Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design.

BACKGROUND: American Indian and Alaska Native peoples experience poor end-of-life care, including more hospitalizations and lower use of hospice and do-not-resuscitate orders. Although advance care planning (ACP) can improve end-of-life care, ACP rates are disproportionately low in American Indians and Alaska Natives. OBJECTIVE: We culturally tailored and delivered an existing evidence-based ACP program for an American Indian tribal community. Here, we present the protocol for assessing the intervention's feasibility and efficacy. METHODS: We measured feasibility via participant recruitment, participants' evaluation (acceptability, appropriateness, comprehension, and satisfaction), and intervention fidelity. Recruitment was measured with participant screening, eligibility, enrollment, and retention. Participant's evaluation of the intervention was measured with surveys. Fidelity was measured with direct observation and the Make Your Wishes About You (MY WAY) Fidelity Checklist Tool. To assess the intervention's efficacy, we used a quasi-experimental waitlist control design with 2 cohorts who were surveyed each on three separate occasions. The intervention's efficacy was assessed by the following: ACP barriers and facilitators as well as ACP self-efficacy, readiness, and completion. RESULTS: A total of 166 participants were screened for eligibility; 11 were deemed ineligible, and 155 participants were enrolled in the study. Of those enrolled, 113 completed the intervention and will be included in subsequent analyses. We finalized data collection in January 2023, and analyses are underway. Study enrollment was successful, and we expect that participants will report high levels of acceptability, appropriateness, comprehension, and satisfaction with the intervention. We expect that the intervention was implemented with fidelity and will demonstrate decreases in ACP barriers and increases in ACP facilitators, self-efficacy, readiness, and completion. CONCLUSIONS: Enrolling over twice as many participants as we had hoped suggests that members of this tribal community are willing to engage in end-of-life ACP. We were able to implement a waitlist study design to show that a culturally tailored ACP program for a tribal community is feasible. TRIAL REGISTRATION: ClinicalTrials.gov NCT05304117; https://clinicaltrials.gov/study/NCT05304117. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50654.

Changes in Mental Health, Emotional Distress, and Substance Use Affecting Women Experiencing Violence and Their Service Providers during COVID-19 in a U.S. Southern State.

Research conducted during the COVID-19 pandemic has revealed many unintended consequences of mandated safety precautions, including increased perpetration of intimate partner violence (IPV), increases in substance use, and worsening mental health conditions. We conducted a repeated, cross-sectional survey of survivors of IPV, a longitudinal survey of service providers working in an IPV shelter, and interviews with both. We conducted surveys at the beginning of the pandemic and nearly half a year later to assess mental health and, for clients, substance use. Results showed that two small samples of survivors living in the shelter in 2020 and 2021 experienced both mental health decline and increased use of substances. Qualitative data from in-depth interviews suggest that COVID-19-related restrictions mirrored survivors' experiences of power and control in violent relationships. Further, IPV service providers-essential workers during COVID-19-experienced stress associated with reports of burnout and mental fatigue. This study suggests that community-based organizations can help mitigate the impacts of COVID-19 on survivors of IPV but should avoid adding additional work for staff as service providers experienced mental and emotional stress.

Achieving Whole Health: A Preliminary Study of TCMLH, a Group-Based Program Promoting Self-Care and Empowerment Among Veterans.

OBJECTIVE: An emerging literature suggests patients with chronic illnesses can benefit from integrated, person-centric approaches to health care, including group-based programs. However, much of the research in this area is disease specific. The objective of this study was to collect preliminary evidence on the efficacy of Taking Charge of My Life and Health (TCMLH), a Whole Health group-based program that emphasizes self-care and empowerment on the overall health and well-being of veterans, a population burdened with high rates of multiple chronic conditions. METHOD: Self-reported outcomes, including standardized survey measures, were collected at pretest, posttest, and 2-month follow-up from 77 participants across 15 groups at four VA sites. Random intercept mixed-model regressions were used to analyze data. RESULTS: Results from this initial study showed high satisfaction with the program and facilitators, and high attendance. There were significant pre-post gains in self-care attitudes and behaviors, patient motivation, meaning and purpose, mental health, perceived stress, goal progress, and goal-specific hope. Outcomes were maintained at 2-month follow-up for patient motivation, perceived stress, goal-specific hope, and goal progress. Significant gains were observed in health care empowerment and physical health from pretest to follow-up. CONCLUSIONS: Preliminary findings support the efficacy of TCMLH, a Whole Health group-based program that emphasizes patient empowerment, self-care practices, and peer support. Future research priorities include a rigorous evaluation with a larger sample size and control group to assess effectiveness.

Gender differences in patient outcomes following drug abuse treatment in Afghanistan: Results from a new evaluation.

