Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century.

Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.Methods: This opinion draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviors, from one another.Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.

Advancing digital health equity: Directions for behavioral and social science research.

The field of digital health is evolving rapidly and encompasses a wide range of complex and changing technologies used to support individual and population health. The COVID-19 pandemic has augmented digital health expansion and significantly changed how digital health technologies are used. To ensure that these technologies do not create or exacerbate existing health disparities, a multi-pronged and comprehensive research approach is needed. In this commentary, we outline five recommendations for behavioral and social science researchers that are critical to promoting digital health equity. These recommendations include: (i) centering equity in research teams and theoretical approaches, (ii) focusing on issues of digital health literacy and engagement, (iii) using methods that elevate perspectives and needs of underserved populations, (iv) ensuring ethical approaches for collecting and using digital health data, and (v) developing strategies for integrating digital health tools within and across systems and settings. Taken together, these recommendations can help advance the science of digital health equity and justice.

The field of digital health is quickly growing and changing. Digital health technologies have the potential to increase access to health-related information and healthcare and improve wellbeing, but it is important that those technologies don't widen existing health disparities or create new ones. Behavioral and social science researchers have a key role to play in centering equity in their research teams and theoretical approaches, focusing on key barriers to access, uptake, and usage, studying digital health in ways that elevate the voices and needs of historically underserved groups, being thoughtful about how digital health data are collected and used, and making sure that digital health tools are designed to be used in real-world settings.

HIV-Related Stigma Research as a Priority at the National Institutes of Health.

The National Institutes of Health (NIH) recognizes that, despite HIV scientific advances, stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV interventions. Achieving the Ending the HIV Epidemic: A Plan for America (EHE) goals will require eliminating HIV-related stigma. NIH has a significant history of supporting HIV stigma research across its Institutes, Centers, and Offices (ICOs) as a research priority. This article provides an overview of NIH HIV stigma research efforts. Each ICO articulates how their mission shapes their interest in HIV stigma research and provides a summary of ICO-relevant scientific findings. Research gaps and/or future opportunities are identified throughout, with key research themes and approaches noted. Taken together, the collective actions on the part of the NIH, in tandem with a whole of government and whole of society approach, will contribute to achieving EHE's milestones.

RESUMEN: Los Institutos de Salud Nacional (NIH, siglas en inglés) reconocen que, a pesar de los avances en la prevención y el tratamiento, el estigma y la discriminación continúan siendo barreras críticas a la adopción de la prevención y el cuido basados en la evidencia. Las metas de Logrando el Fin de la Epidemia de VIH: Plan para América (EHE, siglas en inglés) requerirán la eliminación del estigma relacionado al VIH. Los NIH tienen una historia significativa apoyando la investigación del estigma relacionado al VIH a través de sus Institutos, Centros, y Oficinas (ICOs, siglas en inglés). Esta investigación es una prioridad fundamental y entrelazada para los ICOs. En este artículo, los autores de los NIH proveen una reseña sobre la investigación del estigma relacionado al VIH a través de los ICOs selectos. Cada ICO articula como su misión y prioridad dan forma a su interés en la investigación del estigma al VIH y provee una breve reseña de los hallazgos científicos pertinentes al ICO. Lagunas en la investigación relacionada a la misión, prioridades, y/o áreas de investigación futuras se identifican a través del artículo. También se apuntan en el resumen los temas de investigación claves y sus estrategias. En conjunto, las acciones colectivas de parte de los NIH, junto a la estrategia necesaria de parte del gobierno en su totalidad y de la sociedad en su totalidad, contribuirán al logro de las metas del EHE.

NIH-Funded CBPR: Self-Reported Community Partner and Investigator Perspectives.

