"I'm not Gonna Die Because of an STD": Female African American Adolescents' Perspectives on how they Protected Themselves from Sexual Risks While in Foster Care.

PURPOSE: Youth in foster care are at greater risk for engaging in sexual behaviors that increase their odds of experiencing negative sexual and reproductive health (SRH) outcomes. The purpose of this qualitative study was to describe challenges faced by female African American adolescents in foster care as they tried to protect themselves from SRH risks and protective beliefs and behaviors to avoid these risks. DESIGN AND METHODS: Semi-structured interviews were conducted with 16 female African American adolescents, ages 18-20 years, with a history of foster care placement during adolescence. Purposive sampling was done to recruit participants from a metropolitan area in Virginia. Transcribed interviews underwent inductive thematic analysis. This paper focuses on the theme of protection from SRH risks and its subthemes of challenges that made it difficult to avoid sexual risks and protective beliefs and behaviors that facilitated avoidance of those risks. RESULTS: Participants reported yearning for connection, partners' desire to not use condoms, and judgmental caregivers as challenges. Protective beliefs and behaviors included open communication with their caregivers about SRH, abstinence, contraceptive use, and participants' desire to be healthy. CONCLUSIONS: Study findings shed light on protective beliefs and behaviors female youth in foster care used to safeguard themselves from negative SRH outcomes. Youth at times lacked agency in sexual decision-making and contraceptive use. PRACTICE IMPLICATIONS: Findings highlight the importance of sexual relationships and partner communication related to contraceptive use, and offering trauma-informed interventions, including culturally sensitive counseling regarding long acting reversible contraception.

Very young adolescent perceptions of growing up in rural southwest Uganda: Influences on sexual development and behavior.

Very young adolescents (VYAs) are at the beginning of major physical, cognitive, emotional, and social changes that will set the course for a lifetime of health risks or resilience and yet, they have been largely an invisible group in global health research. The study explored perceptions of VYAs of the context for adolescence in rural Uganda and how these perceptions relate to sexual and reproductive health. Twenty VYAs, aged 11-14 from a southwest province in Uganda participated; 10 girls and 10 boys. All were of low socioeconomic status and attending school. With Institutional Review Board approval, a community-based participatory design was used with community advisory board (CAB) guidance. Community mapping and photovoice were data collection strategies as deemed developmentally appropriate for this age group. VYAs narrated their maps and photographs in focus groups. Field notes were taken on observations of adolescent life in the villages. The CAB assisted in the interpretation of data. Focus group interview transcripts and field notes were thematically analyzed and triangulated with observational field notes to verify and amplify findings. VYAs dichotomized people and places that offered support and protection or exposure to risk and vulnerability. Cultural norms (gendered expectations for roles and responsibilities, the primacy of work), the influences of significant others (peers, family, other important adults) and places in their environment that represented either safe havens or danger zones comprised the major themes. VYA perceptions of their context and experiences will contribute to design of developmentally appropriate and community tailored interventions to promote their health.

Women's Land Rights and Maternal Healthcare in Southwestern Uganda: Exploring the Implications of Women's Decision-Making Regarding Sale and Use of Land on Access to Maternal Healthcare.

Most traditional land tenure practices among developing economies are opposed to protecting and promoting women's land ownership rights. In Uganda, land tenure practices are largely customary and patriarchal in nature, in most communities women's land tenure security is dependent on marriage. This paper builds a body of evidence on how gender biased land tenure negatively affects maternal healthcare decision-making for family planning, antenatal care services and skilled care during childbirth. A cross-sectional mixed methodology was used to collect household survey data. Qualitative data from individual and focus group interviews were analysed using thematic content analysis. Land was found to be an important household factor that shapes women's maternal healthcare decision-making, not only through land ownership, but also through land's role as a source of identity, gendered land use decision-making patterns, and the allocation of resources that accrue from work on land. Most of the land-owning households are headed by men. More women than men expressed insecurity of tenure, despite the household's land ownership status. Land use decision-making, including its sale was significantly associated with maternal healthcare decision- making. Feeling secure on land was significantly associated with maternal healthcare decisions for planned pregnancy and use of antenatal care. Land purchasing was found to significantly determine place and skill level of providers for childbirth. In conclusion, women involvement in land purchasing decisions demonstrates more control and agency in the number of children. Women's land insecurity undermines their prospects for positive maternal health behaviours.

Living in Fear and Prioritizing Safety: Exploring Women's Lives After Traumatic Brain Injury From Intimate Partner Violence.

