Stigma, Social Support, and Decision Satisfaction in Terminations of Pregnancy for Medical Reasons.

Objective: Existing abortion stigma research has rarely isolated the reason for termination; thus, the consequences of termination for medical reasons (TFMR) are poorly understood. We aimed to understand the association of stigma and social support with decision satisfaction in TFMR. Methods: We performed a cross-sectional study on the experiences of 132 individuals who had a TFMR in the second or third trimester. We recruited participants via Facebook. Most participants were non-Hispanic White (85.6%), between 31 and 40 years old (72.7%), highly educated (84.1% with a 4-year degree), and married (89.4%). Participants completed an online demographic data questionnaire, including questions about stigma and social support, and an adapted satisfaction with decision survey. We used t-tests to explore the connection of stigma and social support with decision satisfaction. Results: Results did not reveal an association between stigma and decision satisfaction, but showed that higher social support is associated with higher decision satisfaction. Decision satisfaction was higher in participants who experienced more than one source of support [t(130) = 2.527, p = 0.01], compared with those reporting only one source of support, and in those who experienced support from a relative [t(130) = 1.983, p = 0.049] and physician [t(130) = 2.357, p = 0.020] than in those who did not. Discussion: Social support can alleviate the suffering related to TFMR. Exploring how different forms of social support, including therapy groups, can impact decision satisfaction might help develop interventions to improve postabortion outcomes. Practice Implications: Provider training must encourage providers to (1) support patients having a TFMR and (2) connect patients with other sources of support.

Perceptions of Patient-Centered Care and Their Association With Patient Satisfaction in Abortions for Medical Reasons.

OBJECTIVE: Abortions for medical reasons, which happen in the event of fetal abnormalities or maternal life endangerment, are highly politicized and understudied given their prevalence. Our objective was to understand the health care experiences of U.S. individuals who had an abortion of a wanted pregnancy for medical reasons in the second or third trimester. METHODS: Participants were recruited on Facebook and completed surveys with their demographic information, their perception of their health provider's cultural sensitivity, their patient satisfaction, and their satisfaction with their decision to proceed with an abortion for medical reasons. RESULTS: Participants were 132 women who were mostly between the ages of 31 and 40 (72.7%), highly educated (84.1% had at least a 4-year college degree), and non-Hispanic White (85.6%). There was no statistically significant difference in patients' rated highest average item score on their providers' Competence or Sensitivity; however, average item scores of providers' Competence and Sensitivity were both higher than Respect scores. Linear regression results show that experiencing patient-centered care significantly predicted patient satisfaction (ß = .73, t(131) = 12.03, p < .001) and decision satisfaction (ß = .37, t(131) = 4.63, p < .001). CONCLUSION: Our findings underscore the importance of training providers to deliver patient-centered care that empowers patients to adapt to challenging situations, such as the diagnosis of medical concerns during pregnancy. Providers understanding and supporting the complex process of an abortion for medical reasons can ameliorate the emotional impact of this procedure.

Systematic review: sleep health in the US Latinx population.

Sleep disturbances are a common and unmet health problem in Latinx. While Latinx report similar sleep disturbances as non-Hispanic Whites [NHW], Latinx suffer from these disturbances to a greater degree than their NHW counterparts. Sleep disturbances are associated with increased risk of chronic health conditions, which Latinx experience at high rates. Research also points to significant sleep differences within Latinx. Given that Latinx are a rapidly growing population in the United States, sleep disparities between Latinx and NHWs and sleep differences within Latinx warrant further investigation. While research on Latinx sleep is growing, the last narrative review on US Latinx sleep health was published by Loredo and colleagues in 2010. Our narrative review expands on Loredo et al.'s work, adding the literature on Latinx sleep published since 2010 (N = 70). A total of 78 peer-reviewed articles related to young to middle-aged (i.e., 18-65 years) healthy Latinx adult sleep were identified in three databases-PsycInfo, PubMed/Medline, and Web of Science. With the socioecological model as framework, this review (1) summarizes current evidence pertaining to sleep health in healthy, community dwelling, urban Latinx adults; (2) discusses measurement challenges related to investigating Latinx sleep disparities and differences; and (3) discusses potential contributors to Latinx sleep. The prevalence of short sleep duration, long sleep duration, and poor sleep quality is high among Latinx; there are differences by Latinx subgroup. Our review identifies several multi-level influences associated with poor sleep: SES, sexual minority status, racial discrimination, access to care, neighborhood environment, and shift work. N = 250/250.

A Mixed Method Examination of Sleep Patterns and Barriers to Sleep in Hispanic Women.