Drug use rates among adults in Afghanistan are over twice as high as the global average which complicates an already challenging situation in the country. Although progress has been made toward improving availability of treatment and the rights and status of women, cultural norms and historical precedents have delayed advances, including in drug treatment. Female Afghan patients access treatment via home-based systems without the option of group in-patient treatment centers available to male patients. Using data from a new evaluation of Afghanistan's drug treatment system we report on updated differences in treatment outcomes for male and female patients in drug treatment centers in Afghanistan. A probability sample was used, selecting 32 centers to evaluate, and including baseline and follow-up data from 865 individuals who were officially admitted to drug treatment. Data collection included: (a) baseline and follow-up interviews; (b) baseline and follow-up urine drug tests; and (c) intake and treatment participation records. Random intercept generalized linear models were used to analyze change by regressing outcomes on a contrast representing time and a correction for selectivity biases. Male and female patients had similar, overall pre-treatment characteristics including low levels of education, though education levels were lower for women. At follow-up, there were significant differences between male and female patients' self-reports of substance use and related consequences, including criminal behavior. These findings represent mixed results; while some progress has been made in offsetting gender disparities in Afghanistan, remaining significant gender differences in posttreatment results suggest more positive outcomes for female than for male patients.

Productive Struggle: How Community Coalitions Developed Capacity to Conduct Qualitative Research Through CBPR.

There is a lack of evidence as to how the subcomponents of motivation, innovation-specific capacity, and organizational capacity affect community readiness and the implementation of evidenced-based practices. The Strategic Prevention Framework-Partnerships for Success (SPF-PFS) Initiative in Ohio is guided by a collaboration between the Ohio Department of Mental Health and Addiction Services, Ohio's SPF-PFS Evaluation Team, Ohio's Coaching and Mentoring Network, and community coalitions from 10 Appalachian and/or rural communities. To address the goals of the SPF-PFS, we paired an empowerment evaluation framework with a community-based participatory research approach that enabled communities to take complete ownership of local data and research processes. This approach yielded a pedagogical framework in which all 10 community coalitions were able to extend a quantitative needs assessment by examining local conditions contributing to substance use using qualitative research methods. Members of the coalitions became local leaders in conducting qualitative research, which, in turn, enhanced their organizational capacity. Our purpose is to communicate this successful strategy, along with some challenges we encountered, for developing innovation-specific capacity within the participating community coalitions to utilize qualitative research methods in order to obtain information about the local conditions affecting substance misuse. We describe how an empowerment evaluation framework, when paired with community-based participatory research, can also increase organizational capacity by supporting community coalitions as they successfully leveraged new skills related to strategic planning.

An evaluation of the facilitator training to implement 'Taking charge of my life and health', a peer-led group program to promote self-care and patient empowerment in Veteran participants.

OBJECTIVE: We developed a peer-led group program for Veterans called Taking Charge of My Life and Health (TCMLH) that emphasizes patient education, goal setting, shared decision making, and whole person care. Our aim was to conduct an evaluation of a facilitator training course to deliver TCMLH in VA sites. METHODS: Repeated measures ANOVA models were used to examine change over three timepoints (pre-test, post-test, and two-month follow-up) in outcomes of attitudes, knowledge, skills, and self-efficacy related to patient empowerment, skills acquisition, self-care strategies, and curriculum facilitation. Qualitative data analysis of participant feedback was used to identify potential training adaptations and barriers to TCMLH delivery. RESULTS: Our sample comprised 70 trainees who completed all three assessments. Participants reported high levels of training satisfaction, quality, and utility, and sustained improvements in knowledge of Whole Health, self-efficacy for group facilitation, and self-efficacy for using Whole Health concepts and tools. Implementation barriers included challenges related to group management and site logistics. CONCLUSION: The facilitator training course improved knowledge and self-efficacy associated with successful peer-led program delivery and identified opportunities to improve the training course and TCMLH dissemination. PRACTICE IMPLICATIONS: Findings provide insights on the design and implementation of training models to support peer-led programs.

If momma ain't happy with the mentoring relationship, ain't nobody happy with the mentoring relationship: Parental satisfaction as a predictor of mentoring match strength and length.

Much evidence exists on whether an individual's perception of a match relationship impacts match strength and length, but relatively less is known about whether parental perceptions of the match (i.e., whether the match is meeting their goals) impacts the length and strength of mentoring relationships. These relationships were examined in a sample of 350 newly formed youth-mentor matches who completed multiple measures of match strength and satisfaction with the match. Parents/guardians were also surveyed about their level of satisfaction with the match. The primary finding of this paper was that parent/guardian dissatisfaction with the match relationships meeting goals was the only significant predictor of a higher likelihood of match closure. Although youth and mentor self-reports of satisfaction with how match time was spent were the strongest predictors of volunteer and youth match strength ratings, parent/guardian satisfaction with the match relationship also remained a strong predictor of match strength. The implications of these findings are discussed.

Addressing Health Challenges of Women Across the Life Course: Summary of the Women's Health 2018 Preconference Symposium.

