers of online delivery. CONCLUSIONS: Our findings underscore the importance of education in the rehabilitation of patients to help them get back to their activities. An online accessible tool may improve education by providing information and peer support.

Self-management education assists patients through knowledge and skills to adapt to an amputation.Education should be patient centred.An accessible user-friendly online tool which offers the information and peer support may augment and improve the delivery of self-management education.

Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study.

PURPOSE: This study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role. MATERIALS AND METHODS: This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis. RESULTS: From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users. CONCLUSION: Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles.

The caregivers experienced some burden related to wheelchair-related help, especially around the driving of the powered wheelchair (PWC).However, the PWC provide independence not only to the user but also to the family caregivers, allowing them to share quality time and helping each otherThe PWC impact the interaction with the social and physical environment of the caregivers.Caregiver-oriented interventions should build on the strengths of the caregivers and contribute to their well-being.

Buprenorphine misinformation and willingness to treat patients with opioid use disorder among primary care-aligned health care professionals.

BACKGROUND: Buprenorphine is a highly effective medication for opioid use disorder that is underused by health care professionals (HCPs). Medications for opioid use disorder (MOUD) misinformation may be an important barrier to buprenorphine access, but most implementation strategies have aimed to reduce negative attitudes towards patients with opioid use disorder (OUD) rather than misinformation specific to buprenorphine use. In this study, we assessed the degree to which HCPs endorsed misinformation related to buprenorphine, and whether this is associated with willingness to provide care to patients with OUD. METHODS: In September-December of 2022, we surveyed HCPs practicing in Ohio (n = 409). Our primary outcomes included a previously validated 5-item measure of HCP willingness to treat patients with OUD, and three other measures of willingness. Our key independent variable was a study-developed 5-item measure of endorsement of misinformation related to buprenorphine, which assessed beliefs in buprenorphine's efficacy in managing withdrawal symptoms and reducing overdose deaths as well as beliefs about the role of buprenorphine in achieving remission. We computed descriptive and bivariable statistics and fit regression models predicting each outcome of interest. RESULTS: On average, HCPs scored 2.34 out of 5.00 (SD = 0.80) on the composite measure of buprenorphine misinformation. 48.41% of participants endorsed at least one piece of misinformation. The most endorsed items were that buprenorphine is ineffective at reducing overdose deaths (M = 2.75, SD =0 .98), and that its use substitutes one drug for another (M = 2.41, SD = 1.25). HCP endorsement of buprenorphine misinformation significantly and negatively predicted willingness to work with patients with OUD (b = - 0.34; 95% CI - 0.46, - 0.21); intentions to increase time spent with this patient population (b = - 0.36; 95% CI - 5.86, - 1.28); receipt of an X-waiver (OR = 0.54, 95% CI 0.38, 0.77); and intention to get an X-waiver (OR: 0.56; 95% CI: 0.33-0.94). CONCLUSIONS: Misinformation is common among HCPs and associated with lower willingness to treat patients with OUD. Implementation strategies to increase MOUD use among HCPs should specifically counter misinformation related to buprenorphine. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT05505227. Registered 17 August 2022, https://clinicaltrials.gov/ct2/show/NCT05505227.

The impact of fentanyl on state- and county-level psychostimulant and cocaine overdose death rates by race in Ohio from 2010 to 2020: a time series and spatiotemporal analysis.

