Healthcare providers' perceptions of infant physical activity and communication.

BACKGROUND: Healthcare providers (HPs) play a critical role in disseminating information about infant health and development. Two key developmental areas for infants are physical activity (PA) and communication. Few studies have examined HPs views of these topics. Thus, HPs may need support to promote these early development outcomes in infants. Thus, the study explored HPs' perceptions of infant PA and communication. METHODS: A total of 13 HPs with a wide variety of backgrounds were recruited. Zoom semi-structured interviews were based on the Health Belief Model. Deductive content analysis was utilized to analyze data. RESULTS: HPs knew little about PA guidelines. HPs were concerned about an infant's PA because of limited playtime and tummy time. Most HPs advised parents on PA and motor development milestones, with crawling, walking, and tummy time. HPs also wanted to learn about PA measurement tools. PA promotion was hindered by parents' busy schedules, lack of time, and language barriers. Most HPs advised parents on verbal and nonverbal communication. Many HPs were unfamiliar with communication assessment methods and wanted to learn more. CONCLUSIONS: HPs had limited knowledge about PA guidelines and communication measurement tools. Efforts are needed to identify easily accessible ways to educate HPs that could be disseminated to parents.

Differences in knee joint moments between individuals who are living with obesity and those of a healthy weight when negotiating stairs.

BACKGROUND: Individuals who are living with obesity often adopt alternative lower limb walking mechanics compared to persons with a healthy weight. Stair negotiation is a common activity of daily living that, when used consistently with diet and other physical activity, can help promote the reversal of health-related risk factors associated with people who are obese. The purpose of this study was to determine how stair negotiation affects normalized and non-normalized peak knee extension and abduction moments in young adults who live with obesity (BMI between 30 and 40 kg/m2) compared to adults with a healthy weight (BMI between 18.5 and 25 kg/m2). METHODS: Fifteen young adults living with obesity and fifteen with a healthy weight performed stair ascent and descent walking trials on a 3-step instrumented staircase at a self-selected walking speed. A one-way ANCOVA (covariate: gait speed) was used to compare knee moment variables between groups. RESULTS: No significant differences were found between groups in peak knee joint moments normalized to body mass. The individuals living with obesity demonstrated significantly larger non-normalized peak knee extension moments during stair ascent and descent but no differences in the non-normalized peak knee abduction moments for stair ascent or descent. CONCLUSION: Results of this study indicate differences in non-normalized peak knee extension moments between BMI groups. The young age of the obese group may have contributed to minimal differences overall. Future research should determine how these findings differ in an older obese population and how using a handrail would affect these results.

African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska.

Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.

Value of video-based education to enhance infant motor development.

BACKGROUND: Parents play a vital role in promoting infant motor development and physical activity; however, there is little information available to parents on how to support healthy movement. Therefore, the purpose of this study was to assess the feasibility of implementing video-based education to improve infant physical activity and motor development. METHODS: This multiple case study consisted of semi-structured interviews with mothers (n = 12) and early childhood experts (n = 5, e.g., pediatrician, home visitor). Participants watched pre-recorded videos and answered questions which were developed following Bowens and colleagues guide for designing feasibility studies. Data were analyzed using a directed content analysis approach. RESULTS: Most mothers (91.7 %) reported they were highly likely to recommend the videos to others and said the best way to share these videos would be through an app or social media (83.3 %) or health care entities (e.g., hospital, pediatrician, 75 %). Half of mothers (50 %) reported they would be interested in seeing videos once a month or once every couple of months. Further, all experts agreed parents would be somewhat or highly likely to use the videos and a majority (80 %) stated they were highly likely to recommend and share videos like these. Experts' top suggestions for sharing the videos was through an app/social media (40 %) and credible websites (40 %). DISCUSSION: Overall, the videos appear feasible for mothers. Both groups primarily suggested that videos be disseminated through social media, online, or through an app. Future research should engage parents and healthcare providers in developing videos.

Exploring the Benefits, Barriers, and Facilitators of Physical Activity and Interest in Intergenerational Physical Activity Programming Within a Hispanic/Latino Community in the Midwest.

