Narrative Sense-Making During COVID-19: Using Stories to Understand Birth in a Global Pandemic.

Women who gave birth in the spring and summer of 2020 contended with a host of challenging factors. In addition to facing pregnancy, labor, and delivery during an emerging global pandemic, women grappled with health care restrictions that altered their birth experience. To explore how women made sense of their birth during COVID-19, we analyzed written narratives from 71 women who gave birth in the United States from March to July 2020. Based on tenets of communicated narrative sense-making, the themes that emerged from our data suggest that women framed the role of the pandemic as either completely overshadowing their birth experience or as an inconvenience. Women also wrote about threats to their agency as patients, mothers, and caregivers, as well as the evolving emotional toll of the pandemic that often prompted feelings of fear and sadness, along with self-identified anxiety and depression. We discuss these findings in light of the literature on birth stories as essential sites of narrative sense-making for women and their families.

'We need a culture change': military sexual trauma through the lens of rape culture.

Military sexual trauma remains a critical concern within the US military. One possible explanation for the persistence of this trauma is the presence of rape culture. This study examined perceptions of military sexual trauma within the framework of rape culture (i.e. traditional gender roles, sexism, adversarial sexual beliefs, hostility toward women, and acceptance of violence), in addition to associated factors, to address the US Department of Defense's call to focus on the role of culture on military sexual trauma. Focusing on culture is important as subtle norms in culture shape our behaviour and impact the excusal/perpetration of military sexual trauma. Identifying these norms may provide insight into factors to target in prevention efforts to reduce/eliminate military sexual trauma. Forty-two US service members responded to a series of open-ended questions. Standard content analysis procedures were utilised to determine themes. Results paint a complex picture of military sexual trauma, with participants demonstrating concern regarding military sexual trauma, but minimal acknowledgement of behaviour change to reduce military sexual trauma. These results are consistent with the observed increase in prevalence of military sexual trauma and decrease in reporting of it since 2018. Adding to the existing literature, participants noted the continued existence of rape culture within the military and the need for cultural change to address military sexual trauma.

Looking out for You and Me: College students' Strategies for Preventing Sexual Assault in Drinking Contexts.

Background: Sexual assault and heavy alcohol use are prevalent and interrelated public health concerns on university campuses. Surprisingly, however, few alcohol harm reduction interventions address this intersection to help students reduce both personal and community risks for sexual assault in college drinking contexts. Objectives: In the current study, students (ages 18-24) shared strategies they use to protect themselves and others from sexual assault in college drinking contexts, as well as challenges to implementing these strategies. A series of six focus groups were conducted across two universities in the U.S. (N = 35). Participants responded to open-ended questions focused on drinking and sexual assault (e.g., What are some of the things students might do to avoid or address situations where they feel pressured of coerced to hook up or have sex when they do not want to?). Results: Thematic analyses demonstrated students' awareness of protective behavioral and bystander intervention strategies that could help reduce vulnerability to experience sexual assault for themselves or others in drinking contexts. Perceived barriers to using bystander intervention strategies included student's own and friends' heavy drinking (decreased inhibitions, loss of autonomy), ambiguity in deciphering risk (lack of familiarity, minimization, diffusion of responsibility), and gender (gender norms, power imbalances). Conclusions: This study informs the development of interventions that help students identify strategies and overcome barriers to reduce risks for sexual assault in college drinking contexts.

Towards Understanding Disparities in Using Technology to Access Health Care Information: African American Veterans' Sociocultural Perspectives on Using My HealtheVet for Diabetes Management.

The digital divide, a racial disparity in computer and internet use, persists among Veterans. This study examined African American Veterans' experiences with and attitudes about using My HealtheVet (MHV), the online patient portal used in the Department of Veterans Affairs (VA) health care system. Semi-structured interviews were conducted with 35 non-Hispanic African American Veterans about preferences for health information, use of web-enabled devices, and experiences with and preferences for using MHV. Twenty-nine men and 6 women, ranging 35 to 73 years old, participated in this study. About 75% (n = 26) had completed some college or more, and about 75% (n = 26) considered their families financially comfortable. Ninety-one percent (n = 32) of participants were aware of MHV, and 78% (n = 25) of those who were aware reported having enrolled for an account. Data revealed participants valued that MHV provided realistic solutions to cumbersome aspects (e.g., phone call hold-times) of receiving care at the VA. However, participants admitted to not using the patient portal at all or to its full potential for two reasons: a) preference for their pre-MHV routine, b) distrust in the institutional, technological, and organizational aspects surrounding MHV. By highlighting the sociocultural aspects of patient portal use, this study provides a meaningful explanation for barriers and facilitators of health information technology adoption, particularly for MHV among African American Veterans, and ways practitioners may influence uptake.

