Supportive care interventions and quality of life in advanced disease prostate cancer survivors: An integrative review of the literature.

BACKGROUND: Supportive care interventions can improve quality of life and health outcomes of advanced prostate cancer survivors. Despite the high prevalence of unmet needs, supportive care for this population is sparse. METHODS: The databases PubMed, SCOPUS, CINAHL, and ProQuest were searched for relevant articles. Data were extracted, organized by thematic matrix, and categorized according to the seven domains of the Supportive Care Framework for Cancer Care. RESULTS: The search yielded 1678 articles, of which 18 were included in the review and critically appraised. Most studies were cross-sectional with small, non-diverse samples. Supportive care interventions reported for advanced prostate cancer survivors are limited with some positive trends. Most outcomes were symptom-focused and patient self-reported (e.g., anxiety, pain, self-efficacy) evaluated by questionnaires or interview. Interventions delivered in group format reported improvements in more outcomes. CONCLUSIONS: Additional supportive care intervention are needed for men with advanced prostate cancer. Because of their crucial position in caring for cancer patients, nurse scientists and clinicians must partner to research and develop patient-centered, culturally relevant supportive care interventions that improve this population's quality of life and health outcomes. Efforts must concentrate on sampling, domains of needs, theoretical framework, guidelines, and measurement instruments.

Effect of a smoking cessation intervention for women in subsidized neighborhoods: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a community based participatory research (CBPR) developed, multi-level smoking cessation intervention among women in subsidized housing neighborhoods in the Southeastern US. METHODS: A total of n=409 women in 14 subsidized housing neighborhoods in Georgia and South Carolina participated in this group randomized controlled trial conducted from 2009 to 2013. Intervention neighborhoods received a 24-week intervention with 1:1 community health worker contact, behavioral peer group sessions, and nicotine replacement. Control neighborhoods received written cessation materials at weeks 1, 6, 12, 18. Random coefficient models were used to compare smoking abstinence outcomes at 6 and 12months. Significance was set a p<0.05. RESULTS: The majority of participants (91.2%) were retained during the 12-month intervention period. Smoking abstinence rates at 12months for intervention vs. control were 9% vs. 4.3%, p=0.05. Additional analyses accounting for passive smoke exposure in these multi-unit housing settings demonstrated 12month abstinence rates of 12% vs. 5.3%, p=0.016. However, in the multivariate regression analyses, there was no significant effect of the intervention on the odds of being a non-smoker (OR=0.44, 95% CI: 0.18-1.07). Intervention participants who kept coach visits, attended group sessions, and used patches were more likely to remain abstinent. CONCLUSIONS: This CBPR developed intervention showed potential to engage smokers and reduce smoking among women in these high-poverty neighborhoods. Effectiveness in promoting cessation in communities burdened with fiscal, environmental and social inequities remains a public health priority.

Baccalaureate Minority Nursing Students Perceived Barriers and Facilitators to Clinical Education Practices: An Integrative Review.

AIM: This integrative review synthesized baccalaureate minority nursing students' perceptions of their clinical experiences. BACKGROUND: The diversity of the nursing workforce does not mirror the United States population. Attrition rates of minority nursing students remain higher than rates for White students. Literature examining facilitators and barriers to minority student success predominantly focuses on academic factors, excluding those relevant to clinical education. METHOD: An integrative review using literature from nursing and education. FINDINGS: Three common perceived barriers were identified: discrimination from faculty, peers, nursing staff, and patients; bias in faculty grading practices; and isolation. CONCLUSION: Although little is known about the relationship between clinical failures and overall attrition, this review provides evidence that minority students encounter significant barriers in clinical education. To increase the diversity of the nursing workforce, faculty must address these issues and make modifications to ensure an equal opportunity at a quality education for all students.

The association of individual and neighborhood social cohesion, stressors, and crime on smoking status among African-American women in southeastern US subsidized housing neighborhoods.

The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6%, with an estimated neighborhood household prevalence ranging from 30 to 68%. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities' effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.

Allostatic load and spinal cord injury: review of existing research and preliminary data.

