The Impact of COVID-19 on Hypertension and Hypertension Medication Adherence Among Underrepresented Racial and Ethnic Groups: A Scoping Review.

PURPOSE OF REVIEW: To conduct a scoping review of articles which examined the impact of COVID-19 on HTN and HTN medication adherence among underrepresented racial/ethnic minorities. RECENT FINDINGS: Seven studies were included in this review and impact of COVID-19 was examined at 4 levels: patient, provider, health system and society. The results indicated that patient level factors, such as high unemployment and inequitable access to telemedicine due to society factors- lack of access to high-speed Internet and variation in the offering of telehealth by health systems, were most impactful on adherence. Additionally, provider level clinical inertia may have further impacted adherence to HTN medication. Our review showed that the COVID-19 pandemic did not introduce new barriers but exacerbated preexisting barriers. Ongoing efforts are needed to change policies at the state and local levels to dismantle inequities in underrepresented communities to ensure access to health care with telemedicine to promote health equity.

Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System.

BACKGROUND: Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. PURPOSE: The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. METHODS: The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. DISCUSSION: Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. CONCLUSION: This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Stakeholder perceptions affecting the implementation of teleophthalmology.

PURPOSE: Teleophthalmology has become the subject of heightened interest and scrutiny in the wake of the SARS-CoV-2 global pandemic. A streamlined implementation framework becomes increasingly important as demand grows. This study identified obstacles to teleophthalmology implementation through summative content analysis of key stakeholders' perceptions. DESIGN: Summative content analysis of transcribed interviews with key stakeholders (including patients, technicians, ophthalmic readers, staff, nurses, and administrators at two teleophthalmology clinic sites). METHODS: Keyword Were counted and compared to examine underlying meaning. Two analysts coded text independently using MAXQDA for summative qualitative content analysis to derive themes and hierarchical relationships as a basis for future refinement of TECS implementation. xMind ZEN was used to map conceptual relationships and overarching themes that emerged to identify perceived facilitators and barriers to implementation RESULTS: Analysis revealed two themes common to perceptions: (1) benefits of care, and (2) ease of implementation. Perceived benefits included efficiency, accessibility, and earlier intervention in disease course. The quality and quantity of training was heavily weighted in its influence on stakeholders' commitment to and confidence in the program, as were transparent organizational structure, clear bidirectional communication, and the availability of support staff. CONCLUSION: Using a determinant framework of implementation science, this report highlighted potential hindrances to teleophthalmology implementation and offered solutions in order to increase access to screening, improve the quality of care provided, and facilitate sustainability of the innovation.

The Doctor Will "Friend" You Now: A Qualitative Study on Adolescents' Preferences for Weight Management App Features.

OBJECTIVES: Primary care providers report a lack of resources as a barrier to managing adolescent obesity. Mobile health applications (apps) may be helpful in weight management; however, adolescents' preferences for weight management app features are unknown. Our objectives were to provide insight into adolescents' preferred weight management app features and elicit facilitators and barriers to app use. METHODS: Using the qualitative content analysis method, 14 interviews with adolescents with overweight/obesity were conducted in rural and urban pediatric offices in South Carolina. Eligibility criteria included being 13 to 17 years old, having a body mass index at or above the 85th percentile for age and sex, and having access to a smartphone or tablet. Semistructured key informant interviews were conducted from May to October 2017. Participants were presented with three popular mobile health apps and asked to complete tasks and comment on their various features and usability. Summative content analysis coding was performed on interview transcripts, and interviews were conducted until thematic saturation was reached. RESULTS: Seventy-one percent of participants were from a rural practice, 64% were White, and 86% had a body mass index higher than the 95th percentile. Familiarity with similar apps and accessibility of apps on their smartphones promoted app use. The need for wireless Internet, operating difficulties, or privacy concerns were barriers. Nutritional education, physical activity tracking, and social connection were desirable app features. CONCLUSIONS: Adolescents have expressed preferred app features to help them manage weight; however, further work is needed to see whether these features are effective.

Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities.

We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities.

A feasibility study exploring self-care and parenting for adults recovering from addictive substances.