There is increasing evidence that women are receiving a traumatic brain injury (TBI) during episodes of intimate partner violence (IPV), but little qualitative research exists around how surviving this experience impacts the lives of women. Primary and secondary data ( N = 19) were used with a constructivist grounded theory approach to explore the lives of women aged 18 to 44 years, who were living with a TBI from IPV. Women described multiple aspects of living in fear that shaped their daily lives and ability to seek help and access resources. The central process of prioritizing safety emerged, with salient dimensions of maintaining a present orientation, exhibiting hyperprotection of children, invoking isolation as protection, and calculating risk of death. These findings add to the growing body of knowledge that women living with IPV are at high risk for receiving a TBI and are therefore a subgroup in need of more prevention and treatment resources.

Reconnecting to Spirituality: Christian-Identified Adolescents and Emerging Adult Young Men's Journey from Diagnosis of HIV to Coping.

Spirituality is important to holistic health, yet little is known about its impact on young people with HIV. To address this knowledge deficit, a grounded theory study used semi-structured interviews of 20 Christian-identified adolescent and emerging adult gay males and one perinatally infected male. This study revealed that, to cope with HIV health issues, participants used a process of reconnecting with their spirituality. In order to successfully reconnect with their spirituality, study participants reported a need to re-embrace and re-engage in spiritual practices, hold onto hope, believe they are normal, and commit to beliefs and practices despite rejection from the church.

Nurse and parent perceptions associated with the Parent Education Discharge Instruction Programme in southern India.

UNLABELLED: Introduction Parents of children with CHD require home care knowledge in order to ensure their child's health and safety, but there has been no research on how to achieve this in a resource-constrained environment. The aim of this investigation was to compare parent and nurse perceptions of parent readiness for discharge after a structured nurse-led parent discharge teaching programme in India. Materials and methods A pre-post design was used to compare parent and nurse perceptions of parental uncertainty and readiness for hospital discharge before and after introduction of the parent education discharge instruction programme in a paediatric cardiac surgery unit. RESULTS: Parents (n=68) and nurses (n=63) participated in this study. After the discharge programme implementation, parents had less uncertainty (M=93.3 SD=10.7 versus M=83.6 SD=4.9, p=0.001) and ambiguity (M=40.8 SD=6.8 versus M=33.4 SD=3.7, p=0.001) about their child's illness; however, they rated themselves as being less able to cope with the transition to home (M=24.3 SD=4.1 versus 23.1 SD=2.2, p=0.001) and as having less support at home than that required (M=31.5 SD=9.9 versus 30.9 SD=3.2, p=0.001). Parents' and nurses' perception of parental readiness for hospital discharge were more closely aligned after implementation of a nurse-led discharge programme (r=0.81, p=0.001). CONCLUSION: The results of this study suggest that the discharge programme had positive and negative effects on parental perceptions of uncertainty and readiness for discharge. Further examination is warranted to delineate these influences and to design methods for supporting parents during the transition to home care.

Parent education discharge instruction program for care of children at home after cardiac surgery in Southern India.

UNLABELLED: Introduction In many developing countries, children with CHD are now receiving surgical repair or palliation for their complex medical condition. Consequently, parents require more in-depth discharge education programmes to enable them to recognise complications and manage their children's care after hospital discharge. This investigation evaluated the effectiveness of a structured nurse-led parent discharge teaching programme on nurse, parent, and child outcomes in India. Materials and methods A quasi-experimental investigation compared nurse and parent home care knowledge before and at two time points after the parent education discharge instruction program's implementation. Child surgical-site infections and hospital costs were compared for 6 months before and after the discharge programme's implementation. RESULTS: Both nurses (n=63) and parents (n=68) participated in this study. Records of 195 children who had undergone cardiac surgery were reviewed. Nurses had a high-level baseline home care knowledge that increased immediately after the discharge programme's implementation (T1=24.4±2.89; T2=27.4±1.55; p0.05) after the programme's implementation. CONCLUSION: Nurse, parent, and child outcomes were improved after implementation of the structured nurse-led parent discharge programme for parents in India. Structured nurse-led parent discharge programmes may help prepare parents to provide better home care for their children after cardiac surgery. Further investigation of causality and influencing factors is warranted.

Calculus formation: nurses' decision-making in abortion-related care.

