"It's different here" Afghan refugee maternal health experiences in the United States.

BACKGROUND: The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care. METHODS: Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data. RESULTS: We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. CONCLUSIONS: The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.

Self-regulatory coping among community dwelling older adults with multiple chronic conditions.

Objectives: Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC. Methods: A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study. Results: Three themes were developed from the analysis: (1) "I don't think about it unless something happens": coping in the absence of a health event, (2) "doing what I am supposed to do": coping during a health event, and (3) "How do I know if what I did works?": appraisal of coping success. Discussion: Self-regulatory coping was influenced by individual beliefs and experiences (illness representations), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.

Perceptions and Use of Safe Sleep Baby Boxes at Hospital Discharge by New Mothers.

BACKGROUND: A large community hospital in South Texas began distributing safe sleep baby boxes to reduce sudden unexplained infant death (SUID) in 2017. PURPOSE: To describe safe sleep practices among new mothers who received a safe sleep baby box at hospital discharge. METHODS: An information sheet containing a link to an online survey was mailed to all women who received a safe sleep baby box prior to discharge from the hospital from January 2018 to January 2019. RESULTS: N = 84 women participated. Most reported using the safe sleep baby box only during nap time (n = 62, 88.6%). Only 70.2% of participants reported that baby always slept their back (n = 59). Most reported their baby did not use a pacifier (n = 62, 73.8%), and many reported they were not breastfeeding their baby (n = 38, 45.2%). CLINICAL IMPLICATIONS: Many women were not using the safe sleep baby box as intended and were not following many of the other safe sleep guidelines. Nurses should ask their patients about plans for infant safe sleep after discharge to provide individualized education or recommend specific resources to address the family's needs.

Exploring illness perceptions of multimorbidity among community-dwelling older adults: a mixed methods study.

Background: Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. Although extensive research exists about illness perceptions, little is known about illness perceptions of multimorbidity. Methods: The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n=17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n=116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics. Results: Overall, participants were mostly female (71%), self-reported as Hispanic (35%), Black (33%), White (27%), or Asian (5%). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants' socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions. Conclusions: Illness perception of multimorbidity may not differ by the number of chronic conditions the participants had. Rather, participants prioritized the impact of multimorbidity on their overall wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused interventions to address holistic needs of older adults with multimorbidity.

Application of the Flipped Classroom Approach in an Undergraduate Maternal-Newborn Nursing Course to Improve Clinical Reasoning.

Application of knowledge is shown to improve student comprehension, but with dwindling hands-on clinical opportunities in nursing programs, active learning strategies need to be incorporated into classroom learning. Nursing faculty in an undergraduate nursing program transitioned from a lecture format to a flipped classroom format, thereby incorporating active learning. Quantitative and qualitative data on student performance were collected over three semesters. The Assessment Technologies Institute (ATI) maternal-newborn content mastery exam, used as the final examination for the course, was used to assess student academic performance. End-of-course student feedback was collected from the Campuslabs IDEA Student Rating of Instruction (SRI) evaluation to assess students' perceptions of their ability to understand and apply knowledge, as well as perceptions of the flipped classroom format in general. The ATI exam scores for the course did not change significantly, but the SRI showed a statistically significant increase in the percentage of students who felt they gained a "deeper understanding" and could "apply the knowledge and skills." Although students resisted the flipped classroom format change initially, subsequent cohorts came to accept the change. Implications for educators are that although student dissatisfaction increased initially, the inclusion of the flipped classroom format within a course improved students' confidence in their ability to perform.

Scoping Review of Microaggression as an Experience of Racism and Perinatal Health Outcomes.

