Father's Playbook: From Health Communication Research to Prenatal Health Intervention.

Research has demonstrated benefits of paternal involvement during the prenatal stage: increased prenatal visits, better adherence to postpartum best practices, and improved communication between partners. In the United States, where maternal morbidity remains higher than other advanced economies, the need for varied interventions aimed at improving the wellbeing of the entire family unit should remain a top priority. In an arena that is understandably dominated by interventions aimed at expectant mothers, scholars also advocate for including men in prenatal health care to reduce maternal morbidity and mortality. In practice, however, they are often excluded. Evidence suggests paternal prenatal health interventions can result in better outcomes for the entire family, and researchers developed Father's Playbook - a free bilingual evidence-based app for expectant fathers - in support of that goal. This article examines the creation of and lessons learned from this health communication intervention which represents a case study of implementation science in the field of health communication. This article documents how the project moved from early formative research to app development and now ongoing promotion of a state-funded health communication and public health intervention utilizing a variety of research approaches. Researchers believe this intervention can serve as a blueprint for other public health and health communication practitioners.

The Impact of Health Communication Research on Medical and Health Professional Education and Training.

In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies of how health communication research informed the development and implementation of specific CSTs, and we reflect on how we can productively define "impact" in looking back as well as looking forward within this line of research.

Clinician communication strategies to navigate differences of opinion with patients.

OBJECTIVE: We investigated communication strategies clinicians reported using to navigate differences of opinion with patients regarding medical decisions. METHODS: Twenty physicians of various specialties participated in semi-structured interviews regarding their strategies for maintaining mutual respect when disagreeing with a patient. Reflexive thematic analysis was applied. Enrollment concluded upon theme saturation. RESULTS: In an attempt to limit disagreements, physicians learned to gauge patient values, often deferring to clinicians being the expert on medicine and patients being the expert on themselves. Physicians noticed that disagreements were reinforced by prioritizing educational approaches. Strengthening the relationship by validating patient emotions was seen as a more effective strategy. Clinicians found it difficult to weigh relative potential for benefit to the relationship and feelings of moral distress in capitulating to patient preferences they disagreed with. CONCLUSION: Physicians recognized the value of moving from educational to relationship building strategies to help limit and navigate disagreements. Key strategies include prioritizing gauging the patient's values and validating their emotions. PRACTICE IMPLICATIONS: Anticipating disagreement, training clinicians to limit teaching, and instead prioritize a strong relationship to maintain trust and collaboration has the potential to improve patient health, with more limited resource use, and better experiences of care.

'That gave me a lot of comfort, that he would ask my opinion about how we wanted to talk about this': A qualitative analysis of clinical communication experiences of ostomy patients.

OBJECTIVES: The purpose of this study was to investigate the communication challenges and successes that people with ostomies experienced during their healthcare encounters. DESIGN: We conducted semistructured interviews of people with ostomies. Interviews focused on important social situations and health communication strategies for managing these situations. We transcribed interviews and coded them to create themes. PARTICIPANTS: Participants were eligible to participate if they were above the age of 18 and have had an ostomy for at least a year. 27 people participated in the study. SETTING: The study was conducted in a university setting. RESULTS: Interviews with ostomates surfaced several themes related to ostomate needs. Participants benefited from communication that was open, thorough and had a positive outlook on ostomies. Participants found patient-clinician communication to be challenging when there was a lack of knowledge surrounding ostomy care, communication was unclear or inadequate, and when clinicians had a negative outlook on ostomies. CONCLUSIONS: Findings from this project are intended to amplify existing patient and clinician education materials and to inform the creation of a communication guide specifically for the ostomy context.