The community-based participatory research (CBPR) approach across health contexts has matured greatly over the last 20 years. Though contributions to the literature on the development and effectiveness of CBPR interventions have grown, the number of publications on the function and evaluation of actual community-research partnerships has not kept pace. To help address that gap, we searched National Institutes of Health archival data and identified a set of 489 CBPR projects including collaboration-building, exploratory/pilot, research, and program project grants. We found community partner contact information commonly was absent from grant records and contacted principal investigators (PIs) for community-partner contact information. Subsequently, we built upon established measures to ask principal investigators and community partners for their perceptions of participation in NIH-funded CBPR projects. Many principal investigators and community partners reported existing collaborations-between academicians and community organizations as well as among community organizations. Partners tended to agree on the appropriateness of funding levels to accomplish projects and on the community partners' ability to recruit and retain participants, collect data, and implement interventions. Partners differed in perceptions of participation in research design, data analyses, manuscript and presentation production, and dissemination of findings. Suggestions include collection of lead community partner information without undue burden and increased standard education and involvement of community organizations in research vocabulary and practices.

NIH research opportunities for the prevention and treatment for chronic conditions.

Chronic conditions constitute the leading cause of death and disability in the USA and constitute 86 per cent of the nation's annual healthcare expenses. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions. The National Institutes of Health have funded many projects that explain epidemiology, risk factors, and prevention and treatment of chronic conditions, though research questions remain. This commentary discusses some past projects, current areas of interest, and funding opportunities from many NIH Institutes, Centers, and Offices.

Evaluation of a mid-career investigator career development award: Assessing the ability of OppNet K18 awardees to obtain NIH follow-on research funding.

The National Institutes of Health (NIH) K18 award mechanism provides funded opportunities for established investigators to gain knowledge in fields outside of their primary disciplines, but outcomes associated with these awards have not been evaluated to date. NIH's Basic Behavioral and Social Sciences Opportunity Network (OppNet) is one of the few initiatives that has used this award mechanism. We explored how the unique features of K18 awards affect the ability of recipients to obtain follow-on NIH research funding. We compared outcomes (ability to obtain follow-on funding and interval between receipt of the primary award and receipt of the first follow-on award) associated with OppNet K18 awards to findings from evaluations of other NIH career development (K) awards, which usually target early-career investigators. We hypothesized that K18 award recipients might be (1) more successful than are other K award recipients in obtaining follow-on NIH research funding due to their career experience or (2) less successful due to the competing demands of other projects. By analyzing follow-on NIH research awards and interview data, we found that OppNet K18 award recipients were at least as successful as were other K award recipients in obtaining follow-on funding and may have been more successful by certain measures. K18 awards produce their outcomes with a lower investment per investigator than do other K awards, suggesting continued or enhanced use of the mechanism.

National Institutes of Health Research Plan on Rehabilitation: NIH Medical Rehabilitation Coordinating Committee.

One in five Americans experiences disability that affects their daily function because of impairments in mobility, cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The National Institutes of Health (NIH) recently published a Research Plan on Rehabilitation that provides a set of priorities to guide the field over the next 5 years. The plan was developed with input from multiple Institutes and Centers within the NIH, the National Advisory Board for Medical Rehabilitation Research, and the public. This article provides an overview of the need for this research plan, an outline of its development, and a listing of six priority areas for research. The NIH is committed to working with all stakeholder communities engaged in rehabilitation research to track progress made on these priorities and to work to advance the science of medical rehabilitation.This article is being published almost simultaneously in the following six journals: American Journal of Occupational Therapy, American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Neurorehabilitation and Neural Repair, Physical Therapy, and Rehabilitation Psychology. Citation information is as follows: NIH Medical Rehabilitation Coordinating Committee. Am J Phys Med Rehabil. 2017;97(4):404-407.

Measuring the Influence of Legally Recognized Partnerships on the Health and Well-Being of Same-Sex Couples: Utility of the California Health Interview Survey.