Little information is available on parental self-care while in recovery from addictive substances, and its relationship to parenting and recovery outcomes. We evaluated the feasibility of obtaining self-care and parenting outcomes for adults in long-term recovery from addictive substances, and explored potential contributing factors. Nineteen mothers and fathers who self-reported at least two years of sobriety participated in this study. Feasibility challenges included recruitment and scheduling interviews, given multiple work and personal demands on participants' schedules. Possible associations of self-care to parental efficacy (PE), parenting behaviors, resilience, and total recovery years were examined as indicators to parental functioning. The exploratory analyses showed a significant moderate correlation between PE and parenting behaviors (r = 0.45, p < 0.05) as well as total years in recovery and age (r = 0.43, p < 0.05); total years in recovery differed significantly when compared by race (χ2 (1) = 5.63; p = 0.018) and education (χ2 (1) = 3.94; p = 0.048). There was also a significant inverse relationship between total years in recovery and PE (r = -0.43, p < 0.05) and parental self-care (r = -0.59, p < 0.01). Recruiting parents (especially minorities) in long-term recovery was very challenging indicating that recruitment through community organizations was not feasible without a site champion. Preliminary findings showed statistically significant correlations among self-care, parental efficacy, age, and total years in recovery. As researchers and clinicians, it is necessary to determine the role and impact of self-care for future intervention development, however, recruitment strategies need to be modified to ensure sufficiently large study samples.

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use.

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving.

What Causes Racial Health Care Disparities? A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions.

Progress to address health care equity requires health care providers' commitment, but their engagement may depend on their perceptions of the factors contributing to inequity. To understand providers' perceptions of causes of racial health care disparities, a short survey was delivered to health care providers who work at 3 Veterans Health Administration sites, followed by qualitative interviews (N = 53). Survey data indicated that providers attributed the causes of disparities to social and economic conditions more than to patients' or providers' behaviors. Qualitative analysis revealed differences in the meaning that participants ascribed to these causal factors. Participants who believed providers contribute to disparities discussed race and racism more readily, identified the mechanisms through which disparities emerge, and contextualized patient-level factors more than those who believed providers contributed less to disparities. Differences in provider understanding of the underlying causal factors suggest a multidimensional approach to engage providers in health equity efforts.

The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework.

The drivers of trauma disparities are multiple and complex; yet, understanding the causes will direct needed interventions. The aims of this article are to (1) explore how the injured patient, his or her social environment, and the health care system interact to contribute to trauma disparities and examine the evidence in support of interventions and (2) develop a conceptual framework that captures the socioecological context of trauma disparities. Using a scoping review methodology, articles were identified through PubMed and CINAHL between 2000 and 2015. Data were extracted on the patient population, social determinants of health, and interventions targeting trauma disparities and violence. Based on the scoping review of 663 relevant articles, we inductively developed a conceptual model, The Social Determinants of Trauma: A Trauma Disparities Framework, based on the categorization of articles by: institutional power (n = 9), social context-place (n = 117), discrimination experiences (n = 59), behaviors and comorbidities (n = 57), disparities research (n = 18), and trauma outcomes (n = 85). Intervention groupings included social services investment (n = 54), patient factors (n = 88), hospital factors (n = 27), workforce factors (n = 31), and performance improvement (n = 118). This scoping review produced a needed taxonomy scheme of the drivers of trauma disparities and known interventions that in turn informed the development of The Social Determinants of Trauma: A Trauma Disparities Framework. This study adds to the trauma disparities literature by establishing social context as a key contributor to disparities in trauma outcomes and provides a road map for future trauma disparities research.

African American Veterans Storytelling: A Multisite Randomized Trial to Improve Hypertension.