Although the United States is often ahead in both research and health care fields, it lags behind peer countries in many population health indicators. To address these complex health problems that often reflect the intersection of many socioeconomic and health issues, it is essential that scientists work collaboratively across distinct disciplines. Women's health is but one area which can benefit from such an approach given the multifaceted and complex issues underlying the different aspects of women's health research. The National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) and the Office of Women's Health of the U.S. Food and Drug Administration (FDA) cosponsored a preconference symposium at the Women's Health 2018 Conference, held in May in Arlington, VA, to highlight interdisciplinary approaches to research, how researchers can work collaboratively, and how to apply multifaceted approaches to complex real-world problems. Three speakers presented information on a range of subjects related to the health of women across the life course, including the distinction between multidisciplinary, interdisciplinary, and transdisciplinary approaches; the science behind Team Science and how its findings apply to working collaboratively; and gender inequalities in the opioid epidemic. This article summarizes the major points of the presentations and the subsequent discussions.

Reversing the Trends toward Shorter Lives and Poorer Health for U.S. Women: A Call for Innovative Interdisciplinary Research.

The United States (U.S.) is a leader and innovator in biomedicine, yet trails behind for many key health indicators, especially for women. This paper highlights key evidence indicating that not only is the state of women's health in the U.S. lagging, but it is at risk for falling off the curve. Women's health care remains fragmented; research in the field can be disconnected and difficult to integrate across disciplines-silos prevail. Structural obstacles contribute to this lack of cohesion, and innovative, interdisciplinary research approaches which integrate the multidimensional aspects of sex and gender, and race and ethnicity, with a life course perspective are sorely needed. Such synergistic, scientific strategies have the potential to reverse the trend towards shorter life expectancy and poorer health for women in the U.S. The National Institute for Health (NIH) seeks to raise the bar for the health of all women by tackling these issues through enhancing the relevance of biomedical research to the health of women and driving the sustained advancement of women in biomedical careers.

Distribution of content in recently-viewed scenes whitens perception.

Anisotropies in visual perception have often been presumed to reflect an evolutionary adaptation to an environment with a particular anisotropy. Here, we adapt observers to globally-atypical environments presented in virtual reality to assess the malleability of this well-known perceptual anisotropy. Results showed that the typical bias in orientation perception was in fact altered as a result of recent experience. Application of Bayesian modeling indicates that these global changes of the recently-viewed environment implicate a Bayesian prior matched to the recently experienced environment. These results suggest that biases in orientation perception are fluid and predictable, and that humans adapt to orientation biases in their visual environment "on the fly" to optimize perceptual encoding of content in the recently-viewed visual world.

Structural Content in Paintings II: Artists Commissioned to Reproduce a Specific Image Over-Regularize Orientation Biases in Their Paintings.

Measurements of psychophysical performance show that the visual system is biased in ways that counteract statistical regularities of natural scenes thereby allowing efficient coding. Here we consider the perceptual effects of these encoding biases in a "holistic" way by measuring characteristics of the paintings produced by artists making perceptual matches to a natural scene image; 10 artists were asked to produce an exact copy of a single outdoor landscape scene. The structural content of the paintings produced and the "ground truth" image were compared in the frequency domain. The artists were found to over-regularize the orientation content in the paintings: The anisotropy existing only at the lowest spatial scales in the natural scene image was produced across all spatial scales in these commissioned paintings. These results were compared to those from two other methods of comparing paintings and natural scenes reported previously in a companion paper and all three methodologies indicate very similar over-regularization. We suggest that artists may have a general canonical representation of structural relations of scenes that they apply broadly within their creations.

Structural content in paintings: artists overregularize oriented content of paintings relative to the typical natural scene bias.

Natural scenes tend to be biased in both scale (1/f) and orientation (H > V >> O; horizontal > vertical >> oblique), and the human visual system has similar biases that serve to partially 'undo' (ie whiten) the resultant representation. The present approach to investigating this relationship considers content in works of art-scenes produced for processing by the human visual system. We analyzed the content of images by a method that minimizes errors inherent in some prior analysis methods. In the first experiment museum paintings were considered by comparing the amplitude spectrum of landscape paintings, natural scene photos, portrait paintings, and photos of faces. In the second experiment we obtained photos of paintings at the time they were produced by local artists and compared structural content in matched photos which contained the same scenes that the artists had painted. Results show that artists produce paintings with both the 1/f bias of scale and the horizontal-effect bias of orientation (H > V >> O). More importantly, results from both experiments show that artists overregularize the structure in their works: they impose the natural-scene horizontal effect at all structural scales and in all types of subject matter even though, in the real world, the pattern of anisotropy differs considerably across spatial scale and between faces and natural scenes. It appears that artists unconsciously overregularize the oriented structure in their works to make it conform more uniformly to the 'expected' canonical ideal.

Comparison of event-related potentials elicited by cardinal and oblique orientations with broad-band noise stimuli.

The experiments described here used event-related potentials (ERPs) to investigate the neural processes of the horizontal effect, in which visual performance is worst for horizontal and best for oblique orientations. EEGs were recorded while human adult subjects performed an orientation identification task with broad-band noise stimuli. The results showed that the difference between cardinal orientations and oblique orientations first occurred at P2 component around 200 ms post-stimulus onset, which is much later than the traditional oblique effect. Additionally, the P3 was much smaller and earlier for oblique orientations than for cardinal orientations. These findings indicated that, compared to the classical oblique effect, the horizontal effect with broad-band noise stimuli might occur at relatively later stages of visual information processing and might involve more complex neural mechanisms.