Feasibility and acceptability of a community health worker administered behavioral activation intervention for postpartum depression: a single arm pilot study from India.

Introduction: Women in India experience high rates of postpartum depression (PPD), with minimal availability of screening or treatment. India has an extensive network of community health workers, known as accredited social health activists (ASHAs). While they are knowledgeable about most maternal-child health problems, they have minimal knowledge about PPD. We trained ASHAs to deliver a simple home-based intervention, behavioral activation (BA), which involves individuals in activities that are sources of positive reinforcement to counter depression. The research questions guiding this study were as follows: 1) What are the feasibility and acceptability of ASHAs screening for and delivering a brief behavioral activation intervention addressing PPD among women in Belagavi, South India? 2) What impact did the brief behavioral activation intervention have on PPD? Methods: The mixed methods evaluation used interviews with participants and interventionists, and depression scores were assessed before and after the evaluation. After a 2-day training with 17 ASHAs that focused on understanding PPD, screening using the Edinburgh Postnatal Depression Scale (EPDS), and implementing the BA protocol, ASHAs and researcher supervisors screened the mothers 6-12 weeks postpartum presenting at pediatric immunization clinics. Mothers who screened positive were invited to participate in an ASHA-led 5-week BA intervention, with ASHAs visiting the mothers' homes. We assessed post-intervention EPDS scores and conducted satisfaction assessments and individual interviews. Results: All 26 women who screened positive on the EPDS agreed to be enrolled in the study. All participants had a significant reduction (p < 0.001) in PPD scores. Both ASHAs and mothers had high enthusiasm for the intervention methods and activities. Discussion: This ASHA-delivered BA intervention was found to be feasible, acceptable, and effective in treating PPD in rural Indian mothers. This corroborates literature that demonstrates the efficacy of a BA intervention among individuals with generalized depression in South Asia. In communities with minimal mental health resources, interventions led by trained community workers have the potential to address PPD.

Addressing diversity, equity, and inclusion: A response of professional nursing organizations to the future of nursing: 2020-2030 recommendations.

One way in which professional nursing organizations have chosen to address the social determinants of health (SDoH) is through policy work focused on diversity, health equity and anti-racism activities. The recent report, Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (FON 2020-2030), calls on professional nursing organizations and/or nursing coalitions to focus on addressing the SDoH to mitigate health inequities, including a focus on addressing racism and promoting practices to ensure the diversity of the nursing workforce. While these recommendations highlight issues of high importance to nursing and the broader society, they assume that professional nursing organizations or coalitions have not been sufficiently engaged in this work to date. Our goal was to better understand the current and/or ongoing activities of professional nursing organizations around their anti-racism work of diversity, health equity, and inclusion (DEI) activities recommended in the FON 2020-2030 report. To address this goal, we conducted a needs assessment of professional nursing organizations to document their DEI activities and the timing of these activities relevant to the recommendations in the report. The 26 responding organizations indicated they had been engaged in work addressing DEI issues for periods ranging from 4 months to 51 years. Minimal funding was the major barrier to advancing this work. Creating a vigorous shared DEI agenda across the profession, as suggested in the FON 2020-2030 report, will require input from nurses across the profession, as well as identification of resources to support this critical endeavor.

Breastfeeding interventions and programmes conducted in Portuguese-speaking sovereign states: A scoping review.

AIM: This scoping review aimed to identify and appraise the effectiveness and impact of breastfeeding promotion interventions conducted across Portuguese-speaking sovereign countries. METHODS: Using the PRISMA-ScR guidelines, we searched 14 electronic databases for publications published through 31 July 2023. The search terms were designed to find studies promoting breastfeeding or exclusive breastfeeding in pre-defined Portuguese-speaking countries. RESULTS: Of the 5263 papers initially retrieved, 30 interventional studies on breastfeeding met the inclusion criteria across three countries: Brazil (N = 26), Portugal (N = 2) and Guinea Bissau (N = 2). Participants ranged from pregnant women, mothers, mother-infant pairs, healthcare professionals, and school children. Overall, the interventions increased exclusive breastfeeding and better breastfeeding practices, such as a higher duration of breastfeeding. The interventions positively affected maternal breastfeeding self-efficacy, knowledge and perception. Only four studies used a theoretical framework. CONCLUSION: While the results were often statistically significant, no study had an outcome close to the recommended UNICEF and WHO goal of 70% breastfeeding at six months. The need to determine what works for the recommended six months postpartum period is critical for maximising children's health in Portuguese-speaking countries.

Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use.

BACKGROUND: The wide availability of routine screening with Papanicolaou (Pap) tests and vaccinations against human papillomavirus has resulted in a decline in rates of cervical cancer. As with other diseases, however, disparities in incidence and mortality persist. Cervical cancer, is found more often, at later stages, and has worse outcomes in people who live in rural areas, identify as Black or Hispanic, and in people who are incarcerated. Studies report 4-5 times higher rates of cervical cancer incidence in people detained in jails and prisons than in community-based samples. Studies to explain cervical cancer differences have been inconclusive, though there is broad consensus that issues of access play a role. In this study, we sought to learn more from people who have a history of criminal-legal system involvement and substance use about what barriers and facilitators they perceive in accessing cervical cancer preventive health and other support services in the community. RESULTS: We conducted semi-structured interviews with open-ended questions by telephone with 20 self-identified women, ages 22-58, in Birmingham, Alabama. Interviews were audio recorded and transcribed and the transcripts analyzed using immersion-crystallization techniques. Our team identified two main themes, making connections: the importance of interpersonal communication, which stressed barriers and facilitators related to what makes for effective and humanistic interactions in cervical health prevention and other services, and getting it done: the logistics of access and availability, which highlighted elements of cost and payment; scheduling; transportation; and clinic policies. CONCLUSIONS: People with a history of criminal-legal system involvement and substance abuse meet with a variety of enabling and impeding factors at personal and interpersonal as well as systemic levels in obtaining cervical health services. To better ensure that women in this high-risk group have equitable access to cervical cancer prevention and treatment-and thus better cancer outcomes-will require multilevel efforts that include an emphasis on improving the human connection in health care encounters and improving the nuts-and-bolts logistics related to accessing that care.

Experiences of peer counsellors in supporting exclusive breastfeeding in southern India: An exploratory qualitative study.

OBJECTIVE: Peer counsellors are effective in addressing a variety of health challenges, including exclusive breastfeeding (EBF). Providing education and support from a person of similar background and experience has been an important adjunct to the practice of health workers for the past 50 years. DESIGN: It is an exploratory qualitative study. POPULATION OR SAMPLE: Twenty-two peer counsellors. SETTING: In-depth Interview in the community. METHODS: To better understand the experiences of these important health workers, we conducted qualitative interviews with 22 peer counsellors who participated in a research study in Belagavi District, Karnataka, India. Transcripts of the interviews were organised and assigned codes by the research team. MAIN OUTCOME MEASURES: Experience of Peer counsellor's role in the community to improve breastfeeding practices. RESULTS: Peer counsellors had a good understanding of the larger study and of their role. Analysis of the transcripts identified three themes: personal satisfaction; the effect on the larger circle of family and community; and ideas for future programming. The positive experiences and the ability of peers to be trained in counselling women around EBF support their use in breastfeeding support and other areas of health education. CONCLUSIONS: The women from the community who served as peer counsellors were enthusiastic and satisfied about their work, which provided them with opportunities to do meaningful community work outside of their household routines. Use of the peer counsellor model to deliver a specific objective like improvement in EBF rates, immunisation or mental health in integration with healthcare providers can help in achieving desired goals.

Case example of a jail-based cancer prevention clinical trial: Social determinants of health framework, novel experimental design, and retention strategies to facilitate long-term follow-up of clinical trial participants.

Clinical trials conducted with incarcerated populations are rare. We present a case example of one such jail-based cancer prevention clinical trial to demonstrate the importance of including a theory-driven approach to intervention framing, novel experimental designs to boost access to low-risk trials, and retention strategies for long-term follow-up of hard-to-reach populations. As such we offer a social determinant of health framework to ensure cancer prevention research is conducted through the lenses of health promotion and health equity. Deviations from the gold-standard randomized control design, transparent systematic allotment, and street-based outreach retention strategies contribute to the feasibility of conducting clinical trials in carceral settings and after people leave jail. Best practices presented can be used in design and conduct of future clinical trials with criminal legal system-involved populations.