OBJECTIVE: To introduce allostatic load (AL) as a framework for measuring stress-related outcomes after spinal cord injury (SCI) by identifying the number and nature of biomarkers investigated in existing studies and by generating preliminary data on AL in 30 persons with traumatic SCI. METHODS: This systematic review and pilot study were conducted at a medical university in the southeastern United States. A review of literature published between 1993 and 2012 identified studies using 2 or more of 5 classes of AL biomarkers. We then collected data on 11 biomarkers (n = 30) from self-selected participants using physical exams and blood and urine specimen collection. These included waist to hip ratio, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, dihydroepiandrosterone, glycosylated hemoglobin, C-reactive protein, interleukin-6, and cortisol, norepinephrine, and epinephrine normalized by 12-hour creatinine. RESULTS: We were unable to identify any studies investigating AL biomarkers from each of the 5 areas or any studies specifically proposing to investigate AL. AL scores were relatively low, with metabolic indicators being the most elevated and neuroendocrine the least elevated. CONCLUSIONS: AL is a promising, yet underutilized, construct that may be feasibly assessed after SCI.

Working-Age Caregivers of Stroke Survivors: Needs, Concerns, and Quality of Life.

PURPOSE: The purpose of this study was to characterize the unmet needs and concerns of working-age caregivers of stroke survivors and to explore the relationships between these unmet needs and concerns and factors such as stroke survivor functional independence, caregiver strain, caregiver self-efficacy, caregiver perceived social support, and caregiver quality of life (QoL). DESIGN: Cross-sectional descriptive design was used in this study. METHODS: Participants ( N = 103) completed an online survey. Descriptive statistics, bivariate Pearson correlation, and linear regression analysis was performed. RESULTS: Negative correlations were found between caregiver needs and concerns and both stroke survivor functional independence and caregiver self-efficacy. Positive correlations were identified between caregiver needs and concerns and caregiver strain. In multiple regression models, stroke survivor functional independence, caregiver self-efficacy, race, and gender were statistically significantly associated with caregiver QoL. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Results of this study can inform nurses as they collaborate with informal caregivers and researchers in optimizing the rehabilitation and discharge process and aiding in the support of caregiver QoL. CONCLUSION: Working-age caregivers of stroke survivors expressed many needs and concerns. These needs, along with other factors, can affect outcomes including QoL in caregivers and stroke survivors.

Training partnership dyads for community-based participatory research: strategies and lessons learned from the Community Engaged Scholars Program.

This article describes the development, implementation, evaluation framework, and initial outcomes of a unique campus-community training initiative for community-based participatory research (CBPR). The South Carolina Clinical & Translational Research Center for Community Health Partnerships, which functions as the institution's Clinical Translational and Science Award Community Engagement Program, leads the training initiative known as the Community Engaged Scholars Program (CES-P). The CES-P provides simultaneous training to CBPR teams, with each team consisting of at least one community partner and one academic partner. Program elements include 12 months of monthly interactive group sessions, mentorship with apprenticeship opportunities, and funding for a CBPR pilot project. A modified RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guides the process, impact, and outcome evaluation plan. Lessons learned include challenges of group instruction with varying levels of readiness among the CBPR partners, navigating the institutional review board process with community co-investigators, and finding appropriate academic investigators to match community research interests. Future directions are recommended for this promising and unique dyadic training of academic and community partners.

Partnership readiness for community-based participatory research.

The use of a dyadic lens to assess and leverage academic and community partners' readiness to conduct community-based participatory research (CBPR) has not been systematically investigated. With a lack of readiness to conduct CBPR, the partnership and its products are vulnerable. The purpose of this qualitative study was to explore the dimensions and key indicators necessary for academic and community partnership readiness to conduct CBPR. Key informant interviews and focus groups (n = 36 participants) were conducted with academic and community participants who had experiences with CBPR partnerships. A 'framework analysis' approach was used to analyze the data and generate a new model, CBPR Partnership Readiness Model. Antecedents of CBPR partnership readiness are a catalyst and mutual interest. The major dimensions of the CBPR Partnership Readiness Model are (i) goodness of fit, (ii) capacity, and (iii) operations. Preferred outcomes are sustainable partnership and product, mutual growth, policy and social and health impact on the community. CBPR partnership readiness is an iterative and dynamic process, partnership and issue specific, influenced by a range of environmental and contextual factors, amenable to change and essential for sustainability and promotion of health and social change in the community.

Application of a CBPR framework to inform a multi-level tobacco cessation intervention in public housing neighborhoods.