BACKGROUND: Disparities in hypertension control persist for African American Veterans. OBJECTIVE: To enhance cultural relevance of hypertension control self-management education, in a multisite, stratified randomized trial, we tested an interactive Veteran-to-Veteran storytelling digital video disk (DVD) intervention created with Veteran partners, versus an education-only DVD comparison. METHODS: At 3 VA facilities, African American Veterans with uncontrolled hypertension were randomized to storytelling DVD intervention or didactic comparison DVD and followed for 6 months. We hypothesized that follow-up blood pressure (BP) would be lower among Veterans in the intervention group. RESULTS: African American Veterans (N=619) were 92% male, 39% over age 65, most had a high-school education, over 50% of both the intervention and comparison group reported a household income of <$20,000, and 40% had less than adequate health literacy. At baseline, mean intervention and comparison group BPs were 138/80 and 139/81 mm Hg, respectively; at 6 months, mean systolic BP (SBP) increased by 0.1 in the intervention group and by 1.9 for the comparison group; diastolic BP fell by 0.1 in the intervention group and rose by 0.2 in the comparison group. No differences between the intervention and control groups were statistically significant (all P>0.3). Site differences were large; at one, the intervention group improved while the comparison groups deteriorated, resulting in 6.3 and 3.9 mm Hg more improvement for the intervention group in SBP and diastolic BP (P=0.06 and 0.04), respectively; at the other 2 sites, there were positive and negative changes, all small, in the 2 measures, with minimal differences-one site favored the comparison group and the other, the intervention (these comparisons did not approach statistical significance (all P>0.20). In a secondary analysis stratified by baseline BP, there was no intervention effect among those with uncontrolled BP, but intervention patients who were in control at baseline were more likely to stay in control, compared with comparison [SBP increase by 6.3 mm Hg (SD=14.4) among intervention, and by 10.9 mm Hg (SD=16.9) in comparison, P=0.02]. CONCLUSIONS: In this multisite trial, we did not find a significant overall storytelling intervention effect (Clinicaltrials.gov Reg. #NCT01276197).

Exploring Self-Care and Preferred Supports for Adult Parents in Recovery from Substance Use Disorders: Qualitative Findings from a Feasibility Study.

Very little is known about the self-care behaviors (SCB) that adult parents employ and the preferred supports they utilize to maintain their recovery from substance use disorders (SUD) while also parenting their children. This study used a qualitative descriptive approach to explore perceptions of self-care and parenting to inform future self-care interventions for parents in early recovery. Nineteen mothers and fathers of at least one child between the ages of 6-18 were interviewed by telephone about parental self-care practices while in recovery from SUD, recovery management, and preferred supports in the community. Participants described the experience of parenting as challenging, with variations in the level of support and resources. Self-care included meaningful connection with recovery support and children, taking care of physical health, maintaining spirituality, healthy eating, exercise, journaling, continuing education, staying busy, sponsorship, establishing boundaries, self-monitoring, abstinence, and dealing with destructive emotions. Participants reported SCB as being a critical component of their ongoing recovery and their parenting practices, though differences in SCB by gender and for minorities require further exploration. Parental gains were perceived as benefits of SCB that minimized the negative impact of prior parental drug use on their children.

The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality.

BACKGROUND: Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. METHODS: This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. RESULTS: A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p = .006) and other insurance (OR = 3.02, p = .007) than for Private Insurance. However, when grouped into ages 18-40 years versus 41-64 years, the insurance influences changed with Uninsured and Other insurance (driven by Tricare) predicting mortality in the younger age group, while Medicare remained predictive in the older age group. CONCLUSIONS: Insurance type, not race or socioeconomic status, is associated with trauma mortality and varies with age. Both Uninsured and Tricare insurance were associated with mortality in younger age trauma patients, whereas Medicare was associated with mortality in older age trauma patients. The lethality of the Tricare group warrants further investigation.

Implementation of online suicide-specific training for VA providers.