PURPOSE: This study explored the utility of the California Health Interview Survey (CHIS) to compare health-related outcomes among gay men, lesbians, and heterosexuals who reported being in a legally recognized partnership. METHODS: We regressed sexual identity and marriage/legally recognized partnership status on seven different outcomes related to health insurance coverage, medical services access and use, and general health and well-being using CHIS data collected between 2009 and 2013. RESULTS: There were 1432 respondents who identified as gay, lesbian, or homosexual, and 67,746 who identified as heterosexual. The percentage of participants who reported being married/legally partnered was 54.06% for heterosexual women, 52.93% for heterosexual men, 38.83% for lesbians, and 23.56% for gay men. Legally partnered/married gay and lesbian respondents were more likely to have health insurance and use healthcare than their counterparts not in such partnerships; few trends were statistically significant. Gay men in legally recognized partnerships were more likely than their heterosexual counterparts to report continuous health insurance coverage, a usual medical care source, and at least one provider visit within the past 12 months. We found statistically significant poorer health status outcomes among lesbians in legally recognized partnerships compared to married heterosexual women. CONCLUSIONS: Lesbians in legally recognized partnerships did not fare as well as married heterosexual women. Gay men in legally recognized partnerships fared better than married heterosexual men on some measures. CHIS questionnaire structures limited our sample and analyses. We recommend that CHIS and other researchers ask partnered status-, marriage-, and sexual identity-related questions en bloc to ensure more robust representation, analyses, recommendations, and policy resolutions.

"Risks both known and unknown"a qualitative method to assess the role of situation in HIV/STD risk and prevention.

The idea of situation has gained increased attention in HIV/STD prevention research and practice. In the context of prevention, situation does not simply connote setting or place but also incorporates meanings people attached to the physical setting and how the complex interrelation of setting, meaning, and behaviors influences decisions regarding sexual behaviors and prevention measures. Kenneth Burke's pentadic analysis provides a means to illuminate how situation influences decisions regarding sexual behaviors and risk taking. This manuscript describes the pentadic method, its application to situation and sexual risk behaviors, and its utility through content analysis of transcribed interviews (or texts) with men who patronize bathhouses, bathhouse staff members, and release forms from bathhouse establishments in three geographic areas. In this case, the analysis reveals that bathhouse patrons and policies perceive bathhouses as situations that privilege expedient sexual release rather than individuals and over how those releases occur. This predominant perspective impedes, but does not preclude, risk reduction. The authors provide recommendations for promoting condom use for anal sex in the bathhouse setting as well as for the utility of pentadic analysis in related research.

Perceived HIV-related Stigma and HIV Disclosure to Relationship Partners after Finding Out about the Seropositive Diagnosis.

The present study examined how perceived HIV-related stigma (how much HIV-infected persons believe that the public stigmatizes someone with HIV) influences both reasons for and against HIV disclosure and self-reports of HIV disclosure to a friend, intimate partner and a parent. The research participants were 145 men and women living with HIV. They were asked to recall when they first learned about their HIV diagnosis. Then they indicated how much specific reasons might have influenced disclosing or not disclosing about the HIV diagnosis to a friend, intimate partner and a parent. Findings, based on the total sample, indicated that perceived HIV-related stigma was associated with the endorsement of various reasons against disclosing to a friend and a parent, including concerns about self-blame, fear of rejection, communication difficulties and a desire to protect the other person. Perceived HIV-related stigma was not associated with the endorsement of any reasons for disclosing to a friend, intimate partner or a parent, including catharsis, test other's reactions, duty to inform/educate, similarity and a close/supportive relationship with the other. In addition, perceived HIV-related stigma predicted self-reports of disclosure to a parent but not to a friend or intimate partner. Specific reasons for and against self-disclosure predicted HIV disclosure based on the type of relationship with the potential disclosure recipient. The data analyses were also stratified by gender; these results were, with some exceptions, consistent with the findings with the total sample. The research introduces scales that quantify individuals' reasons for HIV disclosure and/or nondisclosure.