BACKGROUND: Over the past decade in the USA, increases in overdose rates of cocaine and psychostimulants with opioids were highest among Black, compared to White, populations. Whether fentanyl has contributed to the rise in cocaine and psychostimulant overdoses in Ohio is unknown. We sought to measure the impact of fentanyl on cocaine and psychostimulant overdose death rates by race in Ohio. METHODS: We conducted time series and spatiotemporal analyses using data from the Ohio Public Health Information Warehouse. Primary outcomes were state- and county-level overdose death rates from 2010 to 2020 for Black and White populations. Measures of interest were overdoses consisting of four drug involvement classes: (1) all cocaine overdoses, (2) cocaine overdoses not involving fentanyl, (3) all psychostimulant overdoses, and (4) psychostimulant overdoses not involving fentanyl. We fit a time series model of log standardized mortality ratios (SMRs) using a Bayesian generalized linear mixed model to estimate posterior median rate ratios (RR). We conducted a spatiotemporal analysis by modeling the SMR for each drug class at the county level to characterize county-level variation over time. RESULTS: In 2020, the greatest overdose rates involved cocaine among Black (24.8 deaths/100,000 people) and psychostimulants among White (10.1 deaths/100,000 people) populations. Annual mortality rate ratios were highest for psychostimulant-involved overdoses among Black (aRR = 1.71; 95% CI (1.43, 2.02)) and White (aRR = 1.60, 95% CI (1.39, 1.80)) populations. For cocaine not involving fentanyl, annual mortality rate ratios were similar among Black (aRR = 1.04; 95% CI (0.96,1.16)) and White (aRR = 1.02; 95% CI (0.87, 1.20)) populations. Within each drug category, change over time was similar for both racial groups. The spatial models highlighted county-level variation for all drug categories. CONCLUSIONS: Without the involvement of fentanyl, cocaine overdoses remained constant while psychostimulant overdoses increased. Tailored harm reduction approaches, such as distribution of fentanyl test strips and the removal of punitive laws that influence decisions to contact emergency services, are the first steps to reduce cocaine overdose rates involving fentanyl among urban populations in Ohio. In parallel, harm reduction policies to address the increase in psychostimulant overdoses are warranted.

Development of a co-created online self-management program for people with lower limb loss: self-management for amputee rehabilitation using technology (SMART).

PURPOSE: To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART). MATERIALS AND METHODS: We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial. RESULTS: Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning. CONCLUSIONS: Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies.Implications for rehabilitationLearning new coping strategies and habits are essential after lower limb loss.Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery.Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer.

Correlates of Recent HIV Testing Among People Who Inject Drugs in Rural Areas: A Multi-site Cross-Sectional Study, 2018-2020.

The Rural Opioid Initiative surveyed 2693 people who inject drugs (PWID) in eight rural U.S. areas in 2018-2020 about self-reported HIV testing in the past 6 months. Correlates of interest included receipt of any drug-related services, incarceration history, and structural barriers to care (e.g., lack of insurance, proximity to syringe service programs [SSP]). Overall, 20% of participants reported receiving an HIV test within the past 6 months. Multivariable generalized estimating equations showed that attending substance use disorder (SUD) treatment (OR 2.11, 95%CI [1.58, 2.82]), having health insurance (OR 1.42, 95%CI [1.01, 2.00]) and recent incarceration (OR 1.49, 95%CI [1.08, 2.04]) were positively associated with HIV testing, while experiencing a resource barrier to healthcare (inability to pay, lack of transportation, inconvenient hours, or lack of child care) had inverse (OR 0.73, 95%CI [0.56, 0.94]) association with HIV testing. We found that the prevalence of HIV testing among rural PWID is low, indicating an unmet need for testing. While SUD treatment or incarceration may increase chances for HIV testing for rural PWID, other avenues for expanding HIV testing, such as SSP, need to be explored.

Experiential Aspects of Participation in Employment and Mobility for Adults With Physical Disabilities: Testing Cross-Sectional Models of Contextual Influences and Well-Being Outcomes.

OBJECTIVE: To use structural equation modeling to test research- and theory-informed models of potential predictors and outcomes of subjective experiences of employment and mobility participation in a national sample of people with physical disabilities. DESIGN: Cross-sectional survey. SETTING: Canada. PARTICIPANTS: English or French-speaking adults with a physical impairment affecting mobility and restricting activities or participation, and who participated in employment (n=457) or mobility (n=711) life domains. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Participants completed standardized measures of perceived health, and employment-specific and/or mobility-specific measures of perceived abilities, social support, accessibility and policies (predictor variables); the Measure of Experiential Aspects of Participation (MeEAP) in employment and/or mobility; and standardized measures of emotional well-being, social well-being and life satisfaction (outcome variables). RESULTS: Analyses using structural equation modeling showed that in both employment and mobility domains, perceived health, abilities, social support, and accessibility were positively related to experiential aspects of participation. Participation experiences were positively related to social well-being, emotional well-being, and life satisfaction. CONCLUSIONS: Results support and extend current theorizing on participation experiences among adults with physical disabilities. Intrapersonal and environmental factors may play a role in optimizing participation experiences in employment and mobility which, in turn, may lead to better well-being and life satisfaction. These results emphasize the importance of conceptualizing participation from an experiential perspective and provide a basis for advancing theory and practice to understand and improve the participation experiences and well-being of adults living with physical disabilities.