OBJECTIVE: Due to the gap in suicide-specific intervention training for mental health students and professionals, e-learning is one solution to improving provider skills in the Veterans Affairs (VA) health system. This study focused on the development and evaluation of an equivalent e-learning alternative to the Collaborative Assessment and Management of Suicidality (CAMS) in-person training approach at a Veteran Health Affairs medical center. METHODS: The study used a multicenter, randomized, cluster, and three group design. the development of e-CAMS was an iterative process and included pilot testing. Eligible and consenting mental health providers, who completed a CAMS pre-survey, were randomized. Provider satisfaction was assessed using the standard VA evaluation of training consisting of 20 items. Two post training focus groups, divided by learning conditions, were conducted to assess practice adoption using a protocol focused on experiences with training and delivery of CAMS. RESULTS: A total of 215 providers in five sites were randomized to three conditions: 69 to e-learning, 70 to in-person, 76 to the control. The providers were primarily female, Caucasian, midlife providers. Based on frequency scores of satisfaction items, both learning groups rated the trainings positively. In focus groups representing divided by learning conditions, participants described positive reactions to CAMS training and similar individual and institutional barriers to full implementation of CAMS. CONCLUSIONS: This is the first evaluation study of a suicide-specific e-learning training within the VA. The e-CAMS appears equivalent to the in-person CAMS in terms of provider satisfaction with training and practice adoption, consistent with other comparisons of training deliveries across specialty areas. Additional evaluation of provider confidence and adoption and patient outcomes is in progress. The e-CAMS has the potential to provide ongoing training for VA and military mental health providers and serve as a tutorial for psychiatrists in preparation for specialty boards.

Hospital Inpatient Nutrition Service Errors and Patient Safety Interventions: A Scoping Review.

OBJECTIVES: Food service errors are prevalent in healthcare hospital inpatient settings. Like medication administration errors, these mistakes can result in disastrous consequences. This scoping review aimed to identify the evidence describing hospitals' nutrition department service errors and subsequent patient safety interventions. METHODS: The review was conducted on four electronic databases, OVID MedlinePlus, PubMed, Scopus, and CINAHL, to search for articles reporting hospital food-related errors. All studies and reports on parenteral nutrition were excluded, and errors reported by departments other than nutrition services were excluded. A total of 245 studies published from 1984 to 2022 were identified. After removing duplicates, 98 abstracts were evaluated, with particular attention given to dietary errors, meal accuracy, and interventions. RESULTS: Twenty-nine articles were selected, and 14 (n = 14) were considered relevant to the review after a full-text review. More than half of the studies (n = 8) were conducted outside the United States. Eight studies (n = 8) were descriptive, retrospective, and observational; 3 were mixed-method studies (n = 3), 2 (n = 2) were quality improvement projects, and 1 was an implementation study (n = 1). Four (n = 4) studies were published before the year 2000. CONCLUSIONS: Various types of nutrition service inaccuracies were identified. The severity, causes, and stages of food service provision where errors occur were also documented. These errors were used as the basis for interventions to improve patient safety, justify implementing computerized dietary services systems, or add resources to augment dietary department service offerings. This review also generated valuable recommendations to promote patient safety by mitigating food service errors.

Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis.

BACKGROUND: Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care. OBJECTIVE: This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). METHODS: In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. RESULTS: In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. CONCLUSIONS: This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.

Trends in Veteran hospitalizations and associated readmissions and emergency department visits during the MISSION Act era.

OBJECTIVE: To examine changes in hospitalization trends and healthcare utilization among Veterans following Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act implementation. DATA SOURCES AND STUDY SETTING: VA Corporate Data Warehouse and Centers for Medicare and Medicaid Services datasets. STUDY DESIGN: Retrospective cohort study to compare 7- and 30-day rates for unplanned readmission and emergency department visits following index hospital stays based on payor type (VHA facility stay, VA-funded stay in community facility [CC], or Medicare-funded community stay [CMS]). Segmented regression models were used to compare payors and estimate changes in outcome levels and slopes following MISSION Act implementation. DATA COLLECTION/EXTRACTION METHODS: Veterans with active VA primary care utilization and ≥1 acute hospitalization between January 1, 2016 and December 31, 2021. PRINCIPAL FINDINGS: Monthly index stays increased for all payors until MISSION Act implementation, when VHA and CMS admissions declined while CC admissions accelerated and overtook VHA admissions. In December 2021, CC admissions accounted for 54% of index admissions, up from 25% in January 2016. From adjusted models, just prior to implementation (May 2019), Veterans with CC admissions had 47% greater risk of 7-day readmission (risk ratio [RR]: 1.47, 95% confidence interval [CI]: 1.43, 1.51) and 20% greater risk of 30-day readmission (RR: 1.20, 95% CI: 1.19, 1.22) compared with those with VHA admissions; both effects persisted post-implementation. Pre-implementation CC admissions were also associated with higher 7- and 30-day ED visits, but both risks were substantially lower by study termination (RR: 0.90, 95% CI: 0.88, 0.91) and (RR: 0.89, 95% CI: 0.87, 0.90), respectively. CONCLUSIONS: MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post-implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post-implementation risk of ED utilization following CC admissions was estimated to be lower compared with VHA index admissions. Reasons for this divergence require further investigation.