"It Made Me Not Want to See him ": The Role of Patient-Provider Communication in Influencing Rural-Dwelling Women Veterans' Motivation to Seek Health Care for Managing Chronic Pain.

Despite being high health care utilizers, many women Veterans perceive their pain condition to be poorly understood by their providers, which can be a strong demotivator for seeking care. We set out to understand the priorities rural-dwelling women Veterans have for using health care for their chronic pain, and interviewed participants about their experiences with (and priorities for seeking) health care for their chronic pain. Self-Determination Theory identifies three sources of motivation (autonomy, competence, relatedness), all of which were represented through two themes that reflect rural women Veterans' rationale for decision-making to obtain health care for chronic pain: role of trust and competing priorities. Women described their priorities for chronic pain management in terms of their competing priorities for work, education, and supporting their family, but most expressed a desire to function in their daily life and relationships. Second, women discussed the role of trust in their provider as a source of motivation, and the role of patient-provider communication skills and gender played in establishing trust. Rural women Veterans often discussed core values that stemmed from facets of their identity (e.g. gender, military training, ethnicity) that also influenced their decision-making. Our findings provide insight for how providers may use Motivational Interviewing and discuss chronic pain treatment options so that rural-dwelling women Veterans feel autonomous, competent, and understood in their decision-making about their chronic pain. We also discuss importance of acknowledging the effects of disenfranchising talk and perpetuating gendered stereotypes related to chronic pain and theoretical implications of this work.

"I'm Not Comfortable With COVID, But ": Dilemmas and Decision-Making to Mitigate Risks Among Mothers Who Gave Birth During the COVID-19 Pandemic.

Individuals have faced unprecedented uncertainty and risk surrounding the COVID-19 pandemic, and decision-making dilemmas have been complicated by quickly evolving and often contradictory recommendations for staying healthy. Using tenets of problematic integration theory and risk orders theory, we analyzed interview data from 50 mothers who gave birth during the pandemic to understand how uncertainty and risk perceptions shaped their decision-making about keeping themselves and their infants healthy in the first year after birth. Results describe how some mothers in our sample made sense of their decision-making to prioritize first-order risks to their own and their family's physical health, and other mothers prioritized second-order risks to their relationships and identities. We also discuss the social nature of mitigating risk during the COVID-19 pandemic and the catalysts for shifting risk perceptions. Theoretical and practical implications include improving public health messaging and clinical conversations to enable individuals to effectively manage social and identity needs alongside serious threats to physical health.

My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity.

BACKGROUND: Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. OBJECTIVE: We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. DESIGN: We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. PARTICIPANTS: Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. KEY RESULTS: Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. CONCLUSIONS: Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.

The grey zone of collegiate sexual regret: questionable consent and sexual victimisation.

Research identifies sexual regret as the most common source of regret in the USA; however, few studies have explored this phenomenon. This study utilised a mixed-methods approach to explore sexual regret in a sample of 189 US college students. Quantitative analyses assessing who is most likely to experience sexual regret revealed no significant differences in experiences of sexual regret based on most demographics; however, individuals involved in fraternity and sorority life and/or college athletics were significantly more likely to report experiences of sexual regret. Additionally, students who reported experiences of sexual victimisation were more likely to report experiences of sexual regret. Qualitative analyses attempting to determine students' reasoning for experiencing sexual regret revealed five distinct content areas: 1) altered judgement, 2) motivations, 3) partner characteristics, 4) social judgement, and 5) unsatisfying or unpleasant sexual experiences. Results from both quantitative and qualitative analyses demonstrate significant overlap between experiences of sexual regret and sexual victimisation, highlighting the importance of future research and programming regarding sexual regret to increase understanding of the complex relationships between sexual consent and sexual behaviour.

Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial.

BACKGROUND: Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resources. OBJECTIVE: To test a peer coach-delivered pain self-management program for chronic pain. DESIGN: Randomized controlled trial. PARTICIPANTS: Veterans with chronic musculoskeletal pain. INTERVENTION: Intervention patients were assigned a trained peer coach for 6 months. Coaches, who were volunteers, were asked to contact their assigned patients, either by phone or in person, twice per month. Coaches and patients were given an intervention manual to guide sessions. The control group was offered a 2-hour pain self-management class. MAIN MEASURES: The primary outcome was total pain, assessed by the Brief Pain Inventory (BPI). Secondary outcomes were anxiety, depression, pain catastrophizing, self-efficacy, social support, patient activation, health-related quality of life, and healthcare utilization. Outcomes were measured at baseline, 6 months, and 9 months. KEY RESULTS: Two hundred fifteen patients enrolled (120 intervention, 95 control). Adherence to intervention protocol was low, with only 13% of patients reporting having at least the recommended 12 peer coach meetings over the 6-month intervention. BPI total decreased from baseline to 6 months and baseline to 9 months in both groups. At 9 months, this change was statistically significant (intervention, - 0.40, p = 0.018; control, - 0.47, p = 0.006). There was not a statistically significant difference between groups on BPI at either time point. No secondary outcomes improved significantly in either group after adjusting for multiple comparisons. CONCLUSIONS: Patients randomized to peer support did not differ from control patients on primary and secondary outcomes. Other peer support models that do not rely on volunteers might be more effective. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02380690.

Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers.

New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (n = 23, 45%) communicate results to patients by phone. Most clinics (n = 47, 92%) notify patients of results in two weeks or less. For cotesting, 70% (n = 36) always communicate Pap/HPV results at the same time. The majority of clinics (n = 42, 82%) explain the type of abnormal Pap test, while only 43% (n = 22) discuss the cervical cancer risk as indicated by the HPV test result. Even though 98% (n = 48) of participants rated their communication strategy as effective, qualitatively participants acknowledged difficulties in communicating cotesting results with their often transient and low health literate patients populations. These results indicate considerable variation and potential deficits in clinical communication of cotesting results in FQHCs, but several promising communication strategies were identified that may inform improved screening communication for other clinics.

Comparing Prevalence and Correlates of Intimate Partner Sexual Victimization Relative to Other Victim-Offender Relationships in College Students.

Research on sexual victimization (SV) in college women often focuses on perpetration by nonpartners thus, little is known about SV by intimate partners on college campuses. To address this gap in the literature, the current study compared prevalence and revictimization rates and negative correlates of SV based on victim-offender relationship. Findings suggest higher prevalence rates of SV perpetrated by a nonpartner compared to an intimate partner although similar and alarming rates of revictimization. Regarding negative correlates of SV, no differences were identified based on victim-offender relationship; however, victims of SV by both an intimate partner and a nonpartner demonstrated the highest negative correlates. These findings demonstrate the importance of addressing SV by nonpartners and intimate partners and the necessity for tertiary prevention efforts to decrease revictimization.

Comparison of Adding Treatment of PTSD During and After Shelter Stay to Standard Care in Residents of Battered Women's Shelters: Results of a Randomized Clinical Trial.

This study explored the acceptability, feasibility, and initial efficacy of an expanded version of a PTSD treatment developed for residents of battered women's shelters, Helping to Overcome PTSD through Empowerment (HOPE) in women who received standard shelter services (SSSs). A Phase I randomized clinical trial comparing HOPE + SSSs (n = 30) to SSSs (n = 30) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (Blake et al., 1995) and the Revised Conflict Tactic Scales (Straus, Hamby, Boney-McCoy, & Sugarman, ). Participants were followed at 1-week, and 3- and 6-months posttreatment. Only 2 women dropped out of HOPE + SSS treatment. Latent growth curve analyses found significant treatment effects for PTSD from intimate partner violence (IPV) (ß = -.007, p = .021), but not for future IPV (ß = .002, p = .709) across follow-up points. Significant effects were also found for secondary outcomes of depression severity (ß = -.006, p = .052), empowerment (ß = .155, p = .022), and resource gain (ß = .158, p = .036). Additionally, more women in HOPE + SSSs were employed at 3- and 6-month follow-up compared to those in SSSs only. Results showed the acceptability and feasibility of adding IPV-related treatment to standard services. They also suggested that HOPE may be a promising treatment for residents of battered women's shelters. Further research with a larger sample, utilizing more diverse shelter settings and a more rigorous control condition, is needed to confirm these findings.

