Giving Literal Thanks: An ACGME-Sponsored Initiative to Bring Residents Back to the Bedside.

Background Resident burnout is at an all-time high. In response, the Accreditation Council for Graduate Medical Education (ACGME) developed the Back to Bedside grant for resident-led burnout interventions that increase the time residents spend with patients. Objective We designed a resident-patient reading intervention, Giving Literal Thanks (GLT), intended to increase meaningful time residents spend with patients and thereby decrease burnout. Methods All 65 pediatric residents rotating through our academic hospital's inpatient units from Fall 2019 through Fall 2021 were invited to read and gift books to their patients. We studied our intervention's relationship to resident burnout using a convergent mixed-methods design, including anonymous, unlinked pre-, peri-, and post-intervention surveys and focus groups. Qualitative and quantitative data were analyzed separately, then integrated to describe burnout pre- and post-intervention. Results Forty-one of 65 residents (63.1%) completed pre-intervention surveys, and 8 of 65 (12.3%) completed post-intervention surveys. Twenty-seven resident-patient reading interactions were recorded, and 2 focus groups were held (1 pre- and 1 post-intervention). Five themes were identified: (1) limited opportunities exist to spend time at the bedside; (2) spending time at the bedside is valuable; (3) other responsibilities may preclude time at the bedside; (4) GLT could promote positive outcomes; and (5) GLT might not be the right tool to reduce burnout. Further quantitative data analysis was prevented by low survey response rates. While GLT was positively received and feasible, we were unable to show an improvement in burnout. Conclusions GLT was well-regarded but may not improve resident burnout.

Stakeholders' perception of factors influencing adoption of a pediatric weight management intervention: a qualitative study.

Background: Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites. Methods: We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME). Results: In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described. Conclusion: Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.

Social capital, gender, and health: an ethnographic analysis of women in a Mumbai slum.

OBJECTIVE: Quantitative studies have demonstrated that social capital can positively impact community health, but qualitative explorations of the factors mediating this relationship are lacking. Furthermore, while the world's poor are becoming increasingly concentrated in the cities of lower-middle income countries, most of the existing literature on social capital and health explores these variables in Western or rural contexts. Even fewer studies consider the impact of social constructs like race, gender, or class on the creation of social capital and its operationalization in health promotion.Our study aimed to address these gaps in the literature through an ethnographic exploration of social capital among women living in Kaula Bandar (KB) - a marginalized slum on the eastern waterfront of Mumbai, India. We then sought to identify how these women leveraged their social capital to promote health within their households. METHODS: This was a mixed-method, qualitative study involving participant observation and 20 in-depth, semi-structured, individual interviews over a nine-month period. Field notes and interview transcripts were manually analyzed for recurring content and themes. RESULTS: We found that women in KB relied heavily on bonding social capital for both daily survival and survival during a health crisis, but that the local contexts of gender and poverty actively impeded the ability of women in this community to build forms of social capital - namely bridging or linking social capital - that could be leveraged for health promotion beyond immediate survival. CONCLUSIONS: These findings illustrate the context-specific challenges that women living in urban poverty face in their efforts to build social capital and promote health within their households and communities. Community-based qualitative studies are needed to identify the macro- and micro-level forces, like gender and class oppression, in which these challenges are rooted. Directly addressing these structural inequalities significantly increases the potential for health promotion through social capital formation.

Underutilization of Preventive Asthma Visits Among Urban Children With Persistent Asthma.

National guidelines recommend that children with persistent asthma have at least 2 preventive asthma visits (PAVs) per year. We sought to determine the percent of urban children with persistent asthma who had a PAV in the past year, and to identify differences in demographics, health-related variables, and management associated with PAVs. Using data from 530 children (3-10 years) participating in a school-based asthma trial, we found that only 25% of children had at least 1 PAV, with only 5% receiving ≥2 visits. Having a PAV was not associated with demographics or health-related variables. Importantly, having a PAV was associated with having a preventive medication, taking that medication daily, and having a medication adjustment. Although PAVs were associated with actions to improve asthma control and management, these visits were underutilized in this sample. This highlights the need for novel methods to ensure access and deliver care to this vulnerable pediatric population.