Hispanic/Latino individuals across the lifespan generally do not engage in enough physical activity. Intergenerational programming is an innovative solution that could improve opportunities for physical activity across the lifespan in a culturally relevant manner; however, few studies have explored perceptions of intergenerational physical activity programming among Hispanic/Latino communities. This pre-implementation study aimed to: (a) explore the perceived benefits, barriers, and facilitators of physical activity among an intergenerational sample of Hispanic/Latino community members and stakeholders and (b) assess interest in intergenerational physical activity programming. This qualitative study consisted of a total of eight focus groups (N = 45 participants): Hispanic/Latino youth (2 groups), their parents (2 groups), older Hispanic/Latino adults (3 groups), and community stakeholders who work with older adults (1 group). We used thematic analysis techniques integrating the Framework Method to compare and contrast perspectives between participant groups. We found that all groups identified physical, mental, and/or social benefits to physical activity. Primary barriers included limited physical accessibility, environmental considerations, and time constraints. Primary facilitators included physical accessibility, programming format, environmental supports, and social support. Overall, there was general interest in intergenerational physical activity programming across all groups. Practitioners are encouraged to: (a) be aware of how different age groups may view and respond to program context, fit, and communications; (b) reflect on their capacity for high-quality implementation, and (c) weigh the costs and benefits of various programming decisions. Findings can be used to design culturally, linguistically, and contextually relevant intergenerational physical activity programming and to promote health equity.

Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework.

Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.

Development of a Rural Childcare Professionals Advisory Board Focused on Mental and Physical Well-being.

BACKGROUND: Childcare providers have high rates of stress and obesity, which can have an impact on the care they provide for children. Limited research has described strategies for including childcare providers in the development of well-being initiatives, especially in rural areas. OBJECTIVE: To describe the creation and acceptability of a rural childcare advisory board focused on childcare providers' well-being as well as the acceptability of a well-being summit implemented by the board. METHODS: A collaborative model guided the actions of the advisory board. Acceptability of the board and the summit were assessed via surveys. RESULTS: Key factors contributing to the success of the advisory board included flexibility around the COVID-19 pandemic, evening meetings, and group text messaging. Both the advisory board and well-being summit were deemed acceptable. CONCLUSIONS: Future efforts are focused on offering an annual statewide well-being summit and other interventions. Work is needed to identify sustainable funding sources.

A Convergent Mixed Methods Study to Explore Physical Activity Among Teachers and Children During the Preschool Day.

Preschool teachers are uniquely positioned to impact children's physical activity levels, yet the relationship between teachers' and children's physical activity levels has not been widely investigated. The purpose of this study was to explore preschool teachers' physical activity levels, practices, and perceptions and how this relates to children's physical activity at preschool centers. This convergent mixed methods study included eight teachers and 20 children from four preschool classrooms. Accelerometers were used to measure their physical activity. Pearson correlations were used to explore the relationship between teachers' and children's physical activity levels. Direct observation was used to contextualize children's physical activity while at preschool. Teachers completed a semi-structured interview to explore their physical activity perceptions and practices. On average, teachers and children were physically active for 50.2 ± 9.3% and 29.5 ± 7.0% of their time at preschool, respectively. A significant positive correlation (p = 0.02; r = 0.98) was found between teachers' and children's percent of time at preschool per day in moderate-to-vigorous physical activity. Children mostly engaged in low-intensity activities (stationary play; light walking) during free play both indoors and outdoors and were mostly sedentary during teacher-initiated group times. All teachers stated they had a positive influence on children's physical activity. Teachers commonly reported pain or health conditions as a barrier to their physical activity. There was a positive relationship between teachers' and children's physical activity. More research is needed to confirm this relationship and to explore the impacts of high amounts of occupational physical activity on teachers' health. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-023-01486-8.

A comparison of the perceptions of wearing an ankle foot orthosis by individuals with peripheral artery disease according to their baseline-level of physical activity.