Sociodemographic and Health Characteristics of Hispanic Veteran Patients With Traumatic Brain Injury and Its Association to Mortality: A Pilot Study.

INTRODUCTION: Traumatic brain injury (TBI) is among the most common conditions in the military. VA Caribbean Healthcare System (VACHS) patients with Traumatic Brain Injury (TBI) have a higher mortality rate than Veterans in other VA health care systems in the United States. The main goal of this study was to develop sociodemographic profiles and outline health characteristics of Hispanic patients with TBI treated at the VA Caribbean Healthcare System in a search for potential explanations to account for the higher mortality rate. This study advocates for equity in health services provided for minorities inside the militia. MATERIALS AND METHODS: Data collected from electronic medical records and VA databases were used to create sociodemographic and health characteristics profiles, in addition to survival models. The population of the study were post 911 Veteran soldiers who had been diagnosed with TBI. Adjusted models were created to provide hazard ratios (HR) for mortality risk. RESULTS: Out of the 16,549 files available from all 10 selected VA sites, 526 individuals were identified as treated at the VACHS. Of 526 subjects screened, 39 complied with the inclusion/exclusion criteria. Results include: 94.4% male, 48.7% between the ages of 21 and 41 years, 89.7% have depression, 66.7% have post-traumatic stress disorder (PTSD), 82.1% receive occupational therapy, 94.9% have severe headaches, 100% suffer from pain, 94.9% have memory problems, and 10.3% have had suicidal thoughts. Over 60% had a first-hand explosion experience, be it just the explosion or with another type of injury. Data showed that 33% of our patients had a Magnetic Resonance Imaging (MRI), 31% had a CT, 15.4% had a SPECT, and 2.6% had PET scan. Significant associations were found between MRIs and speech therapies, and MRIs and total comorbidities. The Cox proportional-hazards model for survival adjusted for age, gender, race/ethnicity, and comorbidities shows that VACHS Veterans diagnosed with a TBI had a higher mortality risk rate (HR 1.23 [95% CI 1.10, 1.37]) when compared to the other 9 health centers with the highest percentage of Hispanic Veterans. CONCLUSIONS: Since explosions were the most common mechanism of injury, further research is needed into the experiences of Veterans in connection with this specific variable. A high percentage of the patients suffered from depression and PTSD. Additionally, over half of the patients had an unmeasured TBI severity. The effects these aspects have on symptomatology and how they hinder the recovery process in Hispanic patients should be examined in further detail. It is also important to highlight that family and friends' support could be key for injury treatment. This study highlights the use of the 4 types of scans (MRI, CT, PET/CT, and SPECT/CT) as ideal diagnosis tools. The alarming number of patients with suicidal thoughts should be a focus in upcoming studies. Future studies should aim to determine whether increased death rates in TBI Veterans can be linked to other United States islander territories. Concepts, such as language barriers, equal resource allocation, and the experiences of Veterans with TBIs should be further explored in this Veteran population.

Enhancing Access Through Language-Tailored Approach in Telehealth and Veterans Video Connect: Traumatic Brain Injury (TBI) Veterans Satisfaction Assessment.

