Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community.

BACKGROUND: Digital mobile health (mHealth) applications are a popular form of prenatal education and care delivery in the U.S.; yet there are few Spanish language options for native speakers. Furthermore, existing applications do not consider cultural differences and disparities in healthcare access, including those specific to emerging Latino communities. OBJECTIVE: To adapt and translate an English-language pregnancy mobile health app to meet the language and cultural needs of Spanish-speaking Latino immigrants living in the United States. METHODS: We use a multi-step process, grounded in implementation science frameworks, to adapt and translate the contents of an existing pregnancy app. Interviews with stakeholders (n = 12) who advocate for the needs of pregnant individuals in an emerging Latino community were used to identify domains of possible disparities in access to prenatal care. We then conducted semi-structured interviews with peripartum Spanish-speaking Latino users (n = 14) to understand their perspectives within those domains. We identified a list of topics to create educational material for the modified app and implemented a systematic translation approach to ensure that the new version was acceptable for immigrants from different countries in Latin America. RESULTS: The interviews with stakeholders revealed seven critical domains that need to be addressed in an adapted prenatal app: language and communication, financial concerns, social support, immigration status, cultural differences, healthcare navigation, and connection to population-specific community resources that offer Spanish language services. The interviews with peripartum Spanish-speaking Latino women informed how the existing content in the app could be adjusted or built upon to address these issues, including providing information on accessing care offered in their native language and community support. Finally, we used a systematic approach to translate the existing application and create new content. CONCLUSION: This work illustrates a process to adapt an mHealth pregnancy app to the needs of an emerging Latino community, by incorporating culturally sensitive Spanish language content while focusing on addressing existing health disparities.

Studying hot executive function in infancy: Insights from research on emotional development.

Recent calls have urged to bridge the fields of emotional and cognitive development to advance theoretical and empirical pursuits. Yet, despite notable overlap between research on executive function and emotion regulation, a uniting theory that informs future avenues of research is lacking. Infants are known to lack emotion regulation skills, as they are developing the abilities to regulate their emotions and coordinated responses. However, the field of emotional development demonstrates that at an early age, infants are adept at regulating their behaviors in response to others emotional reactions. Moreover, although classic delay of gratification tasks are fairly ecological measures, rarely are rules expressed to infants without emotions. This paper draws from recent interest in hot executive function to link infancy research on executive function and emotion. Hot executive function lends itself as a useful construct in this endeavor because it unites the study emotion and executive function. We offer a perspective that refines hot executive function within prominent emotion theories while discussing infant executive function and emotion empirical pursuits. Our perspective presents reliable paradigms from the field of emotional development to serve as tools for studying the development of hot executive function.

Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients.

Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created. Subsequently, we conducted semi-structured interviews with 10 patients to see if their experience supported the relationships outlined in the model. We identified three pathways by which DMPs are likely to change behavior around medication adherence: (1) providing patients and providers with accurate, personalized information about adherence; (2) improving patient-provider interactions by structuring them around this information; and (3) facilitating routines and habits for medication use. Chronically ill patients often fail to adhere to drug regimens. Patients in a DMP intervention used the DMP-provided information to better understand drug efficacy and collaborated with their physician to develop adherence strategies. DMPs can promote medication adherence among patients who are willing to use them and may be most effective if physicians are active partners in the DMP.

Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study.

BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

Emotions and Coping Strategies During Breast Cancer in Latina Women: A Focus Group Study.

We conducted three focus groups among Latina breast cancer (BC) survivors (N = 23). The aim was to qualitatively identify how Latina women cope with BC treatment, what emotions arose during their treatment, and if they experienced any medical barriers during their journey. Women were also asked about a potential online resource. Specific emotions of anger and fear were commonly identified but related to different contexts. Family support and spirituality were frequently cited as two positive coping resources during BC and its treatment. Additionally, women expressed what they believe would be essential in an online community that would provide aid with BC support. Given the importance of reaching this vulnerable minority group, we recommend that future studies contextualize Latina women's emotional experiences and coping skills associated with BC as indicators of well-being. Along with previous studies, this study highlights the importance of developing culturally appropriate interventions. Additionally, we address alternative forms of resources that may be more accessible.

Adult perceptions of children with dyslexia in the USA.