African American women in urban, high poverty neighborhoods have high rates of smoking, difficulties with quitting, and disproportionate tobacco-related health disparities. Prior research utilizing conventional "outsider driven" interventions targeted to individuals has failed to show effective cessation outcomes. This paper describes the application of a community-based participatory research (CBPR) framework to inform a culturally situated, ecological based, multi-level tobacco cessation intervention in public housing neighborhoods. The CBPR framework encompasses problem identification, planning and feasibility/pilot testing, implementation, evaluation, and dissemination. There have been multiple partners in this process including public housing residents, housing authority administrators, community health workers, tenant associations, and academic investigators. The advisory process has evolved from an initial small steering group to our current institutional community advisory boards. Our decade-long CBPR journey produced design innovations, promising preliminary outcomes, and a full-scaled implementation study in two states. Challenges include sustaining engagement with evolving study partners, maintaining equity and power in the partnerships, and long-term sustainability of the intervention. Implications include applicability of the framework with other CBPR partnerships, especially scaling up evolutionary grassroots involvement to multi-regional partnerships.

Barriers and Facilitators to Supportive Care Implementation in Advanced Disease Prostate Cancer Survivors: A Theory-Informed Scoping Review.

BACKGROUND: Individualized supportive care is recommended to manage the debilitating effects of advanced prostate cancer and its treatments. Yet, the implementation of supportive care in practice remains inconsistent. OBJECTIVE: The aim of this study was to synthesize the barriers and facilitators to implementing supportive care interventions after identifying supportive care interventions for advanced prostate cancer survivors. METHODS: PubMed, SCOPUS, CINAHL Complete, ProQuest, and PsycINFO were searched for relevant studies published between 2011 and 2020. Studies were included if they reported on a supportive care intervention and included a description of implementation barriers and/or facilitators. The Theoretical Domains Framework was used to characterize implementation barriers and facilitators. RESULTS: Of the 620 articles identified, 13 met all prespecified inclusion criteria. Primary barriers were related to the domains of environmental context and resources (eg, limited resources), knowledge (eg, insufficient knowledge on efficacy of supportive care), and beliefs about capabilities (eg, lack of confidence in materials). Facilitators fell under environmental context and resources (partnerships with local services), reinforcement (eg, partners inclusion), and skills (eg, delivery by professionals). CONCLUSIONS: This scoping review highlights barriers and facilitators that affect supportive care implementation. Future research that focuses on overcoming barriers and maximizing facilitators is needed to improve, modify, or supplement existing supportive care implementation practices. IMPLICATIONS FOR PRACTICE: As the number of advanced prostate cancer survivors continues to increase, supportive care must become the standard of care. Future interventions must incorporate increased knowledge and funding, alternative delivery models, and consistent use of specialty nurses.

Survey of South Carolina Public School Personnel Perspectives on Barriers and Facilitators to Regular Physical Activity and Healthy Eating Behaviors in Schools.

BACKGROUND: In South Carolina (SC), 42% of youth are overweight or obese. Two sets of modifiable behaviors contributing to obesity are physical activity (PA) and dietary habits. School-based interventions have successfully improved these behaviors. The purpose of this study was to identify SC public school personnel perspectives on the most common barriers and facilitators to regular PA and healthy eating behaviors in schools. METHODS: A needs assessment survey was conducted with school personnel statewide. There were 17 questions on the survey that addressed: (1) demographic information about participants' educational backgrounds, (2) barriers to regular PA and healthy eating behaviors in schools, and (3) facilitators to regular PA and healthy eating behaviors in schools. Univariate and bivariate descriptive statistical analyses were performed using IBM SPSS Statistics 27. RESULTS: Participants (N = 1311) indicated insufficient time for regular PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating (n = 271, 20.7%) as main barriers. The primary facilitators were support from administrators for regular PA (n = 264, 20.1%) and support from cafeteria staff for healthy eating (n = 234, 17.8%). Further analyses explored how factors compared based on roles in schools, academic levels, and school district classifications. CONCLUSIONS: Results suggest that overarching barriers and facilitators to school-based interventions addressing childhood obesity exist, so common strategies to mitigate challenges and maximize supports can be used in schools. Future studies are needed to examine how decreasing barriers and enhancing facilitators affect the implementation and outcomes of these school-based interventions.

Describing South Carolina Public School Administrators' Perceptions and Experiences Related to School-Based Interventions and Strategies to Promote Healthy Physical Activity and Eating Behaviors: A Qualitative Study.