Research on Hispanic sleep (1) remains far behind research on non-Hispanic White sleep, and (2) seldom focuses solely on Hispanic women. A convergent parallel mixed-methods study design was used to examine (1) sleep quantity, quality, and habits; (2) the association of sleep and health; and (3) perceived barriers to healthy sleep in middle-aged Hispanic women living in [a large Midwest city]. A total of 78 Hispanic women were surveyed, and 27 of these Hispanic women participated in focus groups. Participants had: poor sleep quantity, quality, and sleep hygiene. In focus groups, participants identified three barriers to healthy sleep: poor sleep hygiene, responsibilities and related stress, and additional mental health concerns. While poor sleep quantity and quality have serious health consequences for Hispanic women, sleep disorders in Hispanic women have been understudied. This study underscores barriers to healthy sleep and the associations between sleep and health in Hispanic women.

Views of Black women patients with obesity on desired and undesired weight-focused clinical encounters.

Non-Hispanic Black women have the highest rates of overweight/obesity of any group in the United States. To date, few interventions have worked to reduce overweight/obesity in this population. This study investigated the views of Black women with overweight and obesity treated in a primary care setting regarding desired and undesired verbal and non-verbal behaviours by providers in provider-patient clinical encounters focused on losing weight, maintaining weight loss, and/or obesity. Two focus groups and an individual interview (n = 15) were conducted. Qualitative data analysis yielded five distinct themes, with 11 codes (listed in parenthesis): (a) desired weight-focused discussions (codes: Discussing weight loss with patients and discussing weight-loss maintenance with patients), (b) desired weight-focused support (codes: Supporting patients experiencing weight loss and supporting patients experiencing weight gain), (c) undesired weight-focused discussions (codes: Things to avoid during weight loss discussions and things to avoid during weight gain discussions), (d) desired attitudes and behaviours during weight-focused discussions (codes: Show caring and understanding and encourage behaviour change for weight loss), and (e) building physician-patient rapport (codes: Enable patients to feel respected by doctors, enable patients to feel comfortable with doctors and enable patients to trust their doctors). The qualitative approach employed in this study generates a deep understanding not only of the experiences of Black women patients but also of potential strategies that physicians could employ to succeed in their discussions with patients regarding healthy weight achievement and maintenance.

The association of sleep duration and feeling rested with health in U.S. Hispanic women.

This study aims to understand the health correlates of sleep deficiencies in non-elderly U.S. Hispanic1 women. Data from a sample of U.S. Hispanic women (n = 1531; ages 18-65 [M = 39.98; SD = 12.85]) who completed the 2017 National Health Interview Survey were analyzed to understand (1) sleep duration and quality; (2) the association of sleep patterns with key health indicators; and (3) whether these relationships are mediated by health behaviors (ie, healthy eating and physical activity). Shorter sleep duration was associated with a higher likelihood of often feeling anxious and having hypertension. Worse sleep quality was associated with a higher likelihood of being overweight, having fair or poor health status, often feeling depressed, often feeling anxious, having high cholesterol, and having asthma. Doctor's recommendation to engage in physical activity and to decrease calorie intake served as mediators in some of these relationships. Results indicate that among Hispanic women: (1) sleep is an important determinant of a variety of health outcomes and (2) the association of sleep and many health outcomes are mediated by healthy eating and physical activity. Further research on the association of sleep and risk of chronic disease among Hispanic women is needed.

Impact of Stress and Loneliness on Health-Related Quality of Life Among Low Income Senior African Americans.

Low income senior African Americans are at risk for low health-related quality of life (HRQoL). Loneliness may exacerbate the effects of stress on health. The purpose of this study was to examine the impact of perceived stress and loneliness on the HRQoL of low income senior African Americans (N = 281). Results indicate that loneliness may exacerbate the inverse relationship of perceived stress with psychological HRQoL among this sample. Additionally, both loneliness and perceived stress were associated with poorer physical HRQoL. The present study has implications for interventions seeking to improve HRQoL among a similar sample of senior adults given that loneliness is a modifiable variable.

Sociodemographic and health correlates of sleep in U.S. Hispanic older adults.

BACKGROUND: This project aims to understand the sociodemographic and health correlates of poor sleep in U.S. Hispanic older adults. METHODS: Data from the National Social Life, Health, and Aging Project (NSHAP): Wave 2 were analyzed to understand the prevalence of poor sleep among Hispanic older adults, sociodemographic predictors of sleep patterns, and the association between sleep quality and chronic disease. Only the data from Hispanic participants (n = 345) were used in the present study. Self-reported demographic, self-reported and actigraphy-measured sleep, and self-report health measures were used. RESULTS: Results of regression analyses indicated that self-reported restless sleep significantly predicted self-rated physical and mental health, hypertension, pain, and self-rated general happiness. Feeling rested was significantly associated with self-rated physical health and mental health, pain, and self-rated happiness. Neither restless sleep nor feeling rested were significant predictors of diabetes. Actigraphy-measured sleep duration was not significantly associated with health outcomes. CONCLUSIONS: While sleep deprivation has serious physical and mental health consequences for Hispanics, sleep disorders in Hispanic older adults have been overlooked in research. This study sheds some light on the associations between sleep and health in Hispanic older adults. Examination of potential mechanisms linking poor sleep with mental and physical health in Hispanic older adults is a critical next step.