Nurses routinely provide care to patients in ethically challenging situations. To explore the continuum between conscientious objectors and designated staff in the provision of care to women seeking abortions, the aim of this study was to thickly describe decision-making, using abortion as the clinical context to elucidate how nurses approach ethically challenging work. A purposive sample of 25 nurses who worked in abortion clinics, emergency departments, intensive care units, labor, and delivery, operating rooms, and post anesthesia care units were interviewed. Qualitative description and thematic analysis were used to identify the cognitive, emotional, and behavioral processes in nurses' decisions to care for women needing abortions. Nurses developed and used multifaceted, real-time calculi when making decisions about their participation in emergent or routine abortion care. Nurses tacked back and forth between the personal and professional and/or held multiple contradictory positions simultaneously. Nurses weighed the role and opinion of others to determine if they know how to or know why they would provide abortion care to women, particularly in the elective abortion context. The parameters of the nurse-patient relationship were complex and specific to the experiences of both the nurse and patient. Findings from this study further develop the science of ethically challenging decision-making and expand our understanding of factors that influence how nurses develop relationships to ethically challenging work.

Differences in caregiver-reported health problems and health care use in maltreated adolescents and a comparison group from the same urban environment.

Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth who had an open case with child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths' higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in maltreated adolescents remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care.

A Call for Youth Voice to Support Engagement in Care for 18- to 29-Year Olds Living with HIV in the US South.

Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH.

Dancing around death: hospitalist-patient communication about serious illness.

Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient's understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues.

Adolescent fathers in the justice system: hoping for a boy and making him a man.

Using a constructivist grounded theory approach, we explored the development of father identity among boys involved in the juvenile justice system. Youth were recruited from a juvenile detention center and school district in a northern California county with a high teen birth rate. The participants were expecting a child or parenting an infant and had been arrested, incarcerated, or had committed a crime. We collected data through observations and individual interviews. Using constant comparative and dimensional analysis, we found that expectant adolescent fathers hoped for a boy and envisioned their central role as father to be making their son a man. This article contributes to greater understanding of father identity development for youth involved in the justice system. We suggest that teen parenting policies and programs include interventions sensitized by gender, accounting for the influence masculine ideals of manhood have on the development of father identity and the father-child relationship.

Health profiles of adolescents in foster care.

The purpose of this paper is to describe health profiles of adolescents in foster care. The Child Health and Illness Profile-Adolescent Edition clustered adolescents in foster care into 13 mutually exclusive health profiles using dimensions of satisfaction with health, risks, resilience, and discomfort. Health profiles were further characterized into four health status rankings from best to worst health status. Many reported best health status (39%); nearly equal numbers (30.6%) had profiles indicating poor or worst health status, particularly girls and those with high risk behaviors, aggression, sexual abuse, or suicidality. It is valuable to identify health characteristics of the most vulnerable subgroups of foster youth to tailor specific interventions.

Benefits, Facilitators, and Barriers of Alternative Models of Cardiac Rehabilitation: A QUALITATIVE SYSTEMATIC REVIEW.

PURPOSE: Cardiac rehabilitation (CR) improves health outcomes and quality of life for patients with cardiovascular disease, yet only a quarter of eligible patients enroll. A myriad of CR models that use either an alternative location (ie, home-based) and/or an alternative exercise have been developed to overcome known attendance and physical limitation barriers; however, patient experiences with these models have not been systematically reviewed. Our aim is to review patient experiences with these models of CR. REVIEW METHODS: We conducted a systematic review and thematic analysis of qualitative studies published between 2009 and January of 2022 from CINAHL, PubMed, Web of Science, and PsycINFO. SUMMARY: Twenty-five studies were included, representing the perspectives of 487 individuals who participated in an alternative model of CR. Exercises included walking, tai chi, yoga, aquatic exercise, exergaming, chair-based exercises, aerobics, physical activity trackers, and individualized exercise plans. Nineteen of 25 studies used home-based models and two used live video. Twelve studies included patients with heart failure. Patient perspectives comprised three central themes: exercise benefits, exercise facilitators, and participation barriers. Some thematic categories were reported variably by particular model/study design (eg, home-based) than by others. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise. These patient insights are critical for innovative delivery of CR that is appealing, accommodates physical limitations, and broadens access to improve health equity.

African American Perceptions of Participating in Health Research Despite Historical Mistrust.

A qualitative descriptive approach examined perspectives of African Americans (AA) on their participation in health research despite historical research mistreatment. Nineteen AAs participated in semistructured interviews that provided data that were analyzed using thematic analysis. Salient themes included race concordance, being respected and valued by the researcher, research participation motivators, and cultural experiences of racism in health care. This study challenges dominant ideology that AAs are unwilling to participate in research and offers solutions to promote research inclusive of their perceptions. Therefore, researchers need to design research with inclusiveness and transparency that openly displays how research will impact future generations.

