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Exploring stress and coping among black women in early midlife with elevated blood pressure in a safety-net health system: a qualitative focus group protocol

Por: Sprague · B. N. · Beverly · A. R.
Introduction

Black women in early midlife experience disproportionate exposure to stress and elevated cardiovascular risk, including hypertension. Despite this, few stress management interventions are designed with and for this population. This study aims to explore the lived experiences of stress and coping among black women in early midlife with elevated blood pressure to inform the codesign of a culturally relevant, multilevel stress management intervention.

Methods and analysis

We will conduct one-time, semistructured focus groups with black women aged 35–50 who have elevated blood pressure, recruited from a large safety-net health system. Data will be analysed using a constructivist grounded theory approach, with inductive theme development supported by line-by-line, focused and theoretical coding. The Social Determinants of Cardiovascular Disease framework will serve as a sensitising guide to multilevel contextual factors rather than a prescriptive coding structure. An artificial intelligence (AI)-assisted analytic component will complement human-led analysis by supporting preliminary theme exploration and enhancing transparency.

Ethics and dissemination

Approved by the Indiana University Institutional Review Board (Protocol #21785). All participants will provide written informed consent. Findings will be shared via peer-reviewed publications, conference presentations and lay summaries for stakeholders.

The MINT Program: A Mixed‐Method Approach to Identifying Nature‐Based Resources to Promote Adolescent Parent Social and Psychological Well‐Being

ABSTRACT

Background

Adolescent parents are at an increased risk for loneliness and mental health challenges compared to childless peers. Nature-based interventions are shown to promote social connectedness.

Aim

To identify elements of a nature-based intervention to reduce loneliness and foster nature connection among pregnant and parenting adolescents.

Design

Sequential exploratory mixed methods.

Methods

In 2020 and 2021, we piloted the 8-week MINT program at a school for pregnant and parenting teens. Our qualitative approach (n = 17) included online and in-person group meetings with nature-based educational content, discussion, park excursions, mindfulness activities, journaling and nature photography. Subsequently, we recruited 131 young mothers at a children's hospital for a cross-sectional survey based on qualitative school findings.

Results

Qualitative results from the school-based intervention showed a preference for meditative and contemplative activities and for spending time in nature with extended family. Participants typically accessed nature close to home. Our clinic-based teen parent survey illustrated that participants' access to nature were most limited by lack of time (25% of responses), company (18%) and energy (28%). While participants showed a close nature connection (mean NR-6 score = 3.9 (SD = 0.84)), they also showed moderate levels of loneliness (mean UCLA Loneliness score = 4.78 (SD = 1.60)). Walking, hiking and/or running were the most preferred nature activity.

Conclusion

These findings provide key details to define nature-based activities to address loneliness and psychological well-being among teen mothers.

Implications for the Profession and/or Patient Care

Nature-based health interventions can address loneliness and nature disconnection by building community resilience, improving provider and patient well-being and motivating environmental stewardship.

Impact

We identify key features of a nature-based intervention for adolescent mothers. These findings support teen mothers in the US and abroad and may serve as a foundation for using nature-based solutions for vulnerable mothers and for adolescents facing loneliness and mental health challenges.

Patient or Public Contribution

No patient or public contribution.

Consensus on addressing HIV-related stigma and achieving the societal enabler targets using an adapted Delphi process

Por: Molesworth · K. · Nkosi · S. · Camacho · S. · Caswell · G. · Salem · S. · Baral · S. · Kamarulzaman · A. · Sprague · L. · Stackpool-Moore · L.
Objectives

To seek consensus among global experts on concepts, measures and approaches to guide national and global action to address HIV-related stigma and formulate a call to action. This outlines priorities to unite actors in more effectively responding to and resourcing efforts to address HIV-related stigma.

Design

An adapted Delphi consensus-building process using two rounds of online questionnaires.

Setting

Online questionnaires sent to a global expert panel.

Participants

50 global experts on HIV-related stigma and discrimination representing sectors including civil society, people living with HIV and key populations, research and academia, clinical practice, law, non-profit organisations, the United Nations, and policy and donor organisations.

Results

The panel reached consensus on 55 points relating to the 12 broad themes extracted from the evidence base. These comprised the importance of addressing HIV-related stigma at scale; HIV-related stigma terms and definitions; Frameworks; Programming and approaches; Community leadership in HIV-related stigma-reduction implementation; Intersectional stigma and discrimination; Stigma and discrimination measures and assessment scales; Monitoring and evaluation; Stakeholder and community participation in monitoring and evaluation; Knowledge gaps and research needs; Funding and Commitment calls. From these, a consensus statement and call to action were formulated on priorities for strong political and financial commitments by all countries to reduce and mitigate HIV-related stigma and achieve global HIV targets adopted in 2021.

Conclusions

This study illustrated that global experts across sectors consider that action is needed to support the three critical enablers of the HIV response—society, systems and services—to ensure that HIV services are non-discriminatory and person-centred. The importance of attention and action to reduce stigma is critical in the current geopolitical and funding crisis affecting HIV and global health.

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