INTRODUCTION: Traumatic brain injury (TBI) can impact language processing, necessitating language-tailored approaches. Telehealth may expand rural Veterans' access but has unknown feasibility for language preferences. This study explored telehealth/Veterans Video Connect satisfaction for Spanish/English TBI screening. MATERIALS AND METHODS: The study was approved by the VA Caribbean Healthcare System Institutional Review Board and the Research and Development Committee. Mixed methods evaluated telehealth satisfaction in Veterans receiving TBI assessments from October 2021 to October 2023. Surveys included the 16-item Clinical Video Telehealth (CVT) questionnaire on communication, technical factors, coordination, and overall satisfaction, and the 21-item Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) examining usefulness, ease of use, manners, quality, and satisfaction. Mean domain/item scores were calculated among 57 Veterans, 12 English, and 45 Spanish-speaking. Semi-structured interviews also elicited user experiences from 4 providers and 5 Veterans. Transcripts underwent qualitative coding for themes using Atlas.ti.8. RESULTS: On CVT (0-5 scale), overall satisfaction averaged 4.50 (English) and 4.69 (Spanish). Lowest scoring item for English users was easy video connection (4.25), while unclear expectations had the lowest Spanish score (3.60). For TSUQ, overall mean scores were 4.50 (English) and 4.67 (Spanish), with improved health post-telehealth having the lowest average (English 3.33, Spanish 3.67). Qualitatively, Veterans and providers noted strengths like access and communication but weaknesses around connectivity, care delays, and privacy. Differences emerged regarding convenience (Veterans) versus operational barriers (providers). There was a strong positive correlation for Spanish surveys and a moderate correlation for English surveys (r = 0.71 Spanish surveys, r = 0.69 English surveys) between TSUQ and CVT for individual respondents. CONCLUSIONS: Patients conveyed positive experiences, but qualitative data revealed actionable targets for optimization like infrastructure and coordination improvements. Key limitations include small samples and lack of comparison to in-person care. Still, high satisfaction coupled with specific user feedback highlights telehealth's potential while directing enhancements. The results found high Veteran satisfaction with Spanish/English TBI telehealth, but mixed methods illuminated salient domains for better accommodating user needs, particularly regarding logistics and technology. Rigorously integrating experiences with metrics over expanded diverse samples and modalities can further guide refinements to enhance telehealth with a language-tailored approach.

Veteran-specific suicide prevention.

Suicide rates have been increasing in some subgroups of Veteran populations, such as those who have experienced combat. Several initiatives are addressing this critical need and the Department of Veterans Affairs (VA) has been recognized for its leadership. This integrative review adopts the Research Impact Framework (RIM) to address suicide-specific prevention activities targeting Veterans. The RIM is a standardized approach for developing issue narratives using four broad areas: societal-related impacts, research-related impacts, policy-related impacts, and service-related impacts. The questions addressed in this review are: (1) What are the major initiatives in Veteran-specific suicide prevention in four areas of impact-society, research, policy, and services? (2) Are there gaps related in each impact area? and (3) What are the implications of this narrative for other strategies to address suicide prevention targeting Veterans? Systematic application of the RIM identifies exemplars, milestones, gaps, and health disparity issues.

COVID-19 Vaccine Hesitancy Among Parents: A Qualitative Study.

OBJECTIVES: Addressing parental/caregivers' coronavirus disease 2019 (COVID-19) vaccine hesitancy is critical to improving vaccine uptake in children. Common concerns have been previously reported through online surveys, but qualitative data from KII and focus groups may add much-needed context. Our objective was to examine factors impacting pediatric COVID-19 vaccine decision-making in Black, Spanish-speaking, and rural white parents/caregivers to inform the content design of a mobile application to improve pediatric COVID-19 vaccine uptake. METHODS: Parents/caregivers of children aged 2 to 17 years from groups disproportionately affected by COVID-19-related vaccine hesitancy (rural-dwelling persons of any race/ethnicity, urban Black persons, and Spanish-speaking persons) were included on the basis of their self-reported vaccine hesitancy and stratified by race/ethnicity. Those expressing vaccine acceptance or refusal participated in KII, and those expressing hesitancy in focus groups. Deidentified transcripts underwent discourse analysis and thematic analysis, both individually and as a collection. Themes were revised until coders reached consensus. RESULTS: Overall, 36 participants completed the study: 4 vaccine acceptors and 4 refusers via KIIs, and the remaining 28 participated in focus groups. Participants from all focus groups expressed that they would listen to their doctor for information about COVID-19 vaccines. Infertility was a common concern, along with general concerns about vaccines. Vaccine decision-making was informed by the amount of information available to parents/caregivers, including scientific research; possible positive and negative long-term effects; and potential impacts of vaccination on preexisting medical conditions. CONCLUSIONS: Parents/caregivers report numerous addressable vaccine concerns. Our results will inform specific, targeted interventions for improving COVID-19 vaccine confidence.