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Comparing perspectives of volunteers and patients on the Health Champions intervention in secondary mental healthcare: a qualitative study

Por: Pinto da Costa · M. · Chang · W. C. A. · Wu · Y. · Spence · S. · Cho · H. J. · Mcgrath · R. · Sadler · E. · Tredget · G. · Mdudu · I. · Gaughran · F. · Sevdalis · N. · Bakolis · I. · Williams · J.
Background

People with serious mental illness (SMI) can experience significant physical health challenges. The Health Champions intervention was developed to support their physical health through using trained volunteers. However, volunteer and patient perspectives on the impact and implementation of this intervention have yet to be understood.

Aims

To compare the views of patients and volunteers on the Health Champions intervention.

Design and setting

A qualitative thematic analysis was conducted on interviews with 29 study participants. Interviews were carried out either face-to-face, via Microsoft Teams, or by telephone and included 12 patients (6 men and 6 women) and 17 volunteers (the Health Champions) (5 men and 12 women).

Results

Four overarching themes were identified, highlighting both similarities and differences between stakeholders’ perspectives: (1) supporting goal setting; (2) impact on positive lifestyle; (3) experiences and perception of the programme and (4) navigating challenges during the programme. Both groups found the programme to be largely successful, by motivating patients to work towards their physical health goals and facilitating successful matching of patients with volunteers. Volunteers and patients valued good communication with the research team. Though both groups shared some views on the challenges with scheduling and a lack of face-to-face contact during the COVID-19 pandemic, their perceptions on how patients incorporated their health changes during and after the programme, as well as other administrative concerns such as views on the efficacy of journaling and breakdown of roles, differed.

Conclusions

The Health Champions intervention was perceived as useful to improve the physical health of patients with SMI. Differences in the views between the two stakeholders may result from their distinct experiences and expectations. Future volunteering programmes should further support the diverse physical health needs of patients with SMI.

Culturally appropriate sexual health interventions for STBBI and HIV among racialised immigrant communities in Western nations: a scoping review protocol

Por: Kwame · A. · Maina · G. · Langman · E. · Ndubuka · N. · Caine · V. · Spence · C. · Maposa · S. · Kamrul · R. · Mason · N. · Etowa · J. · Eaton · A. D. · Caron-Roy · S. · Abdulrasheed · A. · Guliak · D. · Chowdhury · I. · Ahmed · A. · Nyoni · N. · Hanson · J. · Alvarez · A.
Introduction

Racialised immigrant communities in Western nations face disproportionate risks for sexually transmitted and blood-borne infections (STBBIs) due to systemic barriers, including racism, stigma and limited access to culturally appropriate care. While the need is well-established, a comprehensive synthesis of effective, culturally responsive sexual health interventions is lacking. This scoping review aims to map the available evidence on sexual health intervention needs and protective factors of racialised immigrants, and to identify and describe existing culturally appropriate programmes in Western nations.

Methods and analysis

The review will follow the JBI methodology for scoping reviews and be reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search strategy, developed and peer-reviewed by a health sciences librarian, will be executed in MEDLINE, Embase, CINAHL and Scopus, alongside grey literature sources, with no date limit. Two independent reviewers will screen titles/abstracts and full texts against the inclusion criteria. Data will be extracted using a standardised tool, analysed via narrative synthesis and framed by a socio-ecological model to categorise interventions across individual, interpersonal, community and structural levels.

Ethics and dissemination

Ethical approval is not required for this review. Findings will be disseminated through a peer-reviewed publication, academic presentations and tailored summaries for community organisations and policy-makers to ensure practical application.

Review registration

Open Science Framework (https://osf.io/9qah6).

Ethnological study of birth timing decisions: a scoping review protocol

Por: Samim · Y. · Spence · N.
Introduction

Birth timing decisions, a type of reproductive decision-making (RDM), have yet to be explored in the RDM literature through an ethnological lens. Existing literature has generally observed reproductive decisions across broad racial categories, which has not allowed for a nuanced understanding of the cultural factors influencing birth timing decisions. This scoping review aims to answer the following questions: (1) How do different ethnic groups approach birth timing decisions? (1a) What social and structural factors influence birth timing/spacing decisions for different ethnic groups? (1b) What cultural logics emerge during these decision-making processes? Specifically, these questions are explored within the geographical context of the USA, as its diverse demographics, size and availability of data make it an ideal case. This scoping review thus makes two key contributions to the health literature: (1) it explores trends in birth timing decisions, which is a type of RDM that has typically been overlooked in favour of topics such as birth control use and timing, abortions and miscarriages, and wrongful births, and (2) it explores birth timing decisions from an ethnological perspective in a highly relevant context, expanding beyond homogenising race-based categorisations, toward a nuanced understanding of cultural considerations in family planning decisions across the USA.