Missed opportunities for prenatal family-centered care during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The purpose of this study was to describe the impact of COVID-19 on fatherhood experiences during pregnancy. METHODS: A semi-structured interview guide was developed to collect qualitative data from fathers about their experiences in pregnancy and prenatal care, how they communicated with providers, strategies for information seeking, and social support they received during the pregnancy. One-time, virtual interviews were conducted via Zoom with fathers that were either expecting a baby or fathers who had a baby after March 2020 and were 18 years or older. Thematic analysis was used to identify themes that highlighted the fatherhood experience. RESULTS: In total, 34 interviews with new or expectant fathers were completed. Two central themes that highlight the experiences of fathers: missed opportunities to shift toward family-centered care and inequity in the parent dyad during pregnancy. Additional supporting themes included: limited patient-provider relationship, lack of telemedicine use, inadequate uncertainty management for parents, unidirectional information sharing between parents, and limited opportunities for achieving role attainment during pregnancy. CONCLUSION: The COVID-19 pandemic created a decision point for prenatal care. Instead of focusing on family-centered practices, prenatal care exclusively centered on the mother and fetus, resulting in problematic experiences for fathers including limited access to information about the pregnancy and health of the mother and fetus, heightened stress related to COVID-19 safety requirements, and few opportunities to attain their role as a father. Prenatal care should actively seek robust strategies to improve family-centered care practices that will withstand the next public health emergency.

Addressing the functional needs of left ventricular assist device candidates: Development and feasibility of an occupational therapy pre-operative evaluation.

BACKGROUND: Everyday living with a left ventricular assist device (LVAD) is complex, particularly for people with physical or cognitive impairments or limited social supports. There is a need for standardized pre-operative functional evaluations. OBJECTIVES: Our objectives were to describe a pre-operative occupational therapy (OT) evaluation for LVAD candidates, assess its feasibility in routine care, and characterize functional needs. METHODS: We retrospectively reviewed electronic medical records of pre-operative OT consultations for LVAD candidates over four years (n = 209). Occupational profile, vision, and sensation were operationalized from documentation narratives. Daily functioning was measured with Activity Measure for Post-Acute Care, grip strength with dynamometer, cognition with Montreal Cognitive Assessment and Allen Cognitive Level Screen-5, and LVAD self-management with a performance-based ordinal scale. RESULTS: 89.5 % of consultations were completed, averaging 61.2 min (n = 187): 79.1 % (148/187) inpatient and 20.9 % (39/187) outpatient. Patients completed 87.7 % (164/187) to 100.0 % (187/187) of evaluation components. 21.9 % (41/187) of candidates lived alone. 6.4 % (12/187) and 7.0 % (13/185) had visual and sensory dysfunction. 57.4 % were independent with daily activities (104/181). 17.7 % (32/181) had impaired grip strength. 69.3 % (124/179) had impaired cognition, 29.7 % (51/172) with impaired functional cognition for everyday activities. 88.4 % (145/164) required physical or cueing assistance while practicing LVAD batteries management. OTs interpreted that 20.9 % (39/187) would likely require 24/7 post-operative support with LVAD self-care. CONCLUSION: Pre-operative OT evaluations were feasible and emphasized complex functional needs. Assessing LVAD self-care abilities may inform candidacy and facilitate early interventions to optimize functioning. OT should be consulted within interprofessional teams for all LVAD candidates.

Development and refinement of a communication guide to help young adults in Texas reconnect and reduce loneliness.

Objective: Loneliness among young people is a contemporary public health crisis exacerbated by the COVID-19 pandemic. The present research examined the development of a modest yet meaningful health communication intervention resource that would become an asset in a larger health campaign: a communication guide aimed at helping young people reach out and reconnect with others. Methods: Study One established the need for a loneliness intervention in Texas with survey data (N = 795). A communication guide was developed based on research and theory. Study Two employed focus group interviews with potential audience members (N = 31) to critically assess and inform revisions to the communication guide. Results: Study One results indicated that a substantial proportion of young adult Texans felt as though their social connection had decreased and their loneliness had increased since the onset of the pandemic. Themes in focus group responses from Study Two suggested several strengths of the communication guide and some opportunities for revision. Conclusion: A communication guide with tips for reconnecting could be a valuable tool to empower young people and promote social connection. Innovation: This study involved the development and refinement of a new communication resource that was informed by a priority audience of a major health communication campaign.

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions.