Illuminating the Contributions of African American Nurse Scientists Despite Structural Racism Barriers: A Qualitative Descriptive Study.

A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.

Nothing About Us Without Us: Involving Youth Living With HIV in a Virtual Advisory Board.

PURPOSE: We adapted a traditional community advisory board to the needs of youth living with HIV (YLWH), resulting in a virtual, asynchronous, and anonymous youth advisory board (YAB). The YAB's evolution fostered participation during the adaptation of an HIV care mobile health application. METHODS: YAB members, comprised of YLWH in South Texas, engaged in the mobile application's formative evaluation, adaptation, and pilot implementation. We collected feedback via surveys and interviews, analyzed and integrated responses, tracked participation and YAB adaptations, and performed content analysis. RESULTS: Driven by feedback, the YAB evolved from in-person group meetings to the current iteration. We administered five surveys, and YAB members provided feedback on communication preferences; mobile app elements; privacy and confidentiality; and virtual support groups. DISCUSSION: Our adaptive process highlights three primary drivers of innovation: COVID-19 risk reduction, asynchrony, anonymity. Our success in maintaining YAB engagement suggests the adapted model could be employed to support youth input in other contexts.

Asian American adolescents' willingness to donate organs and engage in family discussion about organ donation and transplantation.

CONTEXT: Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. OBJECTIVE: To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. DESIGN: A cross-sectional study. SETTING: The Big Island of Hawaii. PARTICIPANTS: Self-identified Asian American adolescents (Japanese, Chinese, Filipino, Korean), ages 16 to 17 years old, and each adolescent's parent or guardian. MAIN OUTCOME MEASURES: Asian American adolescents provided demographic information and completed the Modified Organ Donation Attitude Survey, the Organ Donation and Transplantation Knowledge Survey, and the Suinn-Lew Asian Self-Identity Acculturation Scale. A parent or guardian also provided demographic information. Linear regression analyses were used to examine the associations with willingness to donate and to engage in family discussion about organ discussion. RESULTS: Willingness to donate was associated with positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes (R2 = 0.402, F = 18.86, P = .005). Asian American adolescents with approving or positive attitudes were likely to engage in family discussion about organ donation (R2 = 0.195, F = 27.93, P = .005). To reinforce and maintain high levels of knowledge and positive attitudes, organ donation education is most likely needed in high schools.

Choosing fatherhood: how teens in the justice system embrace or reject a father identity.

The purpose of this qualitative study was to further the understanding of father identity and role development among adolescents involved in the justice system. Youth who were expecting a child or parenting an infant and who were incarcerated, arrested, or had admitted to criminal behavior participated in interviews and observations in a juvenile detention center and in the community. Data analysis revealed 4 patterns of fathering intentions: (a) embracing fatherhood, (b) being barred from fatherhood, (c) being ambivalent about fatherhood, or (d) rejecting fatherhood. Community health nurses can use this information to assess father identity status and address factors that interfere with father engagement.

Young adult couples' decision making regarding emergency contraceptive pills.

PURPOSE: Unintended pregnancy is a significant public health problem among young people worldwide. The purpose of this study was to explore and better understand the reasons for the apparent underuse of emergency contraceptive pills (ECP) in young people in coupled relationships. THEORETICAL RATIONAL: In postmodern explications of grounded theory, social construction of realities and the influence of subjectivities on the meanings of experiences lead to the development of partial truths that may change with time, context, and situation. METHODS: Grounded theory methods guided semi-structured face-to-face interviews and data analysis. Twenty-two couples aged 18 to 25 years old were recruited through public notices. FINDINGS: Four salient and interrelated conditions were constructed to help explain the complexities involved in young couples decision making regarding ECP use: (a) the shifting locus of responsibility for contraceptive decision making: in a perfect world versus biological reality; (b) relationship power: control-vulnerability continuum; (c) a woman's autonomy over her own body; and (d) conflicting views on ECP. CONCLUSIONS: Healthcare professionals whose practice includes young people need to be aware of possible couple dynamics when discussing contraception. Clients in supportive relationships should be encouraged to engage in open communication with their partners about their contraception needs, including possible ECP use. CLINICAL RELEVANCE: The results of this study contribute to the body of knowledge with regard to decision making related to ECP use in young adults.