Methods and analysis

This scoping review follows the protocol laid out in the extension of the Preferred Reporting Items for Systematic Reviews and Meta-analysis, for scoping reviews and will use thematic analysis[1]. Using four databases, Medline, Web of Science, the International Bibliography of the Social Sciences and Sociological Abstracts, original research articles have been captured using the attached search strategy, which contains key terms related to both the independent and dependent variables of interest. Results have been filtered to include only studies published in English within the last 20 years (2005 to present) and conducted in the USA. These criteria were implemented using a verified search string. Additional filters for human-only results were applied to the Medline search. All relevant publications have been imported to Covidence, where the authors will independently conduct title/abstract screening and full-text screening, as well as a thematic analysis of the extracted data from the remaining articles that meet the inclusion criteria. The authors aim to organise and synthesise all findings using the attached data extraction table (see supplemental documents).

Ethics and dissemination

This study uses existing publications and therefore does not require ethics submission or review. We intend to publish our scoping review in a peer-reviewed journal.

Trial registration number

This scoping review protocol has been registered via Open Science Framework (OSF); the preregistration can be found at the following link: https://osf.io/6f4bq

Site-randomised trial of a multilevel digital intervention to reduce maternal morbidity and mortality: a study protocol

Por: Kelpin · S. S. · Margerison · C. E. · McKay · A. S. · Vickers · E. · Crawford · M. K. · Spencer · J. · Sikorskii · A. · Ondersma · S. J.
Introduction

Compared with other high-income countries, the USA continues to have the highest rates of pregnancy-related and associated mortality and morbidity (PRAMM), particularly in rural areas and among non-Hispanic black pregnancies. Over 80% of pregnancy-related deaths are preventable; however, the intensity of existing interventions has proven difficult to broadly disseminate. Technology offers the potential to address such barriers. This study will develop a multilevel digital intervention to reduce PRAMM and evaluate its effects using a site-randomised trial.

Methods and analysis

The Michigan Healthy Mom (MI MOM) intervention will be developed using a community-partnered approach and will seek to address PRAMM risks at four distinct levels: individual, support system, provider and community. Pregnant participants and up to three members of their personal support system will receive an initial brief interactive session through a mobile web app and will thereafter receive a series of text messages with links to extended content. Healthcare providers will receive biweekly text messages and/or flyers distributed in clinic staff areas, and community health workers—who can facilitate access to local services—will be available via secure live chat text access. MI MOM effects will be evaluated using a cluster-randomised trial in 10 antenatal care clinics throughout Michigan (N=500 pregnant participants aged 18+ years receiving Medicaid). We will compare intervention and control arms on two coprimary outcomes: total PRAMM through 1 year post partum as measured using a universally collected linked dataset of Medicaid claims and vital records and an index of PRAMM risk factors directly targeted by MI MOM.

Ethics and dissemination

The Michigan State University Institutional Review Board has provided ethical approval (STUDY00011005). Results will be disseminated via presentations at academic conferences and community forums, as well as publications in peer-reviewed journals.

Trial registration number

NCT07213284.

Randomised hybrid type 1 pilot trial evaluating preliminary effectiveness and implementation of an emergency care action plan (ECAP) for infants with medical complexity within a rural health network: a study protocol

Por: Palaza · A. · Callas · P. · Dayan · P. S. · Kuo · D. Z. · Riney · L. · Spencer · S. P. · Stapleton · R. · Stevens · M. · Studts · C. R. · Pulcini · C. D.
Introduction

Children with medical complexity (CMC) are a subset of children with special healthcare needs, defined by high healthcare utilisation, severe single or multisystem organ dysfunction, and in many cases, reliance on medical technology. In the emergency care setting, known challenges for this population include poor quality of care, avoidable admissions and high caregiver and provider burden. While experts and professional societies recommend emergency care planning tools to address these concerns, evidence to support effectiveness and implementation of such tools is lacking. Through a human-centred design approach, we recently engaged key partners to create and optimise an emergency care action plan (ECAP) for infants with medical complexity. Here, we describe the protocol for a pilot type 1 hybrid effectiveness-implementation randomised controlled trial (RCT) for infants with medical complexity aimed to evaluate ECAP effectiveness and implementation.

