A Directed Content Analysis for Greatest Problems Among People With and Without Traumatic Brain Injury.

OBJECTIVE: To characterize the greatest problem or need among individuals with a history of traumatic brain injury (TBI), as compared to individuals with a history of other neurological conditions, mental health conditions, and no history of neurological or mental health conditions. DESIGN: A directed content analysis of open-text responses to a single online survey question using a framework guided by the Mayo-Portland Adaptability Inventory-4. SETTING: Community. PARTICIPANTS: 2,861 community-dwelling adults (n = 274 with TBI; n = 289 with other neurological conditions besides TBI; n = 454 with mental health conditions but no neurological conditions; n = 1,844 controls). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Open-text responses to the survey prompt: "What was your greatest problem or need over the past 2 weeks?" RESULTS: The Participation index comprised the greatest proportion of responses across all four participant groups. A quarter (25.4%) of controls reported None (no problem/need), whereas only 7.9 -10.7% of participants in all other groups reported None. Among all groups, individuals with TBI reported the greatest proportion of problems in the Adjustment and Ability indices. Among people with TBI, Money Management (19.7%), None (10.6%), and Anxiety (7.7%) were the three most frequently reported problems. Compared to individuals with mild TBI (mTBI), individuals with moderate-to-severe TBI (msTBI) reported a higher proportion of problems in the Ability and Adjustment indices. Among individuals with msTBI, the Adjustment index accounted for the greatest proportion of problems. CONCLUSIONS: This study employed a person-centered approach to understanding the greatest needs among individuals with TBI. Qualitative differences were observed between individuals with and without a TBI, between people with mTBI and msTBI, and across genders among people with TBI. These findings can help guide research and policy towards addressing challenges perceived as highly important by people living in the community with TBI.

Erratum to "Branching out: Feasibility of examining the effects of greenspace on mental health after traumatic brain injury" [Dialogues in Health, Volume 2, 2023, 100129].

[This corrects the article DOI: 10.1016/j.dialog.2023.100129.].

Branching out: Feasibility of examining the effects of greenspace on mental health after traumatic brain injury.

Aim: This pilot study's aim was to determine the feasibility of examining the effects of an environmental variable (i.e., tree canopy coverage) on mental health after sustaining a brain injury. Methods: A secondary data analysis was conducted leveraging existing information on mental health after moderate to severe traumatic brain injury (TBI) from the TBI Model System. Mental health was measured using PHQ-9 (depression) and GAD-7 (anxiety) scores. The data were compared with data on tree canopy coverage in the state of Texas that was obtained from the Multi-Resolution Land Characteristics (MRLC) Consortium using GIS analysis. Tree canopy coverage as an indicator of neighborhood socioeconomic status was also examined using the Neighborhood SES Index. Results: Tree canopy coverage had weak and non-significant correlations with anxiety and depression scores, as well as neighborhood socioeconomic status. Data analysis was limited by small sample size. However, there is a higher percentage (18.8%) of participants who reported moderate to severe depression symptoms in areas with less than 30% tree canopy coverage, compared with 6.6% of participants who endorsed moderate to severe depression symptoms and live in areas with more than 30% tree canopy coverage (there was no difference in anxiety scores). Conclusion: Our work confirms the feasibility of measuring the effects of tree canopy coverage on mental health after brain injury and warrants further investigation into examining tree canopy coverage and depression after TBI. Future work will include nationwide analyses to potentially detect significant relationships, as well as examine differences in geographic location.

Development of the multidimensional health perceptions questionnaire in English and Spanish.

PURPOSE: To develop the novel multidimensional health perceptions questionnaire (MHPQ), a self-reported assessment of health perceptions inclusive of (1) individuals beliefs about the causes and consequences of health conditions, benefits and barriers to maintaining and improving health, ability to accomplish health-related goals and control health circumstances, and the role of God and/or spirituality in health and healthcare, (2) anticipated discrimination in the healthcare systems, and (3) trust in healthcare providers and medicine, illustrated in our newly proposed Multidimensional Health Perceptions Conceptual Model. METHODS: We developed an initial MHPQß item set, corresponding to domains of our conceptual model, using a patient-centered outcomes development approach. This include literature review, expert and end-user feedback, translation and language validation (specifically to Latin American Spanish), and cognitive interviewing. RESULTS: The initial 104 items of MHPQß had excellent content validity, with a Content Validity Index of 98.1%. After expert (n = 13) feedback, translation and language validation, and cognitive interviewing among community-dwelling English-speakers (n = 5) and Spanish-speakers (n = 4), the final MHPQß comprised 93 items rated on a five-point agreement scale (1 = Strongly disagree to 5 = Strongly agree), with a reading grade level of 6th grade in English and 8th grade in Spanish. CONCLUSION: The MHPQß is a promising tool to assess individuals' health perceptions. It has excellent content validity and good reading accessibility. Future work will establish the factor structure and final item set of the MHPQ.