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

The contribution of maternal oral, vaginal, and gut microbiota to the developing offspring gut.

There is limited understanding of how the microbiota colonizing various maternal tissues contribute to the development of the neonatal gut microbiota (GM). To determine the contribution of various maternal microbiotic sites to the offspring microbiota in the upper and lower gastrointestinal tract (GIT) during early life, litters of mice were sacrificed at 7, 9, 10, 11, 12, 14, and 21 days of age, and fecal and ileal samples were collected. Dams were euthanized alongside their pups, and oral, vaginal, ileal, and fecal samples were collected. This was done in parallel using mice with either a low-richness or high-richness microbiota to assess the consistency of findings across multiple microbial compositions. Samples were analyzed using 16S rRNA amplicon sequencing. The compositional similarity between pup and dam samples were used to determine the contribution of each maternal source to the composition of the neonate fecal and ileal samples at each timepoint. As expected, similarity between neonate and maternal feces increased significantly over time. During earlier time-points however, the offspring fecal and ileal microbiotas were closer in composition to the maternal oral microbiota than other maternal sites. Prominent taxa contributed by the maternal oral microbiota to the neonate GM were supplier-dependent and included Lactobacillus spp., Streptococcus spp., and a member of the Pasteurellaceae family. These findings align with the microbial taxa reported in infant microbiotas, highlighting the translatability of mouse models in this regard, as well as the dynamic nature of the GM during early life.

Interaction of curcumin with a winter flounder alpha-helical antifreeze protein.

The winter flounder, Pseudopleuronectes americanus, synthesizes a variety of alpha-helical antifreeze proteins (AFPs) that adhere to ice and inhibit its growth. The best studied of these is AFP6, which is a 37-residue protein abundant in the flounder blood plasma during winter. Curcumin from the turmeric plant (Curcuma longa) was found to interact with AFP6 in aqueous solutions, resulting in measurable changes in the curcumin, but not in the protein. Specifically, the secondary structure and unfolding of synthetic AFP6, shown by circular dichroism, appeared to be unaffected by curcumin. In contrast, the peak absorbance of curcumin shifted and increased in the presence of AFP6, and the maximum fluorescence emission was greater and blue shifted. These results also suggested the possibility of AFP6 detection by curcumin fluorescence. Synthetic AFP6 did not interact with Coomassie blue, silver or a commercial fluorescent stain following electrophoresis; however, the change in curcumin fluorescence upon binding to electrophoresed AFP6 resulted in a fluorescent signal, which was also detected upon interaction with purified natural AFP and flounder blood plasma containing the protein. Thus, aqueous curcumin can be used for the direct detection of AFP6 and curcumin binding could provide new avenues for the study of this protein.

The Role of Informed Consent in Clinical and Research Settings.

Informed consent plays an integral role in governing the patient-physician relationship with origins traced back to ancient Greek philosophy. The main pillars of informed consent are autonomy, integrity, respect, and care. In the last century, these notions have been codified into legislation to promote healthy patient-physician relationships. Understanding the process of informed consent is critical for patients, researchers, and medical practitioners. In this article, the authors provide a brief historical narrative of informed consent, elaborate on the process of obtaining an ethically and legally valid informed consent, and present some of the future challenges in the field.

The labor of talking to stay healthy and socially connected: Communication work during the COVID-19 pandemic.

One of the primary means through which people protect themselves and their loved ones from COVID-19 is by communicating with others, as they discuss preventive health behaviors and make decisions about safe social interaction. These conversations are sometimes quite challenging. Guided by the conceptual lens of communication work, this study was an investigation of how communication during the pandemic was experienced by people as work. Findings validated and extended the communication work construct. Communication during the pandemic is effortful because it is high stakes, relentless, and takes an emotional toll. Nonetheless, many people feel a sense of responsibility and obligation to have these conversations. Communication about COVID-19 is divisible labor that can be shared. People engage in strategic preparation and message design to accomplish multiple goals before, during, and after discussions about pandemic topics.

A qualitative descriptive study of providers' perspectives on human papillomavirus vaccine administration among Latino/a adolescents in South Texas clinics: barriers and facilitators.