Methods and analysis

Infants with medical complexity and their caregivers will be randomly assigned to the intervention group (ECAP) or control group (standard care) in a pilot type 1 hybrid effectiveness-implementation RCT. The primary outcome is number of inpatient hospital days for infant participants. Additional effectiveness outcomes include perceived avoidance of emergency department (ED) visits, healthcare costs, caregiver stress and self-efficacy. Preliminary implementation outcomes include acceptability, feasibility, appropriateness and usability, as well as contextual barriers and facilitators to reach, adoption and implementation. Key partners, including caregivers of CMC and healthcare providers, will be engaged throughout the implementation of the ECAP and execution of the trial.

Ethics and dissemination

This study was approved by the University of Vermont Institutional Review Board (STUDY00002937). Findings will be disseminated through peer-reviewed publications, conference presentations, and focus groups and interviews with key stakeholders.

Trial registration number

NCT06444282.

Readiness to reduce primary care-associated carbon emissions in England: a cross-sectional survey of clinical and non-clinical staff views

Por: Geddes · O. · Twohig · H. · Dahlmann · F. · Eccles · A. · Karaba · F. · Nunes · A. R. · Spencer · R. · Dale · J.
Objectives

To describe current levels of interest and action around decarbonisation in general practice settings, and awareness and use of currently available materials designed to support general practice teams undertake decarbonisation activity.

Design

Cross-sectional, mixed methods, online survey.

Setting

473 general practices in three Integrated Care Board regions in England.

Participants

Multiprofessional general practice staff.

Results

There were 328 responses from 163 (34.5%) practices. Most respondents were general practitioner (GP) partners (98; 29.9%), other clinical staff (93; 28.3%) or managerial staff (76; 23.2%). 229 (69.8%) respondents felt that acting to reduce carbon emissions from primary care is a legitimate part of general practice activity. However, only 44 (13.4%) felt that there is sufficient training and resources to support such activity, and only 59 (18.0%) agreed that there was sufficient leadership from higher levels within the health service to enable this. 58 (35.6%) practices had a lead for sustainability, generally managerial staff (22; 37.9%) or GP partners (17; 29.3%). Compared to other practices, those with a decarbonisation lead reported increased levels of decarbonisation actions currently being undertaken (mean = 5.2 vs 3.1; t(161) = 7.7, p2=31.9, p2=32.3, p

Conclusions

This survey provides insight into how English general practices and their staff regard decarbonisation activities. The findings highlight the importance of leadership, resources and incentives in driving such activities and have implications for initiatives to help achieve wider decarbonisation goals in healthcare.

Association of Gut Microbiota With Fatigue in Black Women With Polycystic Ovary Syndrome

imageBackground Fatigue is a highly prevalent symptom for individuals with polycystic ovary syndrome (PCOS); however, characterization of fatigue and investigation into the gut microbiome—a pathway that may contribute to fatigue—remains inadequately explored in Black women with PCOS. Objectives The purpose of this cross-sectional study was to examine fatigue and its relationship to the gut microbiome in adult Black women with PCOS. Methods Adult Black women with a diagnosis of PCOS were recruited for this cross-sectional study. The Multidimensional Fatigue Inventory-20 (MFI-20) and the PROMIS Fatigue Short Form were used to measure fatigue. The V3/V4 region of the bacterial 16S rRNA gene was sequenced to investigate gut microbial composition. Relative abundance and diversity values were calculated. Results We found that Black women with PCOS experience mild to moderate levels of fatigue. An inverse relationship between fatigue scores and alpha diversity values was found for the gut microbiome. We also found distinct beta diversity profiles based on fatigue. Lastly, when controlling for hypertension and body mass index, Ruminococcus bromii, Blautia obeum, Roseburia, and HT002 were associated with three subscales of the MFI-20. Discussion Black women with PCOS experience mild to moderate fatigue. Clinicians should be cognizant of this population’s increased risk for fatigue to adequately address their healthcare needs. We also found that gut microbial composition was associated with fatigue in Black women with PCOS. Specifically, a higher relative abundance of certain gut bacteria involved in short-chain fatty acid production and anti-inflammatory pathways was correlated with lower fatigue levels. Future studies should further investigate the link between the gut microbiome and fatigue to determine whether this relationship is causal as better insight could inform tailored diet and exercise interventions to alter the gut microbiome and reduce fatigue.
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