OBJECTIVE: To synthesize current knowledge and identify gaps in the literature related to microaggression as an experience of racism and its influence on perinatal health outcomes. DATA SOURCES: We searched PubMed, Race Relations Abstracts, Academic Search Complete, CINAHL, PsycInfo, and Scopus using the keywords "micro-aggression" and "microaggression." Because microaggression is an all-encompassing term, we included articles that used keywords such as "racism," "prejudice," and/or "discrimination" because these terms are precursors to and touch on aspects of microaggression. We also included terms related to perinatal health outcomes. STUDY SELECTION: We included articles in which researchers reported on studies conducted in the United States. Articles focused on perinatal health outcomes, referred to microaggressions or related concepts, and were published in English from January 2014 through July 2020. We chose these dates because the term microaggression became more common in the literature around 2017 and is used primarily in the United States. Following removal of duplicates, we reviewed 2,331 titles and abstracts and identified 103 articles for full-text review. Thirteen articles met inclusion for the final sample. Screening at all levels was blinded. DATA EXTRACTION: We extracted data, including setting, study type, study design, microaggression type, results, health outcomes, and definitions of microaggression. DATA SYNTHESIS: In the selected articles, researchers addressed microaggression as an experience of racism in relation to the following perinatal health outcomes: small-for-gestational-age newborns, hypertension, preterm birth, low birth weight, and symptoms of postpartum depression or anxiety. CONCLUSION: In this scoping review, inconsistencies in how it was defined, measured, and controlled made it difficult to draw conclusions about the role microaggression plays in perinatal health outcomes. We recommend more research to explore, document, and understand this phenomenon.

Qualitative Sampling Methods.

Qualitative sampling methods differ from quantitative sampling methods. It is important that one understands those differences, as well as, appropriate qualitative sampling techniques. Appropriate sampling choices enhance the rigor of qualitative research studies. These types of sampling strategies are presented, along with the pros and cons of each. Sample size and data saturation are discussed.

The Journal of Human Lactation: A Reflective Discussion.

Research about lactation and breastfeeding has exploded since the Journal of Human Lactation (JHL) began publishing in 1985. To discuss the 3-decade-long role of the Journal in promoting, supporting, and disseminating lactation research, editors convened a multidisciplinary group of lactation researchers and providers which comprised three senior researchers and one clinical practitioner, all of whom have a long history of lactation advocacy. Their discussion took place on July 1, 2019. Dr Aimee Eden is a medical anthropologist who leads the qualitative research efforts in a small research department. Her dissertation research focused on the maternal and child healthcare workforce, and the professionalization of breastfeeding support. She served on the Board of Directors of the International Board of Lactation Examiners (2010-2016) and currently serves on the board of the Monetary Investment for Lactation Consultant Certification. Dr Karleen Gribble has been conducting research for 15 years about infant and young child feeding in emergencies, long-term breastfeeding, milk sharing, early childhood trauma, adoption, and fostering. She is an Australian Breastfeeding Association community educator and breastfeeding counselor and a member of the Infant and Young Child Feeding in Emergencies Core Group. Elien Rouw is a practicing physician in Germany specialized in healthy infant care, with a long-standing specialization in breastfeeding medicine. She serves on the Board of Directors of the Academy of Breastfeeding Medicine, is a member of the German National Breastfeeding Committee and their delegate to the World Alliance for Breastfeeding Action. Dr Jackie Wolf is an historian of medicine, whose research focuses on the history of childbirth and breastfeeding practices in the United States and how those practices have shaped women's and children's health, as well as public health, over time. Her latest book, published by Johns Hopkins University Press and funded by a 3 year grant from the National Institutes of Health, is Cesarean Section: An American History of Risk, Technology, and Consequence. Dr Sara Gill moderated the discussion. She was a member of the Board of Directors of the International Lactation Consultant Association for 5 years, and has been an Associate Editor of the Journal of Human Lactation for the past 4 years. Her research has focused on breastfeeding among vulnerable populations. (Participants' comments are noted as AE = Aimee Eden; SG = Sara Gill; KG = Karleen Gribble; ER = Elien Rouw; JW = Jacqueline Wolf).

Health Literacy and Cervical Cancer Screening Among Mexican-American Women.