BACKGROUND: School-based interventions and strategies targeting physical activity (PA) and eating patterns have successfully addressed unhealthy behaviors contributing to excess weight in school-age children. The purpose of this study was to investigate South Carolina (SC) public school administrators' perceptions of and experiences with weight-related issues in schools and associated barriers and facilitators to awareness, selection, and implementation of school-based healthy PA and eating interventions and strategies. METHODS: This qualitative descriptive study, guided by the Social Ecological Model and the Steps in Quality Intervention Development Model, involved semistructured interviews with SC public school administrators from all academic levels (N = 28). Data were analyzed using thematic analysis. RESULTS: Four themes were identified from interviews (N = 28): weight-related terminology or stigma, experiences with school-based healthy PA and eating interventions and strategies, barriers to school-based healthy PA and eating interventions and strategies, and facilitators to school-based healthy PA and eating interventions and strategies. CONCLUSIONS: Schools are well-positioned to provide interventions and strategies to improve PA and dietary habits leading to childhood obesity. School administrators, while knowledgeable and experienced with weight-related issues and school-based interventions and strategies, encounter barriers and facilitators that impact offerings and delivery. Understanding these challenges and supports is important in the development, adaptation, and implementation of school-based interventions and strategies focused on healthy PA and eating behaviors.

Community advisory boards in community-based participatory research: a synthesis of best processes.

Community-based participatory research (CBPR) is a paradigm to study and reduce disparities in health outcomes related to chronic disease. Community advisory boards (CABs) commonly formalize the academic-community partnerships that guide CBPR by providing a mechanism for community members to have representation in research activities. Researchers and funding agencies increasingly recognize the value of the community's contribution to research and acknowledge that community advisory boards are a key component of successful CBPR projects. In this article, we describe the best processes for forming, operating, and maintaining CABs for CBPR. We synthesize the literature and offer our professional experiences to guide formation, operation, and maintenance of CABs.

"We've Had to Build the Plane as We Flew It.": Impacts of the COVID-19 Pandemic on School-Based Weight Management Interventions.

Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, elementary and secondary schools in the United States transitioned to remote learning to slow viral spread and protect students and school officials. This move interrupted academic education and school-based health interventions focused on physical activity (PA) and healthy eating behaviors to help combat childhood obesity. Little is known on how these interventions were affected by COVID-19. Methods: This concurrent multimethodological study incorporated two independent components: qualitative descriptive semistructured interviews with public school administrators and quantitative descriptive cross-sectional needs assessment survey of public school personnel. Results: Three themes were identified from interviews with school administrators (N = 28): changes in school-based interventions addressing PA and healthy eating behaviors, changes in academic delivery affecting PA and healthy eating behaviors, and needs of school administrators. From the survey (N = 1311), 635 (48.4%) participants indicated that schools' abilities to address PA and healthy eating behaviors were negatively impacted by COVID-19. The majority (n = 876, 66.8%) of participants strongly agreed or agreed that the pandemic would affect future school-based interventions related to PA and healthy eating behaviors. Conclusions: While schools are prime locations for delivering school-based weight management interventions related to childhood obesity, participants reported the pandemic had overall negative impacts on interventions addressing PA and healthy eating behaviors. Understanding these impacts is essential to adapting school-based interventions to changes from COVID-19 so students may receive health information and access health promotion interventions in remote learning environments and during social distancing.

Measurement of students' perceptions of nursing as a career.

PURPOSE: Middle school has been identified as the prime age group to begin nursing recruitment efforts because students have malleable perceptions about nursing as a future career choice. The purpose of this integrative review is to present a brief overview of research processes related to middle school students' perceptions of nursing as a future career choice and to critically evaluate the current instruments used to measure middle and high school students' perceptions of nursing as a career choice. DESIGN: An integrative review of the years 1989 to 2009 was conducted searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine PubMed service (PubMed), and Ovid MEDLINE databases using the key words career, choice, future, ideal, nursing, and perception. Reference lists of retrieved studies were hand searched, yielding a total of 22 studies. METHODS: Inclusion criteria were (a) sample of middle school students, (b) sample of high school students, (c) mixed sample including middle or high school students, and (4) samples other than middle or high school students if the instrument was tested with middle or high school students in a separate study. Ten studies met these criteria. FINDINGS: Of the 10 studies, samples were 30% middle school students; 40% high school students; 10% mixed, including school-aged students; and 20% college students with an instrument tested in middle school students. Eighty percent of participants were White females. Overall, participants' socioeconomic status was not identified. A single study included a theoretical framework. Five instruments were identified and each could be completed in 15 to 30 min. The most commonly used instrument is available free of charge. Seventy percent of the studies used Cronbach's alpha to report instrument reliability (0.63 to 0.93), whereas 30% failed to report reliability. Fifty percent of the studies established validity via a "panel of experts," with three of those studies further describing the panel of experts. CONCLUSIONS: Samples of white females may hinder generalization. Socioeconomic status was not consistently reported and may be an important factor with regard to perceptions of nursing as a career choice. An overall absence of theoretical framework hinders empirical data from being applied to nursing theories that in turn may support nursing concepts. The reporting of reliability and validity may be improved by further defining panel of experts and expanding the number of experts (more than seven). More in-depth evaluation of the psychometric properties of the instruments with more diverse populations is needed. CLINICAL RELEVANCE: Rigorously tested instruments may be useful in determining middle school students' perceptions about nursing. Therefore, future researchers should consider testing existing instruments in the middle school population, adhering to theoretical frameworks, diversifying the sample population, and clearly reporting reliability and validity to gain knowledge about middle school students' perceptions about a nursing career.

