Power Dynamics Perpetuate DEI Inaction: A Qualitative Study of Community Health Clinic Teams.

PURPOSE: Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams. METHODS: We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified. RESULTS: Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift. CONCLUSIONS: Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care.

How power shapes behavior: Evidence from physicians.

Power-the asymmetric control of valued resources-affects most human interactions. Although power is challenging to study with real-world data, a distinctive dataset allowed us to do so within the critical context of doctor-patient relationships. Using 1.5 million quasi-random assignments in US military emergency departments, we examined how power differentials between doctor and patient (measured by using differences in military ranks) affect physician behavior. Our findings indicate that power confers nontrivial advantages: "High-power" patients (who outrank their physician) receive more resources and have better outcomes than equivalently ranked "low-power" patients. Patient promotions even increase physician effort. Furthermore, low-power patients suffer if their physician concurrently cares for a high-power patient. Doctor-patient concordance on race and sex also matters. Overall, power-driven variation in behavior can harm the most vulnerable populations in health care settings.

Social power modulates individuals' neural responses to monetary and social rewards.

Although previous research has shown that social power modulates individuals' sensitivity to rewards, it is currently unclear whether social power increases or decreases individuals' sensitivity to rewards. This study employed event-related potentials (ERPs) to investigate the effects of social power on individuals' neural responses to monetary and social rewards. Specifically, participants underwent an episodic priming task to manipulate social power (high-power vs. low-power) and then completed monetary and social delayed incentive tasks while their behavioral responses and electroencephalograms (EEG) were recorded. According to ERP analysis, during the anticipatory stage, low-power individuals exhibited a greater cue-P3 amplitude than high-power individuals in both monetary and social tasks. In the consummatory stage, though no impact of social power on the reward positivity (RewP) was found, low-power individuals showed a higher feedback-P3 (FB-P3) amplitude than high-power individuals, regardless of task types (the MID and SID tasks). In conclusion, these results provide evidence that social power might decrease one's sensitivity to monetary and social rewards in both the anticipatory and consummatory stages.

Medical Error Prevalence, Nursing Power, and Structural Empowerment: A Serial Mediation Analysis.

Aim: To investigate how structural empowerment and power may contribute to and predict the reduction of medical errors. Background: Medical errors threaten patient well-being, leading to adverse outcomes. Improving work conditions holds promise for reducing medical errors among nurses. Methods: A multisite correlational cross-sectional design was utilized. Data were completed by 375 nurses from four hospitals in Jordan. Data collection occurred between September and November 2023 using sociodemographic, structural empowerment, and medical error questionnaires. The study employed descriptive statistics, Pearson r correlation, and serial mediation analysis. Informed consent was obtained from each participant. Results: Pearson r correlation revealed significant negative correlations between medical error and structural empowerment, formal power, and informal power. The conceptual framework was significant and predicted 16% of the variance in medical errors. The mediation analysis confirmed that formal power and informal power mediate the relationship between structural empowerment and medical error. Conclusions and Implications. This study sheds light on the intricate connection of structural empowerment, formal and informal power, and their collective impact on reducing medical errors. Understanding and addressing these dynamics allows nurses and administrators to achieve a culture of patient safety. Reduction of medical errors is paramount to a safe healthcare environment that prioritizes patient outcomes. Strategies should be fostered to enhance structural empowerment, refine formal power structures, and leverage the positive aspects of informal networks.

Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom.

BACKGROUND: Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. METHODS: We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. RESULTS: Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. DISCUSSION: Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.

The Association of Nursing Homes' Organizational Context With Care Aide Empowerment: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. RESEARCH DESIGN AND METHODS: This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. RESULTS: Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). DISCUSSION AND IMPLICATIONS: In this study, modifiable elements of organizational context (i.e., culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care.

Power, policy, and transgender identities: A case study of gatekeeping by mental health professionals in accessing gender affirming surgeries in India.