INTRODUCTION: Peripheral artery disease (PAD) is a prevalent cardiovascular disease that limits an individual's ability to walk. One potential way to improve physical activity for patients with PAD is an ankle foot orthosis (AFO). Previous research has found that various factors may influence an individual's willingness to wear AFOs. However, one factor that has been understudied is an individual's baseline physical activity level prior to wearing AFOs. Therefore, the purpose of this study was to compare the perceptions of wearing AFOs for 3 months among individuals with PAD according to their baseline level of physical activity. METHODS: Accelerometer-derived physical activity prior to AFO prescription was used to classify participants into either a higher or lower activity group. Semi-structured interviews were conducted at 1.5 and 3-months after wearing the AFOs to assess participants' perceptions of using the orthosis. Data were analyzed by a directed content analysis approach, then the percentage of respondents for each theme were calculated and compared between higher and lower activity groups. FINDINGS: Several differences were found. Participants in the higher activity group more often reported positive impacts from wearing the AFOs. Additionally, participants who were in the lower activity group more often reported the AFOs caused physical pain while participants in the higher activity group more often reported the device was uncomfortable during daily activities. CONCLUSION: Baseline physical activity levels may help to better understand barriers to wear and needed support to increase adherence to an AFO wear prescription, especially for patients with PAD with limited activity.

Adaptation of digital navigation training for integrated behavioral health providers: Interview and survey study.

Despite effective treatment options, people who experience mental health conditions often do not receive needed care. E-mental health, for instance the use of mobile apps, is emerging as a way to increase access to and extend care. However, little formal training is available to increase the digital literacy level among behavioral healthcare providers (BHPs), seeking to employ such technology. The purpose of this study was to explore the acceptability and usability of an adapted in-person Digital Navigation Training (DNT) curriculum into e-Learning modules focused on the integrated environment for BHPs. BHP confidence to serve as digital navigators was also explored. E-Learning modules were adapted from an existing in-person DNT. A purposeful sampling strategy was used to recruit BHPs (n = 8) to complete the modules. Acceptability, usability, and confidence were assessed via survey and semi-structured interviews. Descriptive statistics were calculated for survey data and qualitative data were analyzed using a directed content analysis approach. BHPs who completed the training (n = 8) felt the modules were usable, enjoyed the structure, and felt the amount of time to complete the modules was acceptable. All participants thought the structure of the training worked well and enjoyed learning new information. While participants' confidence in their digital navigation skills increased, they desired more information and/or experience with screening apps prior to increasing their use of apps within their care. E-Learning modules were an acceptable method of educating BHPs with digital navigation skills. Future research is needed to explore incentives needed for training along with if participating in these modules can increase use of quality mobile apps to augment care within BHP treatment plans.

Supporting the use of technology in the integrated primary care environment, where patients often seek care for mental health conditions requires training. Behavioral Health Providers (BHPs) are members of the integrated team. BHPs are prime candidates to promote engagement of mobile apps within this model of care. Understanding how providing training in an online format to BHPs which supports their ability to incorporate apps into this unique environment is needed. The purpose of this article is to explore the acceptability and usability, and subsequent confidence to serve as a digital navigator, of an adapted in-person Digital Navigation Training consisting of E-Learning modules. E-Learning module content includes education pertaining to digital skills, shared-decision making and mobile app evaluation to facilitate knowledge among BHPs as well as their confidence in digital navigation. Our findings suggest that the online training is acceptable and usable by those who completed the training and improves their confidence to serve as a digital navigator. BHPs suggested quality improvement changes to the training which are being undertaken to include creating a checklist and adding to the mobile app evaluation content. The training can be accessed at https://www.unmc.edu/bhecn/education/m-health-digital-navigation-training-for-integrated-behavioral-health/index.html.

The Effect of a Parent-Directed Program to Improve Infants' Motor Skills.

Poor motor skills are associated with several factors that might delay children's development. Therefore, early programs to promote a child's motor development are essential. Within the first year of life, parents have a critical role in promoting their infant's motor development. However, little research has explored parent-directed programs that promote infant development in a Scandinavian context. This study aimed to evaluate the effectiveness of a parent-directed program to improve infant motor development. METHODS: Parents of infants received a parent-directed program that included guidance from health visitors on ways to promote motor development, videos with motor development activities and a bag with related materials. Two municipalities in Denmark took part in the study (one intervention, one control). Health visitors in both municipalities measured the infants' age-appropriate motor skills once when the infants were between 9-11 months of age. A logistic regression model was used to analyze the data. RESULTS: No difference was detected in motor development over time in the two municipalities regarding the proportion of children with age-appropriate motor skills. CONCLUSIONS: A parent-directed program in which parents were guided to play and encourage motor development with their infant showed no effect on infants' age-appropriate motor skills at 9-11 months.