Conceptualizations of interprofessional communication in intensive care units: findings from a scoping review.

BACKGROUND: Clinical errors in intensive care units (ICUs) are consistently attributed to communication errors. Despite its importance for patient safety and quality in critical care settings, few studies consider interprofessional communication as more than the basic exchange of information. METHODS: We conducted a scoping review of interprofessional communication in ICUs to (1) characterize how communication is defined and measured and (2) identify contributions the field of health communication can make to team communication in ICUs. Through a series of queries in PubMed and Communication and Mass Media Complete databases, we identified and compared persistent gaps in how communication is framed and theorized in 28 publications from health services and 6 from social science outlets. We identified research priorities and suggested strategies for discussing communication more holistically in future health services research. RESULTS: 34 articles published from 1999 to 2021 were included. Six explicitly defined communication. Six were published in social science journals, but none were authored by a communication studies scholar. Half of the articles addressed communication as a transaction focused on information transfer, and the other half addressed communication as a process. CONCLUSIONS: Methodological implications are identified with the intent to encourage future interdisciplinary collaboration for studying communication in ICUs. We discuss the importance of (1) using language to describe communication that facilitates interdisciplinary engagement, (2) prioritizing communication as a process and using qualitative methods to provide insight, and (3) engaging health communication theories and experts to assist in developing more fruitful research questions and designs.

Expectancy violations and boundary management when giving birth during a pandemic: implications for supporting women.

BACKGROUND: Few life events are as profound as the birth of a child. Yet for those who gave birth during the COVID-19 pandemic, the birth experience and the care of their newborn child were altered in significant ways. METHOD: In this study, we examined the stories of women who gave birth during the COVID-19 pandemic using expectations violations theory and communication privacy management theory. RESULTS: Based on focus group interviews with 65 women from 19 states across the U.S., we found that policies imposed by institutions and visitation rules negotiated by women were prominent in women's birth stories. Policies that affect territorial access to mothers and babies shaped communication to manage health and safety, resulted in intense emotional responses, and affected relationships with women's partners and families. CONCLUSIONS: Our findings offer practical implications for both health care systems and health care providers. Systems must communicate proactively to offer compassionate patient care, and physicians should offer guidance to help new parents manage visitors.

Disentangling the coping process in White rural men who carry guns.

Affluent White rural men have the highest rates of gun ownership in the United States. However, few studies have specifically examined reasons and motivations for gun ownership and gun behaviors in this population. Therefore, this study sought to examine the relationship between stress variables, namely masculine gender role stress, adverse childhood experiences (ACEs), and income level, and subsequent pro-gun beliefs and amount of time an individual carried a gun within this population. Results indicated that only two measures of pro-gun beliefs (i.e., believing guns keep one safe, believing guns are present in one's social sphere) were correlated with percentage of time an individual carried. Additionally, ACEs were positively correlated with believing guns influence how others perceive oneself, levels of masculine gender role stress, and income. These results suggest that White rural gun owners who have increased ACEs have decreased income and tend to believe that owning guns impacts their social status with peers. However, increased ACEs do not influence belief about guns keeping one safe, believing guns are present in one's social sphere, or gun carriage. Instead, White rural gun owners without childhood adversity may be more susceptible to believing their safety depends on guns and belongingness within their social sphere. Future research should assess reasons why affluent White rural men find it important to maintain their safety in the context of gun ownership.

College students' perceptions of positive and negative drinking-related sexual experiences.