BACKGROUND: Transgender individuals seeking gender-affirming surgeries (GAS) are often denied or delayed by mental health professionals (MHPs). Studies on the gatekeeping of GAS have been mainly conducted in the Global North and primarily focus on the perspectives of health professionals. This case study from India incorporates health professional, community, advocate, and activist perspectives to contribute new evidence about MHP gatekeeping in GAS. The study aims to examine the role of power and gender in MHP gatekeeping of GAS in India. METHODS: A qualitative multi-method case study including thematic analyses of key informant interviews (n = 9) and policy analysis using the policy triangle framework. RESULTS: Health professionals and transgender persons participate in the construction, performance, and reproduction of gender indicating the persistence of gender normativity in India which enables gatekeeping by MHPs. However, evidence suggests some signs of a change from binormativity to a culturally intelligible and historically familiar "trinormativity". CONCLUSION: To understand MHP gatekeeping, there is a need to contextualise this example of biopower within the larger social construction of gender within which MHPs operate. A transition from binormativity to "trinormativity" enables MHP gatekeeping of transgender persons seeking GAS. This risks creating new forms of gender-related oppression, such as new hierarchies and class differences between the gender binary and the "third gender".

Empowering adult patients with diabetes for health educators' role within their family members: A cross-sectional study.

BACKGROUND: Patient engagement as partners in diabetes prevention for family members/close relatives is a novel and underexplored approach. This paper aims to assess patients' willingness and confidence in their ability to succeed as health educators for their family members and investigate the influencing factors. METHODS: A cross-sectional descriptive study was conducted between January 2023 and April 2023. A newly developed and validated self-reported questionnaire, based on the Health Belief Model (HBM) and previous research, was administered to a convenient sample of 134 adult participants diagnosed with diabetes. These participants sought care at primary healthcare clinics at King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs in Riyadh and Jeddah (MNGHA). The data was examined using statistical methods including descriptive analysis, ANOVA, Tukey's HSD (Honestly Significant Difference) Post Hoc tests, and Pearson's correlation coefficients. RESULTS: The majority of participants expressed a willingness to assume the role of health educators for their family members (n = 117, 87.31%) and reported a high level of willingness and confidence, as indicated by self-efficacy scores ranging from 12.00 to 25.00, with a mean of 21.12 (SD = 2.76). Participants' willingness to be health educators exhibited positive correlations with their perceptions of diabetes severity and susceptibility (r = .433, p < .01), perceived benefits and barriers (r = .451, p < .01), cues to action (r = .520, p < .01), self-efficacy (r = .789, p < .01), and the total score of the questionnaire (r = .640, p < .01). CONCLUSIONS: The majority of participants expressed their willingness to assume the role of health educators for their family members, and a significant portion reported confidence in their capacity to accomplish this objective. Healthcare providers should emphasize the importance of equipping patients with the skills and knowledge necessary to effectively convey health messages and serve as health educators within their communities. This expansion of the approach holds the potential to have a significant impact on public health strategies for diabetes prevention.

Cardiac Rehabilitation Using the Family-Centered Empowerment Model is Effective in Improving Long-term Mortality in Patients with Myocardial Infarction: A 10-year Follow-Up Randomized Clinical Trial.

INTRODUCTION: Cardiac rehabilitation (CR) play a critical role in reducing the risk of future cardiovascular events and enhancing the quality of life for individuals who have survived a heart attack. AIM: To assess the mortality rates and stability of the effects in myocardial infarction (MI) survivors after implementing a Family-Centered Empowerment Model (FCEM)-focused hybrid cardiac rehabilitation program. METHODS: This double-blind randomized controlled clinical trial, conducted at Shariati Hospital, an academic teaching hospital in Tehran, Iran (2012-2023), involved 70 MI patients and their families. Participants were randomly assigned to an FCEM intervention group or standard CR control group. The intervention commenced after the MI patient's safe discharge from the CCU and continued for the entire 10-year follow-up period. Various questionnaires were utilized to collect data on mortality rates and health-related quality of life (HRQoL). RESULTS: The 10-year follow-up period revealed lower mortality rates in the intervention group (5.7%, 11.4%, and 17.1% at 5, 7, and 10 years, respectively) compared to the control group (20%, 37.1%, and 48.9%). After adjusting for age, gender, and BMI, the control group had a four times higher mortality risk (HR: 4.346, 95% CI 1.671-7.307, P = 0.003). The FCEM-focused program demonstrated a significant and sustained positive impact on participants' quality of life for 48 months, with greater improvement compared to the control group. CONCLUSION: This study highlights the effectiveness of FCEM-based hybrid CR programs in enhancing long-term patient outcomes and reducing mortality rates among MI survivors. Further research is needed to explore the potential benefits in larger samples and diverse populations. TRIAL REGISTRATION: This study (Identifier: NCT02402582) was registered in the ClinicalTrials.gov on 03/30/2015.

