'Capacity building skills in the implementation of evidence-based practice for community health nurses: an exploratory descriptive cohort study'.

Background: While nurses are strategically placed to support the achievement of universal health, their practice may not always be informed by evidence, especially in a context where research evidence is not commonly used to inform practice.Objective/Aim/Hypothesis: Improve management of clients with CNCDs in Caribbean community through evidence-based practice (EBP) capacity building workshops.Design/Methods: A descriptive, quantitative design was used for this study. Participants included Community Based Nurses who attended an initial and recall workshop on EBP in a Caribbean island. All participants were included as the sample. Data were collected as a Pre-Test and Post Test before the initial workshop and at the recall workshop. Analysis was done quantitatively. Since the sample was small, only descriptive statistics were used.Results: Data showed 64% of participants had no experience with EBP, 55% needed more essential resources to participate in EBP and 55% recognized a need to include EBP to change their clinical practice effectively.Conclusions: The nurses and district supervisors observed a high level of interest and commitment to initiating and completing EBP projects. However, the reality of significant workplace demands, and limitations in consistent logistical and supervisory support impacted long-term sustainability.

Exploring Preventive Health Care Utilization Among Black/African American Men.

Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center.

The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being "somewhat" familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study.

OBJECTIVE: This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients. METHODS: We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model. RESULTS: From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure. CONCLUSIONS: BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.

Application of ADAPT-ITT: adapting an evidence-based HIV/STI mother-daughter prevention intervention for Black male caregivers and girls.

BACKGROUND: Black girls are disproportionately impacted by HIV and sexually transmitted infections (STIs), underscoring the urgent need for innovative strategies to enhance the adoption and maintenance of HIV/STI prevention efforts. Historically, Black male caregivers have been left out of girls' programming, and little guidance exists to inform intervention development for Black girls and their male caregivers. Engaging Black male caregivers in Black girls' sexual and reproductive health may reduce sexual risk-taking and improve the sustainability of preventative behaviors. OBJECTIVE: This paper describes the formative phases, processes, and methods used to adapt an evidence-based mother-daughter sexual and reproductive health intervention for Black girls 9-18 years old and their male caregivers. METHODS: We used the ADAPT-ITT model to tailor IMARA for Black girls and their male caregivers. Diverse qualitative methods (interviews, focus groups, and theater testing) were used throughout the adaption process. RESULTS: Findings support using the ADAPT-ITT model to tailor an evidence-based HIV/STI intervention for Black girls and their Black male caregivers. Findings highlight the importance of community engagement and the use of qualitative methods to demonstrate the acceptability and feasibility of the adapted intervention. Key lessons learned are reviewed. CONCLUSIONS: Adapting evidence-based interventions to incorporate Black girls and their Black male caregivers should be driven by a relevant theoretical framework that aligns with the target population(s). Adapting the intervention in partnership with the community has been shown to improve acceptability and feasibility as it is responsive to community needs. Using a systematic process like the ADAPT-ITT model will ensure that the new program is ready for efficacy trials.

Experiential Training Workshops for Group Antenatal Care in Malawi.

The positive effects of the CenteringPregnancy group antenatal care (ANC) model on perinatal outcomes in the United States has led to its adaptation and implementation in many low- and middle-income countries. Facilitative discussions are a core component of this group ANC model. Facilitator training lays a critical foundation for delivery of this paradigm-shifting model as practitioners learn to adapt their approach to health education from didactive to facilitative. However, there is little rigorous research focused on best practices for training group health care facilitators and none that is guided by a theoretical framework. Kolb's experiential learning theory offers a theoretical framework to guide the development of training workshops that allow trainees to experience, reflect on, and practice the facilitation skills needed to deliver this evidence-based intervention. This article describes an experiential learning-based training workshop that was implemented as part of an ongoing effectiveness-implementation trial of a Centering-based group ANC model in Blantyre District, Malawi. We provide a blueprint for conducting group ANC facilitator trainings that, in addition to imparting knowledge, effectively builds confidence and buy-in to this paradigm-changing approach to ANC delivery. This blueprint can be adapted for use in designing and implementing group health care across settings in the United States and globally.

Preliminary Evaluation of a Citizen Scientist Educational Curriculum Aimed at Engaging Black Men in Lung Cancer Early Detection Screening.