Objective: During young adulthood, drinking and sexual behaviors are both normative and inextricably linked. While this association is well documented, little is known about how students define positive and negative drinking-related sexual experiences. Methods: Thirty-five undergraduates participated in a focus group about sexual experiences in the context of drinking. Thematic analysis was utilized to identify themes in the data. Results: Students' descriptions of positive drinking-related sexual encounters included having a good time, feeling safe, maintaining control over alcohol, as well as feeling safe in drinking contexts where sexual partners are located. Students' perceptions of negative experiences included specific consequences such as a damaged reputation, loss of control due to alcohol, and concern of engagement in sex when they or a partner was too intoxicated to consent. Conclusion: Gaining a better understanding of how college students view positive and negative drinking-related sexual experiences could inform interventions aimed at promoting student well-being.

Assessing the feasibility, acceptability, and initial efficacy of a multiple behavior change intervention addressing alcohol use, sexual risk taking, and bystander intervention.

OBJECTIVE: Prevention programs that address the intersecting health problems of risky alcohol use, unsafe sexual behaviors, and sexual violence are needed. This pilot project assessed the feasibility, acceptability, and preliminary efficacy of a two-session group-based intervention, Sex Positive Lifestyles: Addressing Alcohol & Sexual Health (SPLASH), targeting these highly interconnected risks for college students across genders. METHOD: A total of 217 participants (51.6% male, ages 18-24) took part in the SPLASH intervention or a nutrition/exercise control condition. SPLASH included three approaches aimed at reducing the incidence of alcohol problems, unsafe sex, and sexual victimization: normative feedback to modify misperceptions around peers' drinking, sexual behaviors, and support of bystander intervention; drinking and sexual-related protective behavioral strategy training to enhance safer drinking and sex-risk behaviors; and bystander intervention skills training to promote bystander efficacy and engagement. Participants completed baseline and follow-up (1-month and 6-month) online assessments. RESULTS: SPLASH demonstrated high acceptability and feasibility, as well as preliminary efficacy. SPLASH participants reported strong acceptability of the intervention, particularly its integrated content and interactive, in-person group format. Successful enrollment (70% randomized) and retainment point to the feasibility of recruiting students to this two-session in-person intervention. Results showed sustained trends toward more accurate perceived sex-related norms and indications of increasing bystander norms among intervention but not control participants. CONCLUSIONS: Results demonstrate the potential for SPLASH to effectively address the interrelated health risks of risky alcohol use, unsafe sex, and sexual violence on college campuses and point to the need for larger-scale studies.

What's Gender Got to Do With It: Accounting for Differences in Incident Guideline Discordant Prescribing for PTSD Among Women and Men Veterans.

Objectives: Women veterans are more likely than men veterans to receive medications that Department of Veterans Affairs clinical practice guidelines recommend against to treat posttraumatic stress disorder (PTSD). To understand this difference, we examined potential confounders in incident prescribing of guideline discordant medications (GDMs) in veterans with PTSD.Methods: Veterans receiving care for PTSD during 2020 were identified using Veterans Health Administration administrative data. PTSD diagnosis was established by the presence of at least 1 ICD-10 coded outpatient encounter or inpatient hospitalization during the calendar year 2020. Incident GDM prescribing was assessed during 2021, including benzodiazepines, antipsychotics, select anticonvulsants, and select antidepressants. Log-binomial regression was used to estimate the difference in risk for GDM initiation between men and women, adjusted for patient, prescriber, and facility-level covariates, and to identify key confounding variables.Results: Of 704,699 veterans with PTSD, 16.9% of women and 10.1% of men initiated a GDM, an increased risk of 67% for women [relative risk (RR) = 1.67; 95% CI, 1.65-1.70]. After adjustment, the gender difference decreased to 1.22 (95% CI, 1.20-1.24) in a fully specified model. Three key confounding variables were identified: bipolar disorder (RR = 1.60; 95% CI, 1.57-1.63), age (<40 years: RR = 1.20 [1.18-1.22]; 40-54 years: RR = 1.13 [1.11-1.16]; ≥65 years: RR = 0.64 [0.62-0.65]), and count of distinct psychiatric medications prescribed in the prior year (RR = 1.14; 1.13-1.14).Conclusions: Women veterans with PTSD were 67% more likely to initiate a GDM, where more than half of this effect was explained by bipolar disorder, age, and prior psychiatric medication. After adjustment, women veterans remained at 22% greater risk for an incident GDM, suggesting that other factors remain unidentified and warrant further investigation.