BACKGROUND: South Texas Latinas experience higher cervical cancer incidence and mortality compared to Latinas nationwide. Despite the availability of effective human papillomavirus vaccines, South Texas Latino/a adolescents sub-optimally complete the series. Research shows provider recommendation strongly predicts vaccine uptake, but minority adolescents are less likely to report that their provider recommended the vaccine and series completion. There is also scant information on the HPV vaccine administration process in clinic practices providing vaccination services to Latino adolescents with limited access to healthcare resources. The purpose of the study was to describe providers' experience with administering the HPV vaccine to Latino/a patients in their practices. METHODS: The study used qualitative description to describe the experience of 15 South Texas healthcare providers (doctors and nurses) with the process of HPV vaccine administration in their practices. We conducted open ended, audio-recorded interviews, which were subsequently transcribed verbatim and uploaded into Atlas.(ti) 7.0 for analysis. The interviews yielded detailed descriptions of barriers and facilitators that could potentially impact HPV vaccine uptake. RESULTS: Providers identified parental exposure to provider recommendation as enhancing HPV acceptance and existing policies and implementation of evidence-based practices as facilitators of HPV vaccine uptake. Barriers ranged from parental fears of adolescent sexual activity and potential vaccine side effects to lack of transportation and the cost of the vaccine. CONCLUSION: These findings reflect barriers and facilitators to administering the HPV vaccine previously identified and also highlight issues unique to the situation among Latinos in South Texas. Implications include the need to design and implement efforts to improve provider-parent communication and enhance parental and adolescent patients' understanding of and confidence in the HPV vaccine. Furthermore, policy changes are needed to rectify organizational/structural challenges to HPV vaccine administration.

Evaluation and quality improvement of Doctor of Nursing Practice-Family Nurse Practitioner scholarly projects.

BACKGROUND: The Commission on Collegiate Nursing Education's accreditation standards require nursing programs to demonstrate that students acquire doctoral-level knowledge and competencies beyond that expected at the baccalaureate and/or masters levels. The purpose of this article was to describe a quality improvement (QI) project for Doctor of Nursing Practice-Family Nurse Practitioner (NP) scholarly projects. LOCAL PROBLEM: Nurse practitioner faculty inquired about whether students' scholarly projects were of the quality and rigor expected at the doctoral, rather than masters, level. METHODS: This project was conducted as a QI initiative and was designated as such by the institutional review board. Methods were based on Deming Plan-Do-Study-Act QI process model. INTERVENTIONS: Two doctorally prepared nursing faculty evaluated nine doctoral scholarly projects using the Roush DNP-PCAT instrument. This instrument evaluates 16 components, and key elements within each component, for completeness. The DNP-PCAT tool was evaluated for interrater reliability and content validity in an earlier study. RESULTS: Strengths and weaknesses were identified using quantitative and qualitative data analyses. Floor effects were seen in strategic planning, ethical concerns, data collection, results, discussion, and limitations. Qualitative findings identified weaknesses across all 16 components. Findings were similar to the results reported in a prior study. Results were reviewed and action plans were developed to improve the rigor of scholarly projects. CONCLUSIONS: The nursing faculty plan to incorporate routine evaluation of scholarly projects into their program evaluation. Other NP programs may benefit from instituting a similar process.

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities.

The COVID-19 pandemic has made birthing more stressful and isolating, which has raised particular concern for populations of birthing people affected by maternal health inequities. Doulas have been proposed as one means of improving health outcomes by providing emotional, physical, and informational support to patients and their families before, during, or after labor. However, the social and economic conditions of the COVID-19 pandemic have posed new challenges for doula care. We conducted thematic analysis on 25 semi-structured interviews with practicing doulas in the United States to explore changes to doula care during the pandemic. Although doulas have faced many challenges in providing virtual and socially-distanced support during the pandemic, the rising use of telehealth among doulas has revealed new coping strategies and opportunities for virtual communication with the doula community. Our findings indicate that doula experiences during the pandemic can inform future doula care practices, particularly for birthing people of color and low-income birthing people.