Empowering Little Fighters: Post-Cardiotomy Pediatric ECMO and the Journey to Recovery.

INTRODUCTION: Extra Corporeal Membrane Oxygenation (ECMO) has long been used for cardiorespiratory support in the immediate post-paediatric cardiac surgery period with a 2-3% success as per the ELSO registry. Success in recovery depends upon the optimal delivery of critical care to paediatric patients and a comprehensive healthcare team. METHODOLOGY: The survival benefit of children placed on central veno arterial (VA) ECMO following elective cardiac surgeries for congenital heart disease (n = 672) was studied in a cohort of 29 (4.3%) cases from the period of Jan 2018 to Dec 2022 in our cardiac surgical centre. Indications for placing these patients on central VA ECMO included inability to wean from cardiopulmonary bypass (CPB), low cardiac output syndrome, severe pulmonary arterial hypertension, significant bleeding, anaphylaxis, respiratory failure and severe pulmonary edema. RESULTS: The mean time to initiation of ECMO was less than 5 h and the mean duration of ECMO support was 56 h with a survival rate of 58.3%. Amongst perioperative complications, sepsis and arrhythmia on ECMO were found to be negatively associated with survival. Improvements in the pH, PaO2 levels and serum lactate levels after initiation of ECMO were associated with survival benefits. CONCLUSION: The early initiation of ECMO for paediatric cardiotomies could be a beacon of hope for families and medical teams confronting these challenging situations. Improvement in indicators of adequate perfusion and ventricular recoveries like pH and serum lactate and absence of arrhythmia and sepsis are associated with good outcomes.

The dual impacts of guanxi closeness on followership: Mediating roles of burnout and power distance.

Guanxi and followership play important roles in employees' interaction with their supervisors. Extant studies have found that supervisor-subordinate guanxi can predict subordinates' attitudes and behaviors toward their supervisors. However, little is known about the relationship between guanxi closeness and subordinates' following supervisors. Accordingly, drawing on conservation of resource theory (COR), we develop a two-path mediation model and examine the direct impact of guanxi closeness on followership, the mediating role of burnout and power distance orientation, discussing the dual impacts of guanxi closeness. To reduce the common method basis, a two-wave time-lagged (interval of one month) study was conducted. Then, we collected 239 pieces of data to test our hypotheses using path analyses. Results show that the direct effect of guanxi closeness on followership is significant. Additionally, guanxi closeness weakens followership by reducing employee burnout. Meanwhile, guanxi closeness can decrease employees' power distance orientation (PDO) and then enhance followership. These findings reveal the dual impacts of guanxi closeness and extend our understanding of guanxi showing positive impact as well as negative impact. Therefore, managers should cultivate guanxi closeness with subordinates to enhance followership by reducing subordinates' PDO while providing resources and support to employees involved in burnout. These behaviors are conducive to helping managers to attain subordinates' following.

The Mediating Role of Self-efficacy and Coping Mode Between Powerlessness and Quality of Life in Patients with Venous Leg Ulcers.

OBJECTIVE: To explore the mediating effect of self-efficacy and coping mode between powerlessness and quality of life in patients with a venous leg ulcer (VLU). METHODS: The authors used a convenience sampling method to select 208 patients with a VLU in four tertiary grade A hospitals in Qingdao and Tianjin from June 2021 to August 2022. Instruments included the Powerlessness Assessment Tool, Venous Leg Ulcer Self-efficacy Tool, Medical Coping Modes Questionnaire, and Venous Leg Ulcer Quality of Life Questionnaire. The authors used descriptive statistics, Pearson correlation, and PROCESS macros for data analysis. RESULTS: The powerlessness score was significantly negatively associated with self-efficacy and confrontation coping mode scores and positively associated with patients' quality-of-life scores. In addition, self-efficacy and confrontation coping modes separately and sequentially mediated the relationship between powerlessness and quality of life. CONCLUSIONS: Self-efficacy and confrontation coping mode play important mediating roles between powerlessness and quality of life in patients with VLUs. By decreasing patients' sense of powerlessness, boosting their self-efficacy, and encouraging them to adopt confrontation coping mode, health professionals can improve patients' quality of life.