Veterans with chronic pain: Examining gender differences in pain type, overlap, and the impact of post-traumatic stress disorder.

BACKGROUND: Women are more likely to experience multiple overlapping pain conditions (MOPCs) relative to men. Post-traumatic stress disorder can negatively impact the severity and trajectory of chronic pain and its treatment. Specific associations between gender, post-traumatic stress disorder (PTSD), and MOPCs require further examination. METHODS: A cohort of all Veterans in 2021 who met criteria for one or more of 12 chronic pain types was created using national Veterans Health Administration administrative data. MOPCs were defined as the number of pain types for which each patient met criteria. Multivariable logistic regression models estimated gender differences in frequency for each of the 12 pain subtypes, after controlling for demographics and comorbidities. Negative binomial regression was used to estimate gender differences in the count of MOPCs and to explore moderation effects between gender and PTSD. RESULTS: The cohort included 1,936,859 Veterans with chronic pain in 2021, which included 12.5% women. Among those with chronic pain, women Veterans had higher rates of MOPCs (mean = 2.3) relative to men (mean = 1.9): aIRR = 1.31, 95% CI: 1.30-1.32. PTSD also served as an independent risk factor for MOPCs in adjusted analysis (aIRR = 1.23, 95% CI: 1.23-1.24). The interaction term between gender and PTSD was not significant (p = 0.87). Independent of PTSD, depressive disorders also served as a strong risk factor for MOPCs (aIRR = 1.37, 95% CI: 1.36-1.37). CONCLUSIONS: Individuals with MOPCs and PTSD may have complex treatment needs. They may benefit from highly coordinated trauma-sensitive care and integrated interventions that simultaneously address pain and PTSD. SIGNIFICANCE: Women were significantly more likely than men to experience MOPCs. PTSD was also significantly, independently, associated with MOPCs. Patients, particularly women, may benefit from tailored interventions that address both trauma and MOPCs.

Gaps in communication theory paradigms when conducting implementation science research: qualitative observations from interviews with administrators, implementors, and evaluators of rural health programs.

BACKGROUND: Communication is considered an inherent element of nearly every implementation strategy. Often it is seen as a means for imparting new information between stakeholders, representing a Transaction orientation to communication. From a Process orientation, communication is more than information-exchange and is acknowledged as being shaped by (and shaping) the individuals involved and their relationships with one another. As the field of Implementation Science (IS) works to strengthen theoretical integration, we encourage an interdisciplinary approach that engages communication theory to develop richer understanding of strategies and determinants of practice. METHODS: We interviewed 28 evaluators, 12 implementors, and 12 administrators from 21 Enterprise-Wide Initiatives funded by the Department of Veteran Affairs Office of Rural Health. Semi-structured interviews focused on experiences with implementation and evaluation strategies. We analyzed the interviews using thematic analysis identifying a range of IS constructs. Then we deductively classified those segments based on a Transaction or Process orientation to communication. RESULTS: We organized findings using the two IS constructs most commonly discussed in interviews: Collaboration and Leadership Buy-in. The majority of segments coded as Collaboration (n = 34, 74%) and Leadership Buy-in (n = 31, 70%) discussed communication from a Transaction orientation and referred to communication as synonymous with information exchange, which emphasizes the task over the relationships between the individuals performing the tasks. Conversely, when participants discussed Collaboration and Leadership Buy-in from a Process orientation, they acknowledged both constructs as the result of long-term efforts to develop positive relationships based on trust and respect, and emphasized the time costliness of such strategies. Our findings demonstrate that participants who discussed communication from a Process orientation recognized the nuance and complexity of interpersonal interactions, particularly in the context of IS. CONCLUSIONS: Efficient, reliable information exchange is a critical but often overemphasized element of implementation. Practitioners and researchers must recognize and incorporate the larger role of communication in IS. Two suggestions for engaging a Process orientation to communication are to: (a) use interview probes to learn how communication is enacted, and (b) use process-oriented communication theories to develop interventions and evaluation tools.