Mobile Apps as Audience-Centered Health Communication Platforms.

Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms-particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father's Playbook, a mobile app designed to encourage men to be more involved during their partner's pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father's Playbook as a vehicle for their messages.

Examining the Effectiveness of Genetic Counselors' Communication of Variant of Uncertain Significance Results of Breast Cancer Genes.

Receiving a variant of uncertain significance (VUS) result is quite common for individuals who undergo genetic testing. Because VUS results are often unexpected and necessarily complex, they are challenging for genetic counselors to deliver. The current research sought to examine how three specific message features (risk estimate formats, establishment of a future plan, and linguistic agency), and message receivers' intolerance of uncertainty, influenced the effectiveness of genetic counselors' communication of a VUS result. A series of MANCOVAs and multiple regressions suggested that these message features affected message receivers' perception of a genetic counselor's credibility and receivers' uncertainty appraisal and information-seeking intentions. Specifically, establishing a future plan and assigning agency to a VUS result enhanced perceived counselor credibility. When results were presented in a numeric format, assigning agency to counselors resulted in heightened danger appraisal and greater information-seeking intentions. Individuals' intolerance of uncertainty moderated the association between risk formats and uncertainty appraisal. These results have both theoretical and practical implications for communication of uncertainty in the context of genetic counseling.

Missed Empathic Opportunities During Hand Surgery Office Visits.

Background: Empathy (conveyance of an understanding of a patient's situation, perspective, and feelings) deepens the therapeutic alliance and leads to better health outcomes. We studied the frequency and nature of empathic opportunities and physician responses in patients visiting a hand surgeon. We also sought patient characteristics associated with the number of patient-initiated-clues and missed opportunities by surgeons. Methods: For this prospective cohort study, we enrolled 83 new, adult patients visiting 1 of 3 hand surgeons during a period of 4 months. All visits were audio-recorded, and empathic opportunities (patient-initiated emotional or social clues) and physician responses were categorized using the model of Levenson et al. Before the visit, patients completed the Newest Vital Sign health literacy test; 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity function, Pain Interference, and Depression questionnaires; and a sociodemographic survey. Results: Empathic opportunities were present in 70% of hand surgery office visits. Surgeons responded empathically to about half of the opportunities. Patients with limited health literacy and greater symptoms of depression (small correlation; r = -0.29) were less likely to receive a positive response. Response to an empathic opportunity did not affect visit duration. Conclusions: Hand surgeons often miss empathic opportunities. Future research might address the influence of training physicians to address empathic opportunities on trust, adherence, satisfaction, and outcomes.

Increasing Opportunities for Spiritual and Religious Supports to Improve HIV-Related Outcomes for Black Sexual Minority Men.

Given the importance of spirituality and religion in the lives of many Black gay, bisexual, and other Black sexual minority men (SMM) and the need for additional resources to improve HIV outcomes within this population, research on how spiritual and religious support can promote HIV prevention and treatment among Black SMM is greatly needed. We conducted nine focus groups with 52 spiritual and religious Black SMM in Baltimore, Maryland, to explore opportunities for HIV-related programming that incorporates spiritual and/or religious supports. Thematic analysis of the focus group transcripts was conducted using an iterative constant comparison coding process. Participants expressed a desire for more spiritual/religious support in non-church-based settings and identified the use of peer supports, inclusion of prayer and gospel music, and messaging related to the ideas that God is love, the Bible says to treat yourself preciously, and taking care of your health can strengthen your relationship with God as ways in which this could be incorporated into HIV-related programming. Participants living with HIV identified the message of "keeping the faith" as important for maintaining their HIV treatment plans. Participants also expressed a need for parental supports to improve HIV-related outcomes for Black SMM and potentially expand opportunities for spiritual and religious support to Black SMM within the church. Spirituality and religion can influence HIV outcomes for Black SMM, and the strategies identified by Black SMM in this study could aid in designing culturally congruent HIV prevention and treatment programs situated in the community.