Menstrual Equity in the Criminal Legal System.

Background: Menstrual equity, that is, access to menstrual products and safe menstruating environments, is a basic human right not available to many vulnerable populations. Methods: We conducted a cross-sectional survey with a convenience sample of women involved in the criminal legal system to document experiences with access to hygiene and menstrual products while incarcerated. Results: Of the 156 respondents, 62.6% had to trade or barter to receive even basic hygiene products such as soap or shampoo; food and personal favors were used as the common currency. More than half (53.8%) received less than five menstrual products at intake/initial processing; 29.5% had to trade or barter menstrual hygiene products. Almost one-quarter (23.1%) suffered negative health consequences from prolonged use of products because of limited supply. Discussion: Findings document the lack of menstrual equity among women involved in the criminal legal system. Assuring the human right of menstrual equity in this population requires changes at the legal, the policy, the institutional, and the individual level.

A Qualitative Exploration of the Use of Service Dogs in Veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury.

Objective: This qualitative research was conducted to add to the body of knowledge that supports the benefits of service dogs (SDs), as a tertiary treatment modality, to veterans with post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Methods: This grounded theory research design utilized open-ended, semi-structured interviews with veterans (n = 10) who were using SDs as a treatment modality for PTSD and/or TBI. Transcripts were analyzed using NVivo qualitative software until data saturation was achieved. Results: Results from the data analysis identified 4 major themes with concurrent subthemes. The most prominent themes were functional status, impact of a SD, recognition of symptoms of PTSD and/or TBI by the SD, and barriers and challenges to the acquisition of a SD. Participants reported that the SD increased socialization and was a positive adjunct to treatment modalities for PTSD and/or TBI. Conclusions: Our study highlights the benefits of using a SD as a tertiary treatment for PTSD and/or TBI in veterans. Veterans in our study articulated the benefits of using a SD as a tertiary treatment option, and the need to make this a standard treatment option for all veterans who suffer from PTSD and/or TBI.

Creating an Agenda for Black Birth Equity: Black Voices Matter.

Background: The grim inequity that Black women and infants are more than twice as likely to die during birth than their white counterparts is a public health crisis. Methods: Guided by principles of critical race theory, we used content analysis to analyze the themes of the presentation made by five Black community members on a 2020 Juneteenth panel, a holiday celebrating the emancipation of those who had been enslaved in the United States. Results: Panelists sparked the conversation by unpacking the traumatic experiences of health inequities and structural racism on Black families and diverse caregivers. As a part of qualitative content analysis, four major themes emerged: (1) the matrix of domination, (2) specific oppressions of the health care system, (3) empowerment reconceptualized, and (4) dimensions of racism. Participants also discussed how racial disparities may have exacerbated the complexities and challenges of elevating Black voices and creating birth equity. Discussion: Based on Black families' experiences, four areas must be addressed: health care system's policies of oppression that create barriers to listening to Black women, reconceptualizing retention for providers of color and support for Black women and their families, and racism.

Postpartum Depression in India: Perceptions by Key Stakeholders.

While postpartum depression (PPD) rates in India are among the highest in the world, screening and treatment is minimal. Socio-cultural issues including perceptions of stakeholders play role in this treatment gap. Efficient identification and treatment of women experiencing PPD has great importance for not only maternal, but infant outcomes. Infants born to mothers with PPD have a higher likelihood of lower birth weight, breastfeeding, maternal-infant bonding, and even cognitive delays throughout childhood. With the goal of improving maternal mental health outcomes, researchers conducted group and individual interviews with 26 stakeholders working with peripartum women in India to explore social perceptions of PPD. Analysis followed the social ecological model (SEM). Three themes were found: low awareness, minimal resources, and traditions and customs. Conclusion: Findings of this research can be used to develop interventions based on the three themes and their relation to the facets of the SEM framework.

A training curriculum for an mHealth supported peer counseling program to promote exclusive breastfeeding in rural India.