This article describes an educational program to engage African American men as citizen scientists (CSs) and future research partners in a lung cancer screening project. We provide an overview of the curriculum used, the structure and format of the educational sessions, and associated educational outcomes. Furthermore, we describe lessons learned in the engagement of African American men as CS in community-based lung-health equity research. The CS educational program included five group-based sessions delivered through zoom. The educational curriculum was adapted from the University of Florida Citizen Scientist program and tailored to address lung health and the contextual experiences of African American men. Each session lasted 90 minutes. Pre- and post-test measures were collected to examine changes in knowledge, comfort, health literacy, research interests, and medical mistrust. Eight African American men completed the CS educational program. Attendance rates were high for each session (100%). Seven participants completed additional human subject research certification. Improvements were observed from pre- to post-test in participants' level of knowledge, comfort, and health literacy but not medical mistrust. CS reported the most interest in participating in research aimed to identify important community strengths and problems. Study findings suggest that it was feasible to deliver an online citizen scientist educational program designed to prepare participants to serve as partners in a lung cancer screening intervention for African American men. Results suggest the educational program has the potential to improve key outcomes including completion of regulatory training and increased research-related knowledge, comfort, and health literacy.

Strategies to address structural and institutional barriers to success among students of color in nursing programs.

The COVID-19 pandemic and the significant disparities experienced by Black, Indigenous, and people of color (BIPOC) in infections, hospitalizations, and deaths associated with the Coronavirus have underscored the imperative to increase the size and diversity of the healthcare workforce, including nursing. Academically focused pipeline development programs have led to some advances in minority recruitment and retention; however, emerging research highlights the importance of extra-academic factors that reduce the sense of belonging and persistence among underrepresented and minority students. The purpose of this manuscript is to describe the diversity, equity, and inclusion goals and activities of a college of nursing located in a minority-serving institution. Here, we emphasize the description of a range of activities aimed at meeting our diversity goals. Further, we highlight the actions initiated in response to emergent "extra-academic" student needs over the past year related to the COVID-19 pandemic and police brutality. The strategies described have implications for improving diversity, equity, and inclusion among higher education institutions in nursing.

Laying the groundwork for participatory research with a Rohingya refugee community.

Laying the groundwork in preparation for community-based participatory research (CBPR) is critical, particularly for academic-community partnerships with refugees and immigrants who have not yet engaged in CBPR. OBJECTIVE: In this article, we describe the process of developing and nurturing a CBPR partnership between university researchers and a newly arrived Rohingya refugee community, providing background on the community and our collaborative efforts to date. METHOD: Co-occurring, interdependent, and iterative processes related to relationship building, capacity building, and research and informal data gathering helped to develop and promote the partnership. RESULTS: Case study examples illustrate challenges and possible resolutions. CONCLUSIONS: Particularly for newly arrived refugee and immigrant communities, historical disenfranchisement and current stressors can impact how CBPR partnerships are developed and nurtured, thus, ongoing considerations of chronosystemic factors, attending to community-specific priorities while also connecting with other communities, and embracing multiple roles of academic researcher, advocate, and ally, can facilitate CBPR partnership development and future research projects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania.

BACKGROUND: HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS: A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS: Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS: HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

Intimate Partner Violence and the Role of Child Maltreatment and Neighborhood Violence: A Retrospective Study of African American and US Caribbean Black Women.

Background: Research suggests that intimate partner violence (IPV) is associated with childhood maltreatment and violence exposure within the neighborhood context. This study examined the role of child maltreatment and violence exposure on intimate partner violence, with the moderating effects of mental disorders (IPV) among US Black women. Methods: Data from the National Survey of American Life (NSAL), the largest and most complete sample on the mental health of US Blacks, and the first representative sample of Caribbean Blacks residing in the United States was used to address the study objectives. Descriptive statistics, chi-square test of independence, t-test, and logistic regression procedures were used to analyze the data. Results: Bivariate results indicate an association between child abuse and intimate partner victimization among US Black women. Witnessing violence as a child as well as neighborhood violence exposure was also related to IPV but shown to differ between African American and Caribbean Black women. Multivariate findings confirmed the influence of mental disorders and social conditions on US Black women's risk for IPV. Moderating effects of child maltreatment and mental disorders in association with adult IPV were not found. Conclusions: The study addressed the short and long-term impact of child maltreatment and the contribution to the cycle of intimate violence among US Black women including African American and Caribbean Blacks. The study suggests the need for prevention and intervention efforts to improve structural conditions for at-risk populations and communities predisposed to violence and other negative outcomes. Possibilities for future research are also discussed.