BACKGROUND: Health literacy is a requisite skill for making personal health and health care decisions. Low health literacy may contribute to lower cervical cancer screening rates and cervical cancer health disparities among Mexican-American women in South Texas. OBJECTIVE: To explore older Mexican-American women's health literacy related to cervical cancer from the perspective of Zarcadoolas, Pleaseant, and Greer's health literacy model. METHODS: We conducted five focus groups and seven individual interviews with 30 Mexican and Mexican-American women in South Texas. We analyzed demographic data using descriptive statistics and conducted thematic analysis of focus group and individual interview data. KEY RESULTS: Several themes reflected the domains of health literacy, including fundamental literacy ("speaking of language"), science literacy (cancer prevention), cultural literacy ("we are different"), civic literacy (the availability of "consejos" [advice]), and media literacy (e.g., "telenovelas" [soap-operas] teach a lot). In this article, we present findings related to culture and language under the domains of fundamental and cultural literacy. CONCLUSIONS: Mexican-American women's cultural values and language use may serve as both deterrents and incentives to cervical cancer screening. The meaning of words can be lost in translations. Health care providers can use this information to provide cervical cancer screening education congruent with Mexican-American's culture, language, and code switching. [HLRP: Health Literacy Research and Practice. 2019;3(1):e1-e8.]. PLAIN LANGUAGE SUMMARY: The understanding of culture and language can help health care providers improve cervical cancer screening practices among Mexican-American women. The results from this study can be used to individualize patient care and to develop education and communication strategies that are similar to the population we serve, including Mexican-American women.

ßIV Spectrinopathies Cause Profound Intellectual Disability, Congenital Hypotonia, and Motor Axonal Neuropathy.

ßIV spectrin links ankyrinG (AnkG) and clustered ion channels at axon initial segments (AISs) and nodes of Ranvier to the axonal cytoskeleton. Here, we report bi-allelic pathogenic SPTBN4 variants (three homozygous and two compound heterozygous) that cause a severe neurological syndrome that includes congenital hypotonia, intellectual disability, and motor axonal and auditory neuropathy. We introduced these variants into ßIV spectrin, expressed these in neurons, and found that 5/7 were loss-of-function variants disrupting AIS localization or abolishing phosphoinositide binding. Nerve biopsies from an individual with a loss-of-function variant had reduced nodal Na+ channels and no nodal KCNQ2 K+ channels. Modeling the disease in mice revealed that although ankyrinR (AnkR) and ßI spectrin can cluster Na+ channels and partially compensate for the loss of AnkG and ßIV spectrin at nodes of Ranvier, AnkR and ßI spectrin cannot cluster KCNQ2- and KCNQ3-subunit-containing K+ channels. Our findings define a class of spectrinopathies and reveal the molecular pathologies causing nervous-system dysfunction.

"I'm Doing the Best That I Can for Her": Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder.

BACKGROUND: Several professional health organizations have made statements endorsing the safety of breastfeeding for women taking medication-assisted treatment for an opioid use disorder. Yet, breastfeeding initiation rates for this population are approximately 50% lower than the general United States' population. Furthermore, little is known about what influences the infant-feeding decisions of these women. Research aim: This study aimed to describe what influences the infant-feeding decisions of women taking medication-assisted treatment for an opioid use disorder. METHODS: Qualitative description was used. We conducted semistructured, individual interviews with mothers ( N = 8) who were receiving medication-assisted treatment during the postpartum period. We analyzed our data using thematic analysis. RESULTS: We identified two themes: (a) what I heard about breastfeeding, and (b) doing what I feel is best for my baby. What I heard about breastfeeding reflects the information and misinformation that women received about breastfeeding. Doing what I feel is best for my baby describes the inner conflict that the women experienced. Most of the women in this study desired to breastfeed; however, all women reported that the social stigma surrounding methadone use strongly influenced their infant-feeding decision. CONCLUSION: This study sheds new light on what influences the infant-feeding decisions of women taking medication-assisted treatment and represents an initial step toward the development of targeted interventions to improve breastfeeding rates for this unique population.

A Microcosting Study of Establishing a Baby Café® in Texas.

BACKGROUND: This article focuses on the costs of opening and running a Baby Café. A Baby Café is an intervention that focuses on providing peer-to-peer support for breastfeeding mothers. Research aim: This study aimed to estimate the costs of establishing and running a Baby Café. METHODS: The authors used a microcosting approach to identifying costs using the case of a Baby Café located in San Antonio, Texas, and modeled after other existing cafés in the United States. They also used extensive literature review and conducted an informal interview with a manager of an existing Baby Café in the United States to validate our cost data. The cost analysis was done from the provider perspective. RESULTS: Costs of starting a Baby Café were $36,000, whereas annual operating costs totaled $47,000. Total discounted costs for a 5-year period amounted to $250,000, resulting in a cost per Baby Café session of $521 and cost per mother of $104. Varying the number of sessions per week and number of mothers attending each session, the discounted cost per Baby Café session ranged between $460 and $740 and the cost per mother varied between $65 and $246. CONCLUSION: These findings can be used by policy makers and organizations to evaluate local resource requirements for starting a Baby Café. Further research is needed to evaluate the effectiveness of this intervention against other breastfeeding promoting initiatives.

Understanding Self-regulation Behaviors in South Asians With Coronary Artery Disease: A Mixed-Methods Study.

BACKGROUND: South Asians (SAs) have a well-documented risk for mortality related to coronary artery disease (CAD). However, there is a lack of evidence to guide the implementation and dissemination of primary and secondary interventions to control and deter progression of CAD in SAs. OBJECTIVE: The aim of this study is to explore and describe self-regulation behaviors in SAs with CAD using Leventhal's Common Sense Model. METHODS: In this mixed-methods study, quantitative data were collected using 3 survey questionnaires (demographics, Illness Perception Questionnaire-Revised, and Coping/Self-Regulation Behaviors). Before completing the surveys, a subset of the sample (n = 20) participated in individual face-to-face or telephone interviews. RESULTS: A total of 102 SAs were enrolled (age, 53.5 ± 9.98 years). On average, participants rated themselves high (63 ± 3.06) on negative perceptions. In addition, they discussed desi diet, stress, a lack of physical activity, ignoring symptoms, and kismet (fate) as the most important perceived causes of their CAD. Most of the participants modified their lifestyle after their CAD event. Participants expressed regret for not having changed their lifestyle earlier when they were experiencing early symptoms of their CAD. CONCLUSION: Findings from this study enhance the understanding of self-regulation behaviors of SAs with CAD. Ultimately, these findings will inform the development and implementation of targeted interventions that address culture-specific lifestyle modification for SAs with CAD.

"Try not to judge": mothers of substance exposed infants.

PURPOSE: To describe the hospital experiences of mothers who give birth to substance-exposed infants. STUDY DESIGN AND METHODS: Secondary analysis of data from a larger study that was focused on the experiences of Mexican-American mothers in the neonatal intensive care unit (NICU) was conducted. Semistructured interviews with five women who were recovering addicts on methadone were analyzed. Each of their infants spent time in an NICU following birth. The transcribed interviews were analyzed using qualitative content analysis. RESULTS: Four themes were identified: (a) "try not to judge," (b) "scoring" the baby, (c) "share with me," and (d) "I'm the mother here!" CLINICAL IMPLICATIONS: The quality of the relationship between the mothers and the nurses in the NICU was a crucial aspect of the mothers' experiences and may have an effect on long-term outcomes. Women with addictions often have other significant risk factors that may further jeopardize their ability to mother; therefore, it is essential to develop a strong support network. Nurses can be instrumental in organizing resources for this population of women. Judging behaviors may have a detrimental effect on women with addictions. Maternal adaptation to the mothering role can be enhanced by making reasonable efforts to include the mother in the care of the infant.

Role of spirituality in HIV-infected mothers.

The purpose of this study was to describe the processes by which HIV-infected mothers manage mothering. A semi-structured guide was used to facilitate discussion from a convenience sample of 15 mothers. The core category was "The Process of Living for My Children." "Leaning on God" was a part of "Taking Care of Myself" and reflected the ways in which the mothers used spiritual aspects to manage mothering and live with HIV infection. Leaning on God was an important tool in managing mothering and self-care. Health care providers can enhance this tool by being aware of their own values and beliefs.