BACKGROUND: Despite strong evidence about the benefits of exclusive breastfeeding, that is the baby receiving only breast milk, no other foods or liquids, rates have remained relatively unchanged over the past two decades in low- and middle-income countries. One strategy for increasing exclusive breastfeeding is through community-based programs that use peer counselors for education and support. The use of mobile health applications is also gaining increasing applicability in these countries. Minimal information is available about training peer counselors in the use of mobile technologies to support exclusive breastfeeding. The present article describes our curriculum in the state of Karnataka, India for supporting new mothers to exclusively breastfeed using a mobile health application in rural India. METHODS: Twenty-five women from the community surrounding the city of Belgavi, Karnataka, India were trained to be peer counselors and to use a mobile health application to conduct a structured curriculum to support new mothers in exclusive breastfeeding. The three-day interactive training, conducted in March 2018, was based on the WHO breastfeeding course, translated, and adapted to the local culture The curriculum, which included information collected during a formative research process, consisted of eight visits, two during the antenatal period and continuing for six months postpartum. Twelve nursing and obstetric experts validated curriculum content. Pre-post-evaluation of the training focused on breastfeeding knowledge, self-efficacy, skills, and app usability. RESULTS: We observed a significant increase in the mean scores for knowledge (P < 0.0001) and skills (P = 0.0006) from pre- to post-training. Age of the peer counselors and their own breastfeeding experience correlated significantly with the acquisition of knowledge and skills. The mobile health app showed high usability scores. CONCLUSIONS: The culturally adapted curriculum presented here, combined with an mHealth app, can be an important educational strategy for training rural women in the acquisition of exclusive breastfeeding knowledge and skills.

Jail Provision of Pregnancy and Sexual Health Services in Four Midwestern States.

OBJECTIVE: Women incarcerated in local jails have pregnancy and sexual health needs, yet little information is available about what services are provided and how jail administrators prioritize this care. Our objective was to document jails' provision of pregnancy and sexual health services in four states in the Midwest. METHODS: We invited all jail administrators (N = 347) in Kansas, Missouri, Iowa, and Nebraska to participate in a web-based survey conducted from November 2017 to October 2018. We asked administrators which pregnancy and sexual health services they offered and to rate the importance of offering services. Results were analyzed using descriptive statistics and logistic regression. RESULTS: The survey response rate was 55% (192/347). Jails most often provided pregnancy testing (n = 116 [60%]) and distribution of prenatal vitamins (n = 85 [44%]). Sexually transmitted infection treatment was offered at 23% of jails (n = 45). Larger, accredited jails located in urban areas and with high numbers of clinical providers on staff were more likely to provide sexual health services. Jails with privately contracted health care were more likely to provide pregnancy services compared with other entities providing medical care. The most prioritized sexual health service was sexually transmitted infection testing, with 39% of administrators believing it was important. Only 6% of administrators responded that contraception was important. CONCLUSIONS: Local jails in the Midwest do not meet the basic reproductive and sexual health needs of women. Provision of these services is not a priority for jail administrators. Appropriate partnerships could engage administrators and increase the availability of services to meet the needs of women in jail.

A Scoping Review of Digital Health Interventions to Promote Healthy Romantic Relationships in Adolescents.

Despite a robust field of study in healthy romantic relationship education and risk prevention interventions that employ traditional forms of delivery, the field of digital health interventions (DHIs) in healthy relationship programming for adolescents remains undefined. The purpose of this scoping review was to summarize the scope of published research in DHIs that promote healthy romantic relationships in adolescents. We conducted database searches, 2000-2022; hand searches; reference list and literature review searches, and emailed study authors to identify articles. Included were experimental, development, and feasibility studies. We summarized features of selected studies and their healthy relationship aims/components and identified patterns of emphasis and areas of future need. Sixteen publications describing 15 unique DHIs were reviewed with interventions developed and or trialed in 11 countries. We identified 10 web-based or downloadable applications, four serious game applications, one video-voice program, and one social media-based program. DHIs focused on improving knowledge/attitudes/skills of healthy adolescent romantic relationships directly or through prevention-focused programs. Interventions that measured outcomes found small effects, primarily in healthy romantic relationship communication skills. DHIs offer unique opportunities to provide user-responsive and culturally specified programming for adolescents and to involve adolescents themselves in processes of program design, development, and evaluation. Further research is warranted to define relevant outcomes for adolescents and validated measures to evaluate them. Future research might seek to address the social ecology of adolescent romantic relationships beyond the individual and interpersonal and explore combinations of virtual and adult-moderated in-person delivery to ensure youth are adequately supported.

Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study.

BACKGROUND: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. OBJECTIVE: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. METHODS: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby's design and development, including the app's content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby's usability from the PCs' perspective was assessed using the translated System Usability Scale (SUS). RESULTS: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. CONCLUSIONS: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group's EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. TRIAL REGISTRATION: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725.

Nurse Mentorship to Support Healthy Growth of Adolescent Girls.

Adolescent girls from many urban communities are a vulnerable population, with high rates of school dropout, pregnancy, sexually transmitted infections, and substance use disorders. Mentorship programs can support the growth and development of this at-risk population. We report on the content of a pilot girls' empowerment program created by nurse faculty to promote health and self-awareness among underserved adolescent girls. Pre/post program scores of 15 participants using the Harter Self-Perception Profile for Adolescents found positive changes in seven of eight domains: scholastic (p = 0.001), social (p = 0.001), appearance (p = 0.001), job competence (p = 0.003), conduct (p = 0.02), close friendship (p = 0.006), and self-worth (p = 0.001). Nurse faculty and students might consider the development of similar mentorship programs for adolescent girls. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 15-18.].

Developing a Cancer Prevention Health Education Resource: a Primer of Process and Evaluation.

Limited women's health and cancer prevention materials are available that have been validated for vulnerable populations. Such materials are especially important for groups, which have intermittent and typically low-quality healthcare access and are at greatest risk for missing out on women's health and cancer prevention screening. Health education materials are developed from heterogeneous sources. Clinical and research teams have minimal guidance in terms of sources, timelines, outputs, and evaluation in the development of such materials. The goal of this paper is to share our process in developing and evaluating an up-to-date women's health and cancer prevention learning guide appropriate for a target population of women involved in the criminal justice system. A ten-page learning guide was drafted using the current evidence-based data, with the objective of providing educational material on four topics: cervical cancer, breast cancer, sexually transmitted infection, and unintended pregnancy prevention. The learning guide was then tested on a convenience sample of 33 women at a local county jail. Feedback was organized into three parts in which the participants Responded to open-ended question, "What is missing?" Rated each of the four topics for design and content Completed a usability assessment Common themes were participants' interest in learning about side effects of birth control and wanting more information on testing and treatment, specifically for sexually transmitted infections (STIs). Women were satisfied with the cancer prevention information presented to them. This report provides a framework for cancer prevention researchers who are developing health education materials for vulnerable populations.

Feasibility, acceptability, and preliminary impact of an mHealth supported breastfeeding peer counselor intervention in rural India.

OBJECTIVE: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF). METHODS: In this quasi-experimental pilot study, participants received either the intervention plus usual care (n = 110) or usual care alone (n = 112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. Progress notes and surveys were used to assess feasibility. Logistic regression models were used for between-group comparisons of optimal infant feeding outcomes, including EBF for 6 months. RESULTS: The intervention was delivered as intended, maintained over the study period, and had high acceptability ratings. There were statistically significant differences in all outcomes between groups. The intervention group had a significantly higher likelihood of EBF at 6 months compared to the control group (adjusted odds ratio 3.57, 95% confidence interval 1.80-7.07). CONCLUSION: Integration of mHealth with community-based peer counselors to educate women about EBF is feasible and acceptable in rural India and impacts maternal breastfeeding behaviors.

Getting started in jail, prison, and legal system research.

Extensive health inequities exist for persons with criminal-legal involvement in the USA. Researchers, both novice and experienced, are critical in documenting these inequities and implementing programs that address the many health and social problems of this population. However, working with currently or formerly incarcerated persons brings new challenges to researchers that may have not been previously considered as necessary. Because incarcerated persons were systemically exploited by biomedical researchers until reform following the Civil Rights Movement, resulting in their designation as a vulnerable population in the Code of Federal Regulations, enhanced protections are necessary in implementing contemporary research involving incarcerated persons. These enhanced protections can delay or prolong the regulatory approval process, particularly to the novice carceral system researcher, which may discourage some from engaging with this important population. Drawing on the many years of experience working with incarcerated persons accumulated by the Sexual Health Empowerment (S)HE Team at the University of Kansas Medical Center (KUMC), this article offers some concrete steps toward getting started in this work.