This study examined adult perceptions of dyslexia among US adults. Participants (n = 623) answered survey questions pertaining to characteristics, views, and possible causes of DYS. Exploratory factor analysis revealed five distinct factors: (1) psychosocial causes, (2) external causes, (3) biological causes, (4) consequences, and (5) controllability. Three-way ANOVA's were conducted to determine the effects of ethnicity, gender, and parental status on how DYS was perceived. The results revealed ethnic, gender, and parental status differences. Males endorsed psychosocial causes and external causes more often than females. Those who self-identified as Asian viewed DYS as more controllable in comparison to Whites. Results also revealed a three-way interaction regarding controllability. Understanding the public's perceptions about developmental disorders helps distinguish true from erroneous beliefs, and understanding differences that may exist in particular groups can help implement targeted actions to improve awareness, care, and interventions for families.

Vendor of choice and the effectiveness of policies to promote health information exchange.

BACKGROUND: As more hospitals adopt Electronic Health Records (EHR), focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work we examine the role of EHR vendors, hypothesizing that vendors strategically control the exchange of clinical care summaries. Their strategy may involve the creation of networks that easily exchange information between providers with the same vendor but frustrate exchange between providers with different vendors, even as both Federal and State policies attempt to incentivize exchange through a common format. METHODS: Using data from the 2013 American Hospital Association's Information Technology Supplement, we examine the relationship between a hospital's decision to share clinical care summaries outside of their network and EHR vendor market share, measured by the percentage of hospitals that have the same vendor in a Hospital Referral Region. RESULTS: Our findings show that the likelihood of a hospital exchanging clinical summaries with hospitals outside its health system increases as the percentage of hospitals with the same EHR vendor in the region increases. The estimated odds of a hospital sharing clinical care summaries outside their system is 5.4 (95% CI, 3.29-8.80) times greater if all hospitals in the Hospital Referral Region use the same EHR Vendor than the corresponding odds for a hospital in an area with no hospitals using the same EHR Vendor. When reviewing the relationship of vendor market concentration at the state level we find a positive significant relationship with the percentage of hospitals that share clinical care summaries within a state. We find no significant impact from state policies designed to incentivize information exchange through the State Health Information Exchange Cooperative Program. CONCLUSION: There are benefits to exchanging using proprietary methods that are strengthened when the vendors are more concentrated. In order to avoid closed networks that foreclose some hospitals, it is important that future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.

Reading disability and enhanced dynamic spatial reasoning: A review of the literature.

Previous research on reading disabilities (RD) has primarily focused on the cause and expression of the disability. The vast majority of this research has focused on the disorder itself, although it has been proposed that RD embodies other qualities not necessarily related to language or reading deficits. In fact, strengths in nonverbal processing and visual-spatial talents have been proposed to exist in persons with RD. However, the limited empirical data on this matter have yielded inconsistent results. The purpose of this review was to examine this literature, focusing on research concerning dynamic and complex spatial processing or reasoning in people with dyslexia. Our review suggests that there is little evidence in support of a spatial advantage in people with dyslexia, and, in fact, the data show that RD samples most often perform worse or equal to non-RD samples. An exception to this general conclusion may be performance on holistic visualization of complex figures, where RD samples have consistently demonstrated faster response times even though accuracy rates often do not exceed that of controls. The possibility of a unique spatial processing neurology that develops through right-left hemisphere interactions in persons with RD is discussed based on preliminary fMRI data.

[Inconsistent condom use among Mexican women living with HIV: a challenge for health services]. / El uso inconsistente del condón en mujeres mexicanas que viven con VIH: un reto para los servicios de salud.

OBJECTIVE: To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization. MATERIALS AND METHODS: Qualitative analysis of 55 interviews with women of reproductive age living with HIV. RESULTS: Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms. CONCLUSIONS: Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.

El uso inconsistente del condón en mujeres mexicanas que viven con VIH: un reto para los servicios de salud / Inconsistent condom use among Mexican women living with HIV: a challenge for health services

Objetivo. Describir prácticas de uso del condón en mujeres mexicanas con VIH y analizar factores que lo facilitan u obstaculizan. Material y métodos. Análisis cualitativo de 55 entrevistas con mujeres que viven con VIH en edad reproductiva. Resultados. El uso inconsistente y el no uso del condón en la última relación sexual fueron comunes y no mostraron una relación clara con el estatus serológico de la pareja. Factores favorables al uso del condón fueron las percepciones de su beneficio para la salud, significados simbólicos del condón en relaciones de pareja y transformación o persistencia de normas de género. Conclusiones. Las normas de género y las actitudes de la pareja masculina intervienen en el uso del condón entre mujeres con VIH. Para incrementar su uso consistente, el sistema de salud debe ofrecer consejería y servicios con perspectiva de género e implementar acciones innovadoras que involucren a las parejas masculinas.

Objective. To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization. Materials and methods. Qualitative analysis of 55 interviews with women of reproductive age living with HIV. Results. Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms. Conclusions. Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.