A Qualitative Community Assessment of Racial/Ethnic Sexual Gender Minority Young Adults: Principles for Strategies to Motivate Action(s) for Realistic Tasks (SMART Thinking) Addressing HIV/AIDS, Viral Hepatitis, Mental Health, and Substance Abuse.

HIV/STI, substance use, and mental health issues disproportionately affect racial/ethnic sexual minority young adults. These health vulnerabilities intensify across the life course, most notably when young adults are independent college students. To identify the perspectives of racial/ethnic sexual gender minorities living on or near an urban university, we implemented an intersectionality-informed SWOT (strengths, weakness, opportunities, and threats) analysis, as a qualitative community assessment situated within in a campus-community setting. The community needs assessment was the first step in the strategic prevention framework (SPF) to co-locate substance abuse, mental health, viral hepatitis, and HIV prevention care services for Latinx and Black/African American sexual gender minority young adults at a minority-serving institution. The SWOT analysis identified principles for selecting, adapting, and implementing an evidence-based intervention. The significance of these principles demonstrates the value of intersectionality in evidence-based interventions to influence health education and behavior among racial/ethnic sexual gender minorities.

White Paper from a CTSA Workshop Series on Special and Underserved Populations: Enhancing Investigator Readiness to Conduct Research Involving LGBT Populations.

Despite the significant health disparities experienced by lesbian, gay, bisexual and transgender (LGBT) populations, few investigators affiliated with NIH-funded Clinical and Translational Science Award (CTSA) programs are conducting research related to this underserved population. We provide recommendations shared during a half-day workshop aimed at increasing researcher readiness to conduct LGBT research. This workshop was presented as part of a series on conducting research with underserved populations offered by the Recruitment, Retention, and Community Engagement Program of the Center for Clinical and Translational Science at the University of Illinois at Chicago. Six LGBT health research experts provided focused presentations. The workshop presentations included a summary of significant health inequality issues, theoretical models relevant to research on LGBT health, best practices in measuring sexual orientation and gender identity, recommendations for recruitment and retention, a discussion of community engagement, and ethical considerations in conducting LGBT research. We provide a summary of recommendations to guide future research, training, and public policy related to LGBT health. The information can increase capacity among CTSA affiliated researchers in conducting research in this special population.

Intimate Partner Violence May Be One Mechanism by Which Male Partner Socioeconomic Status and Substance Use Affect Female Partner Health.

Background: Although male partners' socioeconomic status (SES) and substance use is associated with worse health of female partners, the mechanism behind this link is still unknown. Objectives: To investigate whether intimate partner violence (IPV) is a mechanism by which male partners' SES and substance use influence female partners' self-rated health (SRH) as victims and survivors of IPV. Materials and Methods: Fragile Families and Child Wellbeing Study (FFCWS) is an ongoing population-based cohort. Male and female partners' SES, anxiety, depression, and substance use, and their relationship status were measured at baseline. IPV victimization was also asked among female partners' at baseline. Female partners' subjective health was measured 3 times (baseline-1998, 3 years later-2001, and 5 years later-2003). Using AMOS, we fitted two structural equation models (SEM) for data analysis. In Model 1 we tested direct paths from male partners' SES and mental health to female partners' SRH, in the absence of IPV. In the Model 2 we conceptualized female partners' IPV victimization between male partners' SES and mental health and female partners' SRH. In both models we controlled for the effect of female partners' SES and mental health. Results: In Model 1, male partners' poor SES and substance use were associated with worse trajectory of SRH of female partner. In Model 2, male to female IPV was the mechanism by which male partners' SES and substance use were associated with female partners' SRH. Conclusions: IPV is one of the mechanisms by which male partners' SES and substance use can influence female partners' health. That is, IPV may operate as a vehicle by which male partners' social and psychological risk factors impact female partners' health. Thus, this study demonstrates how male partners' socio-ecological risk factors such as low SES and substance use impact female partners' health. Therefore, there is a need for broader socio-ecological approach to IPV prevention and intervention that recognizes the relationship between male partners' risk factors and their female partners' health outcomes. Such approach can inform prevention and treatment of IPV and enhance partner wellbeing.