Hope and health-related quality of life among chronically ill uninsured/underinsured adults.

AIMS: Uninsured/underinsured individuals with chronic health conditions report low health-related quality of life. Empowerment-based strategies (e.g., hope) may improve the health-related quality of life of uninsured/underinsured individuals with chronic health conditions by enabling them to take charge of their health. METHODS: The present study used structural equation modeling to examine the relationships among number of chronic health conditions, the components of hope (i.e., agency and pathways), and the health-related quality of life of 197 uninsured/underinsured adults in the United States living with at least one chronic health condition. RESULTS: Results indicate that number of chronic health conditions negatively impacted health-related quality of life and that agency significantly mediated that relationship. CONCLUSIONS: Results from this study can be used to promote health-related quality of life by empowering individuals to take charge of their lives despite their unique contextual circumstances.

Clinical Staff's Motivators and Barriers to Engagement in Health-Promoting Behaviors.

Clinical staff can promote patients' engagement in health-promoting behaviors to prevent/treat obesity. However, some clinical staff are overweight/obese and may not model health behaviors for their patients. This cross-sectional survey study tested the hypotheses that clinical staff's level of (1) motivators and (2) barriers to engaging in health-promoting behaviors would be significantly associated with their body mass index (BMI). Barriers were significantly correlated and motivators were not correlated with caregivers' BMI. Implications for nurses in professional development are discussed.

Associations of Health Self-efficacy With Engagement in Health-Promoting Behaviors and Treatment Adherence in Rural Patients.

Rural residents have lower levels of engagement in health-promoting behaviors and treatment adherence than their urban counterparts. This cross-sectional study sought to understand the role of health self-efficacy as a precursor to engagement in health-promoting behaviors and treatment adherence in 273 rural patients. Structural equation model was used to examine whether health self-efficacy predicted engagement in health-promoting behaviors and treatment adherence. Results show that health self-efficacy predicts engagement in health-promoting behaviors and treatment adherence. Boosting patients' health self-efficacy could be a way of increasing their engagement in health-promoting behaviors and treatment adherence and thus of improving their health outcomes.

Health Self-Empowerment Theory: Predicting Health Behaviors and BMI in Culturally Diverse Adults.

Health Self-Empowerment Theory asserts that 5 controllable psychological variables predict engagement in health-promoting behaviors. This study tests the theoretical integrity of Health Self-Empowerment Theory and its usefulness in predicting health-promoting behaviors and body mass index. Results from surveying 189 predominantly low-income, overweight/obese, and culturally diverse adults showed that most Health Self-Empowerment Theory variables were positively correlated. Structural equation modeling showed that 4 variables significantly predicted engagement in health-promoting behaviors, which mediated the relationships between body mass index and (a) motivation, (b) health self-efficacy, and (c) self-praise. Results support creating psychologically informed interventions to increase engagement in health-promoting behaviors and decrease body mass index among low-income adults, particularly racial/ethnic minorities, at risk for obesity-related health problems.

Validation of an Inventory for Providers to Self-Assess Their Engagement in Patient-Centered Culturally Sensitive Health Care.

OBJECTIVE: Cultural sensitivity training of health-care providers could help eliminate health disparities. The Tucker-Culturally Sensitive Health-Care Provider Inventory (T-CSHCPI) is an inventory for providers to self-assess their engagement in patient-defined/-centered culturally sensitive health care. The T-CSHCPI is novel in that it assesses providers' strengths and areas of growth in their efforts to provide culturally sensitive care as defined by culturally diverse patients. METHODS: Using ratings on this inventory by a sample of culturally diverse providers (N = 291) from 67 health-care sites across the United States, a confirmatory analysis of the T-CSHCPI was conducted, and its validity and reliability were determined. RESULTS: Factor analysis produced a final solution with 4 factors (interpersonal skills, conscientiousness, sensitivity, and disrespect/disempowerment) that were reliable. These 4 factors are associated with cultural competence, suggesting validity. DISCUSSION: The T-CSHCPI measures independent dimensions of patient-centered care as identified by a national sample of health-care providers. The T-CSHCPI can be used to inform training that promotes patient-centered culturally sensitive health care by providers.