RIvER Clinic: Rethinking Incarceration and Empowering Recovery-An Innovative Postincarceration Care Delivery Model Implemented During the COVID-19 Pandemic.

The Rethinking Incarceration and Empowering Recovery (RIvER) Clinic was launched in June 2021 to address the health disparities experienced during and after incarceration. The RIvER Clinic's multidisciplinary, community-centered team engages patients during jail detention and after release via telehealth, collocated in community locations, on a mobile van, and in clinic. The clinic serves as a bridge between incarceration and the establishment of permanent health care and social services in the community. In 2022, a total of 479 visits were completed. The clinic provided multidisciplinary substance use support to all eligible patients, paying for 104 medication for opioid use disorder (MOUD) prescriptions for uninsured patients. Twenty-five percent of patients were transitioned to community-based care, and less than 5% of patients were reincarcerated. Despite some limitations, results demonstrate that the RIvER Clinic is successfully reintegrating a marginalized population into its community. The purpose of this article is to describe the implementation and preliminary outcomes of this postincarceration clinic.

Empowering macrophages: the cancer fighters within the tumour microenvironment in mantle cell lymphoma.

In Mantle Cell Lymphoma (MCL), the role of macrophages within the tumour microenvironment (TME) has recently gained attention due to their impact on prognosis and response to therapy. Despite their low absolute number in MCL tumour tissue, recent findings reveal an association between the levels of macrophages and prognosis, consistent with trends observed in other lymphoma subtypes. M2-like macrophages, identified by markers such as CD163, contribute to angiogenesis and suppression of the immune response. Clinical trials with MCL patients treated with chemoimmunotherapy and targeted treatments underscore the adverse impact of high levels of M2-like macrophages. Immunomodulatory drugs like lenalidomide reduce the levels of MCL-associated CD163+ macrophages and enhance macrophage phagocytic activity. Similarly, clinical approaches targeting the CD47 "don't eat me" signalling, in combination with the anti-CD20-antibody rituximab, demonstrate increased macrophage activity and phagocytosis of MCL tumour cells. Cell-based therapies such as chimeric antigen receptor (CAR) T-cell have shown promise but various challenges persist, leading to a potential interest in CAR-macrophages (CAR-M). When macrophages are recruited to the TME, they offer advantages including phagocytic function and responsiveness to microenvironment alterations, suggesting their potential as a manipulable and inducible alternative when CAR T-cell therapies fails in the complex landscape of MCL treatment.

Empowering precise advertising with Fed-GANCC: A novel federated learning approach leveraging Generative Adversarial Networks and group clustering.

In the realm of targeted advertising, the demand for precision is paramount, and the traditional centralized machine learning paradigm fails to address this necessity effectively. Two critical challenges persist in the current advertising ecosystem: the data privacy concerns leading to isolated data islands and the complexity in handling non-Independent and Identically Distributed (non-IID) data and concept drift due to the specificity and diversity in user behavior data. Current federated learning frameworks struggle to overcome these hurdles satisfactorily. This paper introduces Fed-GANCC, an innovative federated learning framework that synergizes Generative Adversarial Networks (GANs) and Group Clustering. The framework incorporates a user data augmentation algorithm predicated on adversarial generative networks to enrich user behavior data, curtail the impact of non-uniform data distribution, and enhance the applicability of the global machine learning model. Unlike traditional approaches, our framework offers user data augmentation algorithms based on adversarial generative networks, which not only enriches user behavior data but also reduces the challenges posed by non-uniform data distribution, thereby enhancing the applicability of the global machine learning (ML) model. The effectiveness of Fed-GANCC is distinctly showcased through experimental results, outperforming contemporary methods like FED-AVG and FED-SGD in terms of accuracy, loss value, and receiver operating characteristic (ROC) indicators within the same computing time. Experimental results vindicate the effectiveness of Fed-GANCC, revealing substantial enhancements in accuracy, loss value, and receiver operating characteristic (ROC) metrics compared to FED-AVG and FED-SGD given the same computational time. These outcomes underline Fed-GANCC's exceptional prowess in mitigating issues such as isolated data islands, non-IID data, and concept drift. With its novel approach to addressing the prevailing challenges in targeted advertising such as isolated data islands, non-IID data, and concept drift, the Fed-GANCC framework stands as a benchmark, paving the way for future advancements in federated learning solutions tailored for the advertising domain. The Fed-GANCC framework promises to offer pivotal insights for the future development of efficient and advanced federated learning solutions for targeted advertising.