Lessons learned: Evaluating the program fidelity of UNWomen Partnership for Peace domestic violence diversion program in the Eastern Caribbean.

To date, there have been a plethora of punitive and diversion programs to address domestic violence around the world. However, the evaluative scholarship of such programs overwhelmingly reflects studies in developed countries while barely showcasing the realities of addressing domestic violence in developing countries. This paper features a multi-year (2008-2011) evaluation study that measured the fidelity of the United Nations Partnership for Peace (PfP) domestic violence diversion program in the Eastern Caribbean country of Grenada. Our findings illuminate organic engagement strategies that were built within existing multi-sectoral partnerships that included magistrate court judges, law enforcement officials, and social service agencies. Furthermore, we documented how the locally-devised implementation strategies ensured the program's fidelity within a resource-limited context. This paper contributes to the global evaluative scholarship, highlighting the lessons learned about implementing culturally-adapted and theoretically-driven domestic violence diversion within a developing country.

Exposing the culture of silence: Inhibiting factors in the prevention, treatment, and mitigation of sexual abuse in the Eastern Caribbean.

This article features a study that explored the presence of adverse childhood experiences (ACEs), including childhood sexual abuse and neglect, among women associated with Partnership for Peace (PfP), the first and only culturally adapted domestic violence diversion program for men in the Eastern Caribbean. Within a multiyear evaluative study that assessed the impact of the PfP intervention in reducing domestic violence in Grenada in the West Indies, life-history interviews were collected from a subsample of women (N=9) associated with men enrolled in the PfP program between 2009 and 2011. We found that the exposure to sexual abuse and neglect during childhood was evident in the histories of the women. Most perpetrators were trusted family or community members who suffered from a common set of behavioral patterns, most prominently alcohol use. Our findings reflect an evidence-based connection, as one causative factor, of a culture of silence that is related to child sexual abuse and its management. The apparent lasting effects of these traumatic childhood exposures reflect cycles of abuse in the life histories collected during the domestic violence evaluation study. Our study identified three key structural deficiencies (insufficient research, ineffective policy, and lack of public-health interventions) and one embedded cultural norm (the culture of silence) that together "inhibit current attempts to address ACEs as a means of curbing domestic violence in the Caribbean."

Barriers and Facilitators toward HIV Testing and Health Perceptions among African-American Men Who Have Sex with Women at a South Side Chicago Community Health Center: A Pilot Study.

In the United States, African-Americans' (AAs) HIV infection rates are higher than any other racial group, and AA men who have sex with women (MSW) are a significant proportion of new cases. There is little research into AA MSW HIV/AIDS knowledge, barriers, and facilitators of HIV testing in Chicago. We enrolled a convenience sample of AA MSW from a community health clinic who completed self-administered surveys assessing HIV knowledge and testing-related barriers and facilitators. The survey was a combination of questions from several validated instruments, and additional questions were written based on key informant interviews with social scientists to tailor the questionnaire for AA men living on the South Side of Chicago. We recruited 20 AA MSW (mean age 47.4 years). Sixty-five percent had incomes <$10,000/year, 30% were insured, and 50% had post-secondary education. Despite low socioeconomic status, their HIV literacy was relatively high. The identified major barriers to testing were low perceived HIV risk, concerns over privacy, and external stigma at testing sites. Future efforts should focus on educating AA MSW on actual risk for HIV and address issues of privacy and stigma at testing sites.

Patterns of Caribbean Masculinities and Condom Compliance Among Males in Grenada.

The construction of Caribbean male identities based on ideas of masculinity has raised widespread concerns across the island states, and in a region with such high rates of teenage pregnancy (18%), stigmatizing safe sex, contraception, and HIV/AIDS prevalence can only exacerbate the problem. The purpose of this study was to examine the extent to which males use condoms and to explore the association of condom use with their concern with acquiring and transmission of sexually transmitted infections.