Development of an Inventory for Health-Care Office Staff to Self-Assess Their Patient-Centered Cultural Sensitivity.

BACKGROUND: Patient-centered culturally sensitive health care (PC-CSHC) is a best practice approach for improving health-care delivery to culturally diverse populations and reducing health disparities. Despite patients' report that cultural sensitivity by health-care office staff is an important aspect of PC-CSHC, the majority of available research on PC-CSHC focuses exclusively on health-care providers. This may be due in part to the paucity of instruments available to assess the cultural sensitivity of health-care office staff. The objective of the present study is to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF). This instrument is designed to enable health-care office staff to self-assess their level of agreement that they display behaviors and attitudes that culturally diverse patients have identified as office staff cultural sensitivity indicators. METHODS: A sample of 510 health-care office staff were recruited at 67 health-care sites across the United States. These health-care office staff anonymously completed the T-CSHCOSI-SAF and a demographic data questionnaire. RESULTS AND LEVEL OF EVIDENCE: Confirmatory factor analyses of the T-CSHCOSI-SAF revealed that this inventory has 2 factors with high internal consistency reliability (Cronbach's αs= .916 and .912). CONCLUSION AND IMPLICATIONS: The T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity. Such self-assessment data can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff and to help draw the attention of these staff to displaying patient-centered cultural sensitivity.

Validation of a patient-centered culturally sensitive health care office staff inventory.

AIM/BACKGROUND: Research suggests that patient-perceived culturally sensitive health care encompasses multiple components of the health care delivery system including the cultural sensitivity of front desk office staff. Despite this, research on culturally sensitive health care focuses almost exclusively on provider behaviors, attitudes, and knowledge. This is due in part to the paucity of instruments available to assess the cultural sensitivity of front desk office staff. Thus, the objective of the present study is to determine the psychometric properties of the pilot Tucker-Culturally Sensitive Health Care Office Staff Inventory-Patient Form (T-CSHCOSI-PF), which is an instrument designed to enable patients to evaluate the patient-defined cultural sensitivity of their front desk office staff. METHODS: A sample of 1648 adult patients was recruited by staff at 67 health care sites across the United States. These patients anonymously completed the T-CSHCOSI-PF, a demographic data questionnaire, and a patient satisfaction questionnaire. Findings Confirmatory factor analyses of the TCSHCOSI-PF revealed that this inventory has two factors with high internal consistency reliability and validity (Cronbach's αs=0.97 and 0.95). CONCLUSIONS: It is concluded that the T-CSHCOSI-PF is a psychometrically strong and useful inventory for assessing the cultural sensitivity of front desk office staff. This inventory can be used to support culturally sensitive health care research, evaluate the job performance of front desk office staff, and aid in the development of trainings designed to improve the cultural sensitivity of these office staff.

Validation of a patient-centered, culturally sensitive, clinic environment inventory using a national sample of adult patients.

The purpose of this study was to determine the factor structure, internal consistency reliability, and validity of the Tucker Culturally Sensitive Health Care Clinic Environment Inventory-Patient Form (T-CSHCCEI-PF), a novel instrument designed to assess an aspect of health care often ignored in health care quality research: the cultural sensitivity of health care center policies and environment as perceived by adult, racially/ethnically diverse patients. Using ratings on this inventory by a culturally diverse national sample of adult patients (N = 1,639) from 67 health care sites across the United States, a confirmatory factor analysis of the T-CSHCCEI-PF was conducted, and its reliability and validity were determined. The T-CSHCCEI-PF was shown to be a reliable and valid inventory for culturally diverse patients to provide feedback to the administrators at their health care centers regarding the degree to which these centers have characteristics that are reflective of patient-centered culturally sensitive health care.

Patients' perceived cultural sensitivity of health care office staff and its association with patients' health care satisfaction and treatment adherence.

Research suggests that patients' interactions with their front desk office staff and patient-centered culturally sensitive health care are important factors in diverse patients' overall health care satisfaction. Yet, patient-centered culturally sensitive health care research has focused almost exclusively on provider care. This study tested the hypothesis that patient-perceived cultural sensitivity of front desk office staff has a significant positive association with patient treatment adherence and that this relationship is mediated by patient health care satisfaction. Study participants were a culturally diverse sample of 1,191 patients from health care sites across the U.S. Results of a meditational analysis supported the tested hypothesis. Patient health care satisfaction fully mediated the relationship between patient-perceived cultural sensitivity of front desk office staff and patient treatment adherence. The patient satisfaction and cultural sensitivity variables explained 10% of the variance in patient treatment adherence. Training front desk office staff in patient-centered culturally sensitive health care may improve patients' health care satisfaction and treatment adherence.