Are There Regional Differences in Mental Health among Black Americans? An Exploration of Explanatory Mechanisms.

Using data from the National Survey of American Life (NSAL) (2001-2003), we examine regional differences in past-year anxiety disorder and past-year major depressive episodes among a geographically diverse sample of Black Americans (N = 3,672). We find that Black Americans residing in the South experience a mental health advantage over Black Americans living in other parts of the country, experiencing lower rates of both anxiety disorder and past-year major depression. We also examine the extent to which stress exposure, religious involvement, and neighborhood contexts help explain any regional differences. We find that stress exposure helps to explain much of the differences observed across regions, while religious involvement and neighborhood contexts help explain observed regional differences to a lesser extent. These findings highlight the importance of considering regional contexts in understanding intra-racial differences in mental health.

Monitoring and Evaluation of Patient Engagement in Health Product Research and Development: Co-Creating a Framework for Community Advisory Boards.

PURPOSE: While patient engagement is becoming more customary in developing health products, its monitoring and evaluation to understand processes and enhance impact are challenging. This article describes a patient engagement monitoring and evaluation (PEME) framework, co-created and tailored to the context of community advisory boards (CABs) for rare diseases in Europe. It can be used to stimulate learning and evaluate impacts of engagement activities. METHODS: A participatory approach was used in which data collection and analysis were iterative. The process was based on the principles of interactive learning and action and guided by the PEME framework. Data were collected via document analysis, reflection sessions, a questionnaire, and a workshop. RESULTS: The tailored framework consists of a theory of change model with metrics explaining how CABs can reach their objectives. Of 61 identified metrics, 17 metrics for monitoring the patient engagement process and short-term outcomes were selected, and a "menu" for evaluating long-term impacts was created. Example metrics include "Industry representatives' understanding of patients' unmet needs;" "Feeling of trust between stakeholders;" and "Feeling of preparedness." "Alignment of research programs with patients' needs" was the highest-ranked metric for long-term impact. CONCLUSIONS: Findings suggest that process and short-term outcome metrics could be standardized across CABs, whereas long-term impact metrics may need to be tailored to the collaboration from a proposed menu. Accordingly, we recommend that others adapt and refine the PEME framework as appropriate. The next steps include implementing and testing the evaluation framework to stimulate learning and share impacts.

The Mental Health Consequences of Work-Life and Life-Work Conflicts for STEM Postdoctoral Trainees.

Research has shown that work-life conflicts exist among all kinds of workers, including academics, and these conflicts are a key contributor to workers' reports of poor well-being. Very little research has been done on work-life conflict among post-baccalaureate PhD trainees (e.g., graduate students and postdoctoral trainees) who reside in an important liminal stage in the professoriate pipeline. In this study, we examine the degree to which postdocs believe they suffer from conflicts between their work responsibilities and their home responsibility and the relationship between those conflicts and postdoc's mental health. We argue that, like other workers, postdocs suffer (in numerical terms and its relationship to health) more from the work-to-life imbalances than from life-to-work imbalances; life matters more than work, ultimately. Our results, based on a survey of 215 STEM postdoctoral trainees, reveal that a majority of postdocs say they have work-life conflicts and these work-life conflicts are associated with negative mental health outcomes. We discuss the potential impact of these findings on attempts to broaden participation in STEM careers and diversify the professoriate.

The contribution of theory to the design, delivery, and evaluation of interprofessional curricula: BEME Guide No. 49.

BACKGROUND: Interprofessional curricula have often lacked explicit reference to theory despite calls for a more theoretically informed field that illuminates curricular assumptions and justifies curricular practices. AIM: To review the contributions of theory to the design, delivery, and evaluation of interprofessional curricula. METHODS: Four databases were searched (1988-2015). Studies demonstrating explicit and a high-quality contribution of theory to the design, delivery or evaluation of interprofessional curricula were included. Data were extracted against a comprehensive framework of curricular activities and a narrative synthesis undertaken. RESULTS: Ninety-one studies met the inclusion criteria. The majority of studies (86%) originated from the UK, USA, and Canada. Theories most commonly underpinned "learning activities" (47%) and "evaluation" (54%). Theories of reflective learning, identity formation, and contact hypothesis dominated the field though there are many examples of innovative theoretical contributions. CONCLUSIONS: Theories contribute considerably to the interprofessional field, though many curricular elements remain under-theorized. The literature offers no "gold standard" theory for interprofessional curricula; rather theoretical selection is contingent upon the curricular component to which theory is to be applied. Theories contributed to interprofessional curricula by explaining, predicting, organizing or illuminating social processes embedded in interprofessional curricular assumptions. This review provides guidance how theory might be robustly and appropriately deployed in the design, delivery, and evaluation of interprofessional curricula.

Reviews of theoretical frameworks: Challenges and judging the quality of theory application.

BACKGROUND: Rigorous reviews of available information, from a range of resources, are required to support medical and health educators in their decision making. AIM: The aim of this article is to highlight the importance of a review of theoretical frameworks specifically as a supplement to reviews that focus on a synthesis of the empirical evidence alone. Establishing a shared understanding of theory as a concept is highlighted as a challenge and some practical strategies to achieving this are presented. This article also introduces the concept of theoretical quality, arguing that a critique of how theory is applied should complement the methodological appraisal of the literature in a review. METHOD: We illustrate the challenge of establishing a shared meaning of theory through reference to experiences of an on-going review of this kind conducted in the field of interprofessional education (IPE) and use a high scoring paper selected in this review to illustrate how theoretical quality can be assessed. FINDINGS: In reaching a shared understanding of theory as a concept, practical strategies that promote experiential and practical ways of knowing are required in addition to more propositional ways of sharing knowledge. Concepts of parsimony, testability, operational adequacy and empirical adequacy are explored as concepts that establish theoretical quality. CONCLUSIONS: Reviews of theoretical frameworks used in medical education are required to inform educational practice. Review teams should make time and effort to reach a shared understanding of the term theory. Theory reviews, and reviews more widely, should add an assessment of theory application to the protocol of their review method.

Testing theory in interprofessional education: social capital as a case study.

Theory is essential to understand our interprofessional educational (IPE) practice. As a discipline, IPE has moved from being widely atheoretical to having a plethora of theories imported from the psychosocial disciplines that have utility to understand, articulate and improve IPE practice and evaluation. This paper proposes that when taking this deductive approach to theoretical development in IPE, a greater focus must now be placed on the rigorous testing of these theories within the IPE context. It synthesizes two approaches to achieving this, using the social capital theory as a case study, and focuses on the first two stages of this synthesis: first, the identification of the concepts and propositions that make up a theory within the study context and second, the value-based judgments made by the researcher and other stakeholders on the utility of these propositions. The interprofessional student group is chosen as a possible exemplar of a social network and theory-derived concepts and propositions are identified and classified within this context. With a focus on physical network characteristics, validation of these propositions with a sample of IPE educationalists is described. We present a range of propositions specifically related to the size and mix of IPE student groups, the frequency and level with which students participate in these as well as some of the existing evidence that have explored these propositions to date. Refined propositions and the way forward in the future application and empirical testing of social capital theory in IPE are presented.

IN-2-THEORY--Interprofessional theory, scholarship and collaboration: a community of practice.

Theoretical awareness is essential in the development and delivery of effective interprofessional education and collaborative practice (PECP). The objective of this paper was to explain the origins and purpose of an international network, IN-2-THEORY--interprofessional theory, scholarship and collaboration: a community of practice (CoP) that aims to build theoretical rigor in IPECP. It explains why the network is viewed as a CoP and lays out the way forward for the community based on the principles for developing a CoP outlined by Wenger, McDermott, and Snyder (2002).

Activating diversity: the impact of student race on contributions to course discussions.

Racial diversity is understood to play an important role for all students on the college campus. In recent years, much effort has gone into documenting the positive effects of this diversity. However, few studies have focused on how diversity impacts student interactions in the classroom, and even fewer studies attempt to quantify contributions from students of different races. Using Web blog discussions about race and religion, the authors uncover the differences in contributions black and white students make to those discussions. The implications of these findings are important for scholars interested in how diversity impacts student learning, and for policymakers advocating on behalf of affirmative action legislation.

An evaluation of practice-based interprofessional education initiatives involving service users.

There is little published evidence regarding the impact of service-user focused interprofessional education in the practice setting. This article reports evaluative case studies of two practice-based interprofessional initiatives, in which service users played a central role. These initiatives formed part of the Trent Universities Interprofessional Learning in Practice (TUILIP) project ( http://tuilip.hwb.shu.ac.uk ), a collaboration between Sheffield Hallam University and the University of Nottingham. Practice settings were an acute mental health service and a community organisation offering care and services to adults with learning disabilities. Interprofessional initiatives were developed by facilitators, and empirically studied at each site. Facilitators, managers, practitioners, students and service users took part in interviews and focus groups to discuss their perceptions of the initiative in their practice setting. The study revealed participants' perceptions of the projects' aims, process and outcomes, factors which facilitated success or proved challenging, and their impact upon individuals, clinical practice and the organisations involved.

A partnership approach to learning about accountability.

Clinicians and healthcare providers are frequently reminded that they are 'accountable' practitioners - but what is the definition of accountability, and how does it apply in a practical and legal context? To clarify these issues, the University of Nottingham School of Nursing has formed a partnership with Browne Jacobson Solicitors. Together they have developed a 7-stage training programme for nursing students which covers the key aspects of accountability, including ethical concepts, the law of negligence, and scenario-based training on being called as a witness in an investigation. This article introduces the implications of accountability and describes the structure and syllabus of the programme, including participants' feedback on the benefits of the experience.

"Still looking for my Jonathan": gay Black men's management of religious and sexual identity conflicts.

This article looks at homosexual Black men who are heavily involved in fundamentalist African-American churches. These men describe themselves as "out as same-sex loving individuals" even though the messages preached by their church leaders and the doctrines of their churches are, at the very least, heterosexist, but more likely to be stridently anti-homosexuality. Not only do these men attend the churches they are parts of, but they are viewed as leaders in these churches in positions ranging from associate pastor to director of facilities management. The study uses structured interviews to understand how these men manage the conflict between a committed gay identity and a strong religious identity that says the two cannot coexist.

Developing sustainable models of interprofessional learning in practice--the TUILIP project.

This paper will describe the background and development of the Trent Universities Interprofessional Learning in Practice Project (TUILIP). It will review some of the contributing literature on recent policy initiatives for interprofessional learning (IPL) and in particular the literature that supports the case for IPL to be embedded in the practice learning environment. The impact of IPL on health outcomes is discussed and on team working in practice. The modernisation of the National Health Service in the UK is explained and how the East Midlands Strategic Health Authority has commissioned the TUILIP project that will promote and facilitate the interprofessional skills of students through collaborative working within the practice setting. The TUILIP project is described, in particular, staff development for practitioners, the centrality of service users and the innovative approach of IPL Facilitators in pilot sites across the Trent region.