Maternal-Child Microbiome and Impact on Growth and Neurodevelopment in Infants and Children: A Scoping Review.

BACKGROUND: Pathologic changes in the microbiome (dysbiosis) have been implicated in affecting the growth and neurodevelopment of infants and children. There is evidence to suggest that prenatal and postnatal stressors may be a factor in dysbiosis and there is also a growing body of evidence to suggest that interventions may reduce this negative impact. A scoping review was undertaken to identify association between maternal and/or child microbiome with child growth and neurodevelopment. Additionally, intervention studies such as use of nutritional supplementation and its impact on the microbiome, growth and neurodevelopment were reviewed. METHODS: An exhaustive literature search identified 654 relevant citations. After review of abstracts, 557 were eliminated, and 97 remained for full text review. We identified and reported on 42 articles which met inclusion criteria. RESULTS: Seven studies examined associations between microbiome and neurodevelopment and 36 studies evaluated anthropometric measurements, most commonly weight, and microbiota relationships. One study evaluated both growth and neurodevelopment and microbiota. Fourteen studies evaluated supplemental nutrients. Preterm, low birth weight (LBW), and very low birth weight (VLBW) infants were most studied. Findings were inconclusive for consistent associations between microbiota and growth and neurodevelopment. Further, there were no consistent conclusive changes with prescribed treatment interventions. DISCUSSION: There is a need for high-quality longitudinal studies evaluating repeated developmental assessment measures using consistent microbial analysis techniques to inform conclusions regarding the association between microbiome and infant and child growth and neurodevelopment. Additional intervention studies that may mitigate dysbiosis are warranted.

Long-term use of an ankle-foot orthosis intervention in patients with peripheral artery disease using the integrated promoting action on research implementation in health services (i-PARIHS) framework.

BACKGROUND: Peripheral artery disease (PAD) is a cardiovascular disease that limits patients' walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. PURPOSE: The purpose of the study was to determine the implementation and patients' perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. DESIGN: A convergent mixed methods design was used to evaluate participants' perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. SETTING: Vascular surgery clinic and biomechanics research laboratory. PARTICIPANTS: Patients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. INTERVENTIONS: A certified orthotist fit participants with an AFO that was worn for 3 months. MAIN OUTCOME MEASURES: Qualitative analysis of semi-structured interviews and quantitative analysis of the survey. RESULTS: The highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. CONCLUSIONS: Barriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients' perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject's lifestyle. CLINICAL TRIAL REGISTRATION NO: NCT02902211.

Assessing wear time and perceptions of wearing an ankle foot orthosis in patients with peripheral artery disease.

BACKGROUND: Peripheral artery disease (PAD) is a cardiovascular disease that affects walking ability. An ankle foot orthosis (AFO) may improve walking distances in those with PAD. Little research has explored if those with PAD wear a prescribed AFO and their perceptions of wearing the device. OBJECTIVE: To assess wear time of an AFO and explore perceptions of wearing the device in patients with PAD. DESIGN: Convergent mixed methods. SETTING: The study was conducted through a tertiary care medical center, and the research participants used the device in the community. PARTICIPANTS: Thirty-six patients, all older adult males, were enrolled in this study. Fourteen patients completed the study and 11 supplied sufficient accelerometer data to include in the analysis. INTERVENTIONS: An AFO was worn for 3 months. An accelerometer was placed on the AFO for 7 days at the midpoint (1.5 months) and endpoint of the intervention (3 months) to assess wear time. Semi-structured interviews explored patients' perceptions of wearing the AFO. MAIN OUTCOME MEASURE: The primary outcome measure was wear time measured objectively via accelerometer and subjectively via interview. RESULTS: Patients (n = 14) wore the AFO approximately 8 hours/day. Patients reported barriers such as challenges wearing the AFO during daily household activities (using stairs, being on uneven terrain), discomfort, clothing or footwear issues, and driving challenges. Positive effects of wearing the AFO were also reported, primarily the ability to walk further. CONCLUSIONS: An AFO may be an acceptable therapeutic intervention to improve perceived walking performance in older adult males with PAD. Addressing participants' perceptions of the AFO and barriers to wear are essential to increasing the positive effect the device has on participants' ambulatory activity.

Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska.

Compared to urban residents, rural populations are less likely to engage in colorectal cancer (CRC) screening. As part of a statewide cancer needs assessment, we aimed to elicit rural perspectives about CRC screening and resources. We conducted three focus groups with rural Nebraska cancer survivors and caregivers (N = 20) in Spring 2021 using a collective case study design. Participant awareness of and knowledge about CRC screening methods varied across focus groups; overall, 95% of participants had heard of colonoscopy. Participants were less familiar with fecal tests and had confusion about them. Colonoscopy was associated with negative perceptions regarding the time, cost, and discomfort of the preparation and procedure, but some providers did not discuss alternative methods unless the patient resisted colonoscopy. Healthcare providers played a key role educating rural communities about CRC screening recommendations (age, risk) and testing options and being persistent in those recommendations. CRC awareness campaigns should include a variety of communication channels (TV, radio, billboards, health fairs, churches, healthcare settings). Promotion of CRC screening should include education about screening age guidelines, alternative test types, and informed decision-making between provider and patient regarding preferred screening methods based on the pros and cons of each test type. Individuals with a family history of colon issues (Crohn's disease, CRC) are considered high risk and need to be aware that screening should be discussed at earlier ages.

Addressing and evaluating health literacy in mHealth: a scoping review.

Background: Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development. Methods: A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework. Results: Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was end-user focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. Conclusions: The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.

Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review.

OBJECTIVE: The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings. METHODS: Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance. RESULTS: Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics. CONCLUSIONS: Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.

Qualitative analysis of cancer care experiences among rural cancer survivors and caregivers.

PURPOSE: Rural (vs urban) patients experience poorer cancer outcomes and are less likely to be engaged in cancer prevention, such as screening. As part of a community needs assessment, we explored rural cancer survivors' and caregivers' experiences, perceptions, and attitudes toward cancer care services. METHODS: We conducted 3 focus groups (N = 20) in Spring 2021 in rural Nebraska. FINDINGS: Three patterns of cancer diagnosis were regular care/screening without noticeable symptoms, treatment for symptoms not initially identified as cancer related, and symptom self-identification. Most participants, regardless of how diagnosis was made, had positive experiences with timely referral for testing (imaging and biopsy) and specialist care. Physician interpersonal skills set the tone for patient-provider communication, which colored the perception of overall care. Participants with physicians and care teams that were perceived as "considerate," "compassionate," and "caring" had positive experiences. Participants identified specific obstacles to care, including financial barriers, transportation, and lack of support groups, as well as more general cultural barriers. Survivors and caregivers identified organization-based supports that helped them address such barriers. CONCLUSIONS: Rural populations have unique perspectives about cancer care. Our results are being used by the state cancer coalition, state cancer control program, and the National Cancer Institute-designated cancer center to prioritize outreach and interventions aimed to reduce rural cancer disparities, such as revitalizing lay cancer navigator programs, conducting webinars for primary care and cancer specialty providers to discuss these findings and identify potential interventions, and collaborating with national and regional cancer support organizations to expand reach in rural communities.

Early impact of the COVID-19 pandemic on promotion of infant activity, strength and communication: A qualitative exploration.

INTRODUCTION: Fostering physical activity, muscle strengthening and communication skills in diverse environments are vital to ensuring healthy infant development; however, promotion of these skills may be impacted by the COVID-19 pandemic. Therefore, the purpose of this study was to explore healthcare workers, parents and childcare providers' perceptions of the pandemic's influence on how they engage with infants to promote physical activity, muscle strength and communication. METHODS: 37 subjects (12 = parents; 12 = childcare providers, 13 = healthcare workers) participated in a semi-structured interview. Data were analyzed via an inductive content analysis. RESULTS: The majority of caregivers identified concerns related to: limitations in social interactions (especially masks impacting communication), lack of access to peer modeling, fewer opportunities for physical exploration, and a need for creative activities in diverse environments (e.g., home/childcare) for infant development during and after the pandemic. CONCLUSIONS: Caregivers are concerned about the role COVID-19 is having on infant development. Additional resources on how to promote infant physical activity, muscle strength and communication despite challenges associated with the COVID-19 pandemic are needed.