Evidence-based advocacy: using Photovoice to identify barriers and facilitators to community participation after spinal cord injury.

People with spinal cord injury (SCI) face many environmental barriers to community participation. In this article, a community-based participatory research (CBPR) project that implemented the Photovoice method with 10 individuals with SCI to gather evidence of the environmental factors affecting their participation in the community in and around Charleston, SC, is described. The specific aim of this project was to use Photovoice to create an evidence base of environmental barriers and facilitators to community participation through analysis of data based on the World Health Organization's International Classification of Functioning, Disability and Health taxonomy of environmental factors. Barriers and facilitators were most frequently photographed in the built environment. The participants have started to share their evidence of issues affecting citizens with disabilities with the public and policy makers. The results of this project illustrate that Photovoice is effective in empowering individuals with SCI to address environmental factors affecting their community participation.

Self-efficacy measurement instrument for neonatal resuscitation training: An integrative review.

Neonatal resuscitation is recognized by the World Health Organization as one of the priority interventions to reduce neonatal mortality rate. Measuring self-efficacy regarding neonatal resuscitation is one important criterion for evaluating the effectiveness of related training programs. This integrative review aims to critique evidence from high and low-to-middle-income countries. Additionally, guides appraisals of the instruments that measure self-efficacy in resuscitation training programs and adapt for low-to-middle-income countries. The databases searched for studies from 1980 to 2017 include: PubMed, CINAHL, SCOPUS, PyschINFO, and ERIC. and revealed 212 publications. Data extracted from eight instruments included theoretical framework, study location, instrument description and scoring, reliability and validity, and self-efficacy measurement outcomes. Six of eight self-efficacy instruments reported utilizing Bandura's Social Cognitive Theory while two of the eight instruments implied the use of self-efficacy. Most of the instruments reported acceptable internal consistency as Cronbach's alpha values ranged from 0.74 to 0.98 for reliability. Five of eight instruments were used in low-to-middle-income countries. A valid and reliable self-efficacy instrument is a necessary antecedent to evaluating the effectiveness of a neonatal resuscitation training program. Future studies may consider self-efficacy instruments with Visual Analog Scales in low-to-middle-income countries due to the ease of implementing the simple visual instrument.

Translating a spinal cord injury self-management intervention for online and telehealth delivery: A community-engaged research approach.

Objective: To develop educational content and pilot test the use of tablet computers (iPads), online content management platform (iTunes U) and video conferencing (FaceTime) for delivery of a peer supported, spinal cord injury self-management intervention, using a community-engaged research approach. Design: Cross-sectional convenience sampled pilot study; evaluation using a combination of observation and questionnaires. Setting: Community-based. Participants: Individuals with SCI (n = 10) recruited from the community. Interventions: Participants engaged in a hands-on evaluation of the educational content and technology. Outcome Measures: Usability and acceptability of educational content and technology. Results: Participants were receptive and satisfied with the iPad and iTunes U platform and the video chat experience. Statements by our participants demonstrated a clear preference for interactive and multimedia platforms to promote engagement with educational materials. The use of FaceTime to facilitate contact between the participant and PN demonstrated satisfactory usability and acceptability. The hands-on evaluation process highlighted the need for consideration of connectivity for rural participants and assistive technology needs. Conclusion: Our community-engaged research approach and evaluation processes provided direct user feedback on the online and telehealth implementation of PHOENIX that will guide development of the remaining educational content, and testing of the intervention in a future feasibility trial.

Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy.

BACKGROUND: Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality. AIM: This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries. METHODS: An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria. FINDINGS: Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births. CONCLUSION: Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates.