Passport to Freedom: A Trauma-Informed Mindfulness Program for Previously Incarcerated Women.

Poly-victimization is often reported by formerly incarcerated women and leads to physical and mental health problems that interfere with daily functioning, sustained employment, and housing stability. Although reentry programs exist, few focus on the physical and emotional impact of multiple traumas. Passport to Freedom (P2F), a woman-centered, trauma-informed reentry program, was developed to support formerly incarcerated women. The pilot intervention, performed in 2017, focused on the connections between trauma and health, coping with symptoms, and managing one's own health. To examine the effectiveness and feasibility of the intervention, we performed the current mixed methods study with two phases: (1) focus groups, and (2) sessions combining mindfulness and health promotion activities with follow-up evaluations. Participants (N = 24) showed decreased symptoms of depression and concerns of everyday stressors after the intervention. Of participants, 84% (n = 16) reported practicing mindfulness and 63% (n = 8) stated that mindfulness exercises helped with daily stress management. The P2F program offers a promising approach to support formerly incarcerated women with health self-management. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 18-26.].

Comparison of different methods of screening to identify intimate partner violence: A randomized controlled trial.

OBJECTIVE: Screening for intimate partner violence in the home is often challenging due to the lack of privacy. The aim of this study was to compare two different screening methods (paper-pencil vs. tablet) for identifying intimate partner violence during perinatal home visits. DESIGN: Randomized control trial. SAMPLE: Pregnant women (N = 416) in perinatal home visiting programs were randomized to either paper-pencil or computer assisted, intimate partner violence screening. MEASUREMENTS: The Abuse Assessment Screen was used to screen for physical and sexual IPV and Women's Experiences with Battering for emotional intimate partner violence. RESULTS: No significant differences in prevalence were found between the screening methods. Intimate partner violence prevalence rates for the year before and/or during pregnancy using paper-pencil was 21.8% versus 24.5% using tablets (p = .507). There were significant differences in prevalence among the three race/ethnic groups (Caucasian, 36.9%; African American, 26.7%; Hispanics, 10.6%; p < .001) and significant differences in rates across three geographical areas: urban 16.0%; rural 27.6%, suburban women 32.3% (p < .001). CONCLUSIONS: This study provides evidence that both methods are useful for identifying intimate partner violence during perinatal home visits.

Development of an HIV/STI and partner violence health promotion intervention for abused US Virgin Islands women.

Women in the US Virgin Islands (USVI) experience intimate partner violence (IPV) and human immunodeficiency virus (HIV) at disproportionate rates compared to women on the US mainland. Women in violent relationships report experiencing controlling behaviours that decrease their ability to negotiate for sex using condoms or to prevent unwanted pregnancies. Though several evidence-based interventions exist to prevent either IPV or HIV, few address them through an integrated health promotion approach or attend to particular USVI cultural mores. This article describes the systematic development of a theory based, culturally tailored, integrated health promotion intervention that addresses IPV and HIV among USVI women experiencing abuse. The process included: (i) identifying and integrating evidence-based health promotion interventions, (ii) conducting formative research using focus groups, (iii) synthesizing focus group data to inform intervention development and (iv) developing a culturally and linguistically appropriate intervention specific to the needs and concerns of USVI women. The Empowered Sisters Project: Making Choices Reducing Risks (ESP) was developed through this research. ESP is a three-session health promotion curriculum focussed on enhancing sexual health and safety among women experiencing abuse. The ESP intervention components included promoting condom use, increasing IPV and HIV knowledge and developing a personalized safety plan. Health professionals facilitated individual intervention sessions using culturally tailored visual media and scripts. This program focussed on experiences of women living in the USVI and has implications for utility across the Caribbean diaspora.

Community-based health literacy focused intervention for cervical cancer control among Black women living with human immunodeficiency virus: A randomized pilot trial.

BACKGROUND: Health literacy plays an essential role in how individuals process health information to make decisions about health behaviours including cancer screening. Research is scarce to address health literacy as a strategy to improve cancer screening participation among women living with human immunodeficiency virus (HIV), particularly Black women who, despite the heavy burden of cervical cancer, report consistently low screening rates. AIM: To assess the feasibility, acceptability and preliminary efficacy of a health literacy-focused intervention called CHECC-uP-Community-based, HEalth literacy focused intervention for Cervical Cancer control-among women living with HIV. METHODS: We conducted a community-based, single-blinded randomized pilot trial. A total of 123 eligible women were enrolled and randomized to one of two conditions, control (i.e., cervical cancer brochure) or intervention (cervical cancer brochure plus 30-60 min health literacy-focused education followed by monthly phone counselling and navigation assistance for 6 months). Study assessments were done at baseline, 3 and 6 months. The final analysis sample included 58 women who completed all data points and whose Papanicolaou (Pap) test status was confirmed by medical records. RESULTS: All intervention participants who completed the programme would recommend the CHECC-uP to other women living with HIV. However, adherence in the experimental conditions was low (49.6% attrition rate including 20 women who dropped out before the intervention began) due, in large part, to phone disconnection. Those who had received the intervention had a significantly higher Pap test rate compared to women in the control group at 6 months (50% vs. 21.9%, p = .025). Participation in the intervention programme was associated with improved health literacy and other psychosocial outcomes at 3 months but the trend was attenuated at 6 months. CONCLUSIONS: The CHECC-uP was highly acceptable and led to improved Pap testing rates among Black women living with HIV. Future research should consider addressing social determinants of health such as phone connectivity as part of designing a retention plan targeting low-income Black women living with HIV. IMPLICATIONS: The findings should be incorporated into a future intervention framework to fulfil the unmet needs of Black women living with HIV to facilitate their decision-making about Pap test screening. PATIENT OR PUBLIC CONTRIBUTION: Nineteen community members including women living with HIV along with HIV advocates and care providers participated in four focus groups to develop cervical cancer screening decision-relevant information and the health literacy intervention. Additionally, a community advisory board was involved to provide guidance in the general design and conduct of the study.

Web-based chlamydia education for university students: A pilot project.

AIMS: Chlamydia disproportionately affects individuals aged 15-24 years. A lack of chlamydia knowledge in this high-risk group likely contributes to decreased testing, but interventions to increase chlamydia knowledge in this population are not well-described in the literature. The purpose of this pilot project was to increase chlamydia knowledge in a sample of university students using nurse-developed web-based education. DESIGN: A pre- and post-test design was used to evaluate participant knowledge of chlamydia before and after completing a nurse-developed web-based education intervention designed for university students. METHODS: Forty-seven undergraduate students at one U.S. university participated. A focus group and scientific evidence informed the development of the web-based education. RESULTS: Participants had a significant increase in chlamydia knowledge after completing the online educational intervention (M = 8.0, SD = 0.000) compared to baseline (M = 6.5, SD = 1.5), t(33) = -5.821, p < .0001. Pilot results provide promising evidence that web-based nurse-developed education designed specifically for university students can increase chlamydia knowledge.

Social Determinant of Housing Instability and Adverse Pregnancy Outcomes: A Scoping Review.

BACKGROUND: We conducted a scoping review to examine the literature regarding pregnancy-related morbidities among birthing individuals and infants experiencing housing instability (HI). METHODS: Articles were identified through electronic database searches, using numerous search terms related to pregnancy and housing. US studies published in English between 1991 and 2019 were included. Peer-reviewed qualitative and quantitative articles were synthesized and critically appraised by 2 reviewers using quality appraisal tools from the Joanna Briggs Institute. RESULTS: Inconsistent definitions for HI weakened the rigor of aggregate findings, and birthing individual outcomes were underreported compared with infant outcomes (n = 9 095 499 women, 11 articles). Many studies reported mental health-related outcomes among birthing individuals with HI. DISCUSSION: Study sampling approaches and lack of a standard definition of HI limit review findings, but examining this relationship is critical to understanding the effect of social determinants on birthing individual health. Future research should address the nescience regarding birthing individual outcomes in this population. Policy-level advocacy addressing social determinants must also refine policy impacting community-based prenatal programs and services for the birthing individual with HI.

Greenness and the Potential Resilience to Sexual Violence: "Your Neighborhood Is Being Neglected Because People Don't Care. People With Power Don't Care".

There is increasing evidence that green space in communities reduces the risk of aggression and violence, and increases wellbeing. Positive associations between green space and resilience have been found among children, older adults and university students in the United States, China and Bulgaria. Little is known about these associations among predominately Black communities with structural disadvantage. This study explored the potential community resilience in predominately Black neighborhoods with elevated violent crime and different amounts of green space. This embedded mixed-methods study started with quantitative analysis of women who self-identified as "Black and/or African American." We found inequality in environments, including the amount of green space, traffic density, vacant property, and violent crime. This led to 10 indepth interviews representing communities with elevated crime and different amounts of green space. Emergent coding of the first 3 interviews, a subset of the 98 in the quantitative analysis, led to a priori coding of barriers and facilitators to potential green space supported community resilience applied to the final 7 interview data. Barriers were a combination of the physical and social environment, including traffic patterns, vacant property, and crime. Facilitators included subjective qualities of green space. Green spaces drew people in through community building and promoting feelings of calmness. The transformation of vacant lots into green spaces by community members affords space for people to come together and build community. Green spaces, a modifiable factor, may serve to increase community resilience and decrease the risk of violence.

Lessons learned from implementing SNAP-Ed in a nursing/K-8 partnership school during the pandemic.

The COVID-19 pandemic had forced schools and school-based partnerships in the US to re-imagine extracurricular activities while schools were closed for in-person learning. We highlight lessons learned from implementing the Supplemental Nutrition Assistance Education Program (SNAP-Ed) virtually, a nutrition education program to improve nutrition literacy and skills among children, in a Maryland School of Nursing/K-8 Partnership school amid in-person school closures.

A mixed-methods systematic review identifying, describing, and examining the effects of school-based care coordination programs in the US on all reported outcomes.

Children learn best when they are healthy. Therefore, access to school-based health and providing family support for social needs play an essential role in shaping a child's ability to succeed academically. The purpose of this mixed-methods review, which considers studies with all methods, is to describe and examine the effect of US school-based care coordination programs on all the outcomes reported. Care coordination is an organized approach to connect families to resources in the community to address social needs. The literature search identified 260 papers published since 2012 through CINAHL, ERIC, EMBASE, MEDLINE, Social Sciences Full Text, and Web of Science, from which 11 were included that described a US school-based care coordination program. An a priori organizing framework: Program Development, Implementation, and Evaluation were used to organize the findings. Whether quantitative or qualitative, all evaluation results were transformed into qualitative texts, then converted into codes then themes. Various health and learning issues such as asthma and vision screening were addressed. More than half of the care coordination programs were nurse-led. Parents and students characterized care coordination activities as convenient, trusting, and perceived to improve parent-teacher engagement. They also enhanced asthma knowledge and management, immunization adherence, follow-up care for vision and hearing, mental health, and school attendance. Nevertheless, challenges included staff shortages, unmet family needs, privacy laws regarding student data, and lack of resources (i.e., medications). This review highlights the need to expand school-based care coordination programs in the US and conduct robust program evaluations to assess their effectiveness.

Using Innovation to Address Adolescent and Young Adult Health Disparities in Pelvic Inflammatory Disease: Design of the Technology Enhanced Community Health Precision Nursing (TECH-PN) Trial.

New approaches to pelvic inflammatory disease (PID) care among adolescents and young adults (AYAs) that optimize self-care and personalize treatment are warranted to address age and racial-ethnic PID-related health disparities. Here we describe the 13-month preliminary feasibility and acceptability outcomes of recruitment, retention, and intervention delivery for Technology Enhanced Community Health Precision Nursing (TECH-PN) randomized controlled trial. Urban AYAs 13-25 years assigned female sex at birth with acute mild-moderate PID provided baseline and follow-up interview data and vaginal specimens for sexually transmitted infection (STI), cytokine, and microbiota assessment. All participants received medications and text-messaging support. Participants were block randomized to either control or intervention. Control participants received 1 community nursing visit with self-management for interim care per national guidelines. Intervention participants received unlimited precision care services driven by interim STI and macrolide resistance testing results by an advanced practice provider. In the first 13 months, 75.2% patients were eligible, and 76.1% of eligible patients enrolled. Of the participants, 94% completed the intervention and 96%, 91%, and 89%, respectively, completed their 14-, 30-, and 90-day visits. Baseline laboratory results revealed infection rates that were highest for Mycoplasma genitalium (45%) followed by Chlamydia trachomatis (31%). Preliminary enrollment, STI, intervention delivery, and retention data demonstrate the feasibility and acceptability of the TECH-PN intervention and support rationale for precision care for PID among urban AYAs. ClinicalTrials.gov Identifier. NCT03828994.

The Role of Sources and Types of Health Information in Shaping Health Literacy in Cervical Cancer Screening Among African Immigrant Women: A Mixed-Methods Study.

BACKGROUND: Health literacy is a strong determinant of health outcomes among immigrants. How sources and types of health information influence health literacy in the context of cervical cancer screening among African immigrant women remains unknown. OBJECTIVE: This study was undertaken to explore how various sources and types of health information influence information sharing and health literacy in the context of cervical cancer screening among African immigrant women. METHODS: Using a mixed-methods approach, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of survey participants. The relationship between sources and types of health information and health literacy was assessed using multivariate logistic regression. Emergent themes were identified in the qualitative interviews using content analysis. Qualitative and quantitative data were merged to describe differences and similarities in African immigrant women's experiences and display of health literacy by different sources and types of health information. KEY RESULTS: Health care providers (78%), women friends (46%), and internet (45%) were the most common sources of health information used by African immigrant women, followed by women relatives (32%), television (22%), social media (17%), and church (16%). Content analysis revealed that the health care provider was rated as the most credible source; personal experiences of family and friends made health information more relatable; and church was the least endorsed source. Health information presented verbally (adjusted odds ratio of 5.51, p = .01) was associated with higher health literacy even after controlling for covariates. Most African immigrant women had health information presented in verbal form (80%), with pictures (43%) being the least popular type of health information. CONCLUSIONS: Study findings suggest that verbal communication is associated with health literacy in the context of cervical cancer screening among African immigrant women. Health interventions that use peer educators (women friends and family) and incorporate verbal communication may be a more effective strategy in promoting positive cervical cancer health behaviors among African immigrant women. [HLRP: Health Literacy Research and Practice. 2021;5(2):e96-e108.] Plain Language Summary: For this mixed-methods study, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of the survey participants. Study findings show a strong association between verbal communication and health literacy in the context of cervical cancer screening among African immigrant women.

Faculty peer review of teaching taskforce: A quantitative descriptive research study for the peer review process.

BACKGROUND: Peer review of teaching is important for both the faculty and student experience. Enhanced awareness of student learning experiences and a deeper reflection on teaching makes this process attractive to faculty leaders, staff and students. Evidence suggests that teachers who are reviewed gain confidence, anticipate improvement in teaching and are inclined to discuss their teaching with colleagues in the future. OBJECTIVE: To describe the development of a peer review of teaching process by the Faculty Peer Review of Teaching Taskforce at a school of nursing. METHODS: A five-step Design for Six Sigma methodology was used and includes: Define, Measure, Analyze, Design, Verify (DMADV). In keeping with this methodology we: (1) established a Faculty Peer Review of Teaching Taskforce; (2) conducted a literature review on best practices; (3) reviewed peer institution practices; and (4) surveyed faculty to obtain their perspectives on the qualities of good teaching and the peer review of teaching process. Twenty-seven of the 68 full-time faculty members returned Qualtrics surveys (return rate = 39.7%). RESULTS: Review of the literature yielded four major themes, including post-observation discussion and systematic assignment of peer review pairs. Variation in practices across institutions was identified, from formal structured processes, to peer review conducted only in special circumstances. Survey findings revealed that faculty members overwhelmingly endorse the qualities of good teaching, agree that the peer review process should be required, and that peer reviewers should have several years of teaching experience. CONCLUSIONS: Our faculty were supportive of a peer review teaching process. As teaching demands continue to increase given the evolving complexities of nursing care, teaching platforms (i.e. online, hybrid), and diverse student body, we hope the process we develop may serve as a model for other higher education schools to enhance and maintain excellence in teaching for both the faculty and student experience.

Measuring the contribution of clinical rotations to skills confidence in primary care nurse practitioner students.

ABSTRACT: Primary care providers (PCPs) are essential components of a health care system, but there are shortages of PCPs. Nurse practitioners (NPs) are essential in meeting the needs of an increased demand for primary care, but there is a wide variety in the training offered to NP students. The purpose of this analysis is to determine student self-reported comfort in a variety of care delivery, covering primary care topics, including knowledge and skills. We conducted a preclinical and postclinical survey. Surveys were obtained before and at the conclusion of two clinical rotations in Baltimore, MD. Students were a part of a Health Resources and Services Administration-funded program to prepare NP students to practice in urban, underserved settings. Seventeen NP students NP students responded to both our pre- and postsurveys. Overall, student comfort increased in many focus areas, but no change was seen in important domains, including interpreting imaging studies, filling out common forms, and interpreting certain diagnostic tests. Further study of student skills and confidence at the conclusion of their study would be beneficial in determining if these gaps persist at entry into NP practice. Given wide variation in NP student training programs, it would be additionally beneficial to understand how these differences impact student skills and confidence during their clinical rotations and on entry to practice. Well rounded, broad-based education is necessary for the development of highly trained PCPs; greater understanding of student confidence, knowledge, and skills can assist educators in assuring that all NPs enter practice as safe and competent providers.

Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study.

African immigrant (AI) women have low rates of Pap testing. Health literacy plays a pivotal role in health behaviors. Sources and types of health information could shape health literacy and inform the Pap testing behaviors of AI women. However, the influences of health literacy, sources, and types of health information along with cultural and psychosocial correlates on the Pap testing behaviors of AI women are poorly understood. To examine how sources and types of health information impact health literacy, and in turn, how health literacy and cultural and psychosocial factors influence the Pap testing behaviors of AI women. An adapted Health Literacy Skills Framework guided the selection of variables for this cross-sectional study. Convenience sampling was used to recruit 167 AI women, 21-65 years. Multivariate logistic regression was used to assess correlates of Pap testing after adjusting for covariates (age, education, English proficiency, employment, income, health insurance, access to primary care, marital status, and healthcare provider recommendation). Most participants (71%) had received a Pap test in the past and used multiple (two or more) sources (65%) and types (57%) of health information. Using multiple sources of health information (aOR 0.11, p < 0.01) but not types of health information was associated with Pap testing. Having negative cultural beliefs (aOR 0.17, p = 0.01) and having high self-efficacy (aOR 9.38, p < 0.01) were significantly associated with Pap testing after adjusting for covariates. High health literacy (OR 3.23, p < 0.05) and high decisional balance (OR 5.28, p < 0.001) were associated with Pap testing in bivariate models but did not remain significant after controlling for covariates. Cultural beliefs was a significant correlate of AI women's Pap testing behaviors regardless of other known social determinants of health (education, English proficiency, age, access to primary care). Disseminating health information through various sources has the potential to promote Pap testing among AI women. Larger studies which utilize a robust sampling strategy and include a diverse group of AI women are needed in order to optimize health interventions aimed at improving Pap test screening behaviors among AI women.