Empowering patients in primary care: a qualitative exploration of the usability and utility of an online diabetes self-management tool.

BACKGROUND: Despite the potential advantages of Internet-based diabetes self-management education, its adoption was not widespread among Singapore's public primary care clinics (polyclinics). An interactive online tool was thus developed to help educate patients with Type 2 diabetes mellitus (T2DM), and was now ready for user testing before implementation. AIM: To explore the perceived utility and usability of the educational tool in patients with suboptimally-controlled T2DM in a Singapore primary care setting. METHODS: In-depth interviews were used to gather qualitative data from multi-ethnic Asian adults who had suboptimally-controlled T2DM. A total of 17 IDIs were conducted between April 2022 to March 2023, audio-recorded, transcribed, and analyzed to identify emergent themes via thematic analysis. RESULTS: Regarding utility, users found the educational tool useful because it provided them with information that was comprehensive, accessible, reliable, and manageable. Regarding usability, the majority of users reported that the educational tool was easy to use, and suggested ways to improve navigational cues, visual clarity, readability and user engagement. CONCLUSION: Participants generally found the educational tool useful and easy to use. A revised educational tool will be developed based on their feedback and implemented in clinical practice.

Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing.

BACKGROUND: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. OBJECTIVE: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. METHODS: We evaluated the prototype using Nielsen's 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). RESULTS: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app's design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. CONCLUSIONS: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone.

Peer and land-based approaches for fostering empowering and healthy relationships with Indigenous and northern young people in the Northwest Territories.

Indigenous and Northern women in Canada experience high rates of intimate partner violence (IPV), and this is particularly true in the Northwest Territories (NWT). Adolescents are also at increased risk of IPV, which has far-reaching, lifelong effects. Indigenous youth are particularly vulnerable to IPV due to ongoing effects of intergenerational trauma caused by colonialism, racism and residential school legacies. We explored attitudes towards IPV and the healthy relationship knowledge, skills, and experiences among participants of Fostering Open eXpression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) Peer Leader Retreats in the NWT. Multi-method approaches included quantitative surveys youth completed before and immediately following retreats. Quantitative analysis from retreats (2018-2021) included 240 participants aged 12-19 (mean age 14.5) who reported ever having an intimate partner. Most were from the FOXY program (64.2%), Indigenous (69.6%) and heterosexual (66.4%). Qualitative methods included Focus Group Discussions (FGD) (n = 69) conducted with peer leaders and apprentices (n = 311) and youth and adult staff (n = 14 FGDs, n = 165 participants). We thematically analysed FGDs to explore healthy relationship knowledge and skills, alongside paired t-tests to examine pre/post retreat changes in attitudes towards IPV. Qualitative findings suggest that leadership and embodied learning were effective in equipping youth with violence prevention and healthy relationship skills. While young women were committed to sharing knowledge and skills about healthy relationships in their communities, young men resonated with values of respect and appreciated support to identify and express emotions. Participants across programmes demonstrated their belief that healthy intimate relationships have communal, relational and intergenerational benefits. Quantitatively, we found a statistically significant reduction in attitudes accepting of IPV among young women, but no changes were noted among young men. Findings contribute to emergent evidence on strengths-based, culturally-responsive IPV prevention programming. Components of effective IPV prevention programming with young men merit further exploration.