Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies.

INTRODUCTION: Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS: Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS: Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS: Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER: CRD42014014547.

Examining the Preliminary Efficacy of a Dating Violence Prevention Program for Hispanic Adolescents.

The purpose of this study is to evaluate the preliminary efficacy of a dating violence (DV) prevention program for Cuban American adolescents (JOVEN/YOUTH: Juntos Opuestos a la Violence Entre Novios/Together Against Dating Violence). A randomized-controlled experimental design with a delayed condition was used to evaluate the effects on DV victimization and perpetration (N = 82). Self-administrated assessments were completed at baseline, 1 week, 3 months, and 12 months after the intervention to assess for psychological victimization and perpetration and physical and sexual victimization and perpetration. Effect sizes were estimated, and generalized estimating equations were generated to test intervention effects over time and potential gender interactions. The intervention had medium to strong effects on DV victimization and perpetration for male participants but not for females. However, intervention effects were not statistically significant over time. More research is needed to enhance intervention effects of JOVEN on DV outcomes and to evaluate these effects among a larger and more diverse sample.

Acculturation, risk behaviors and physical dating violence victimization among Cuban-American adolescents.

The purpose of this study is to describe the relationships among acculturation, risk behaviors, and reported physical dating violence among Cuban-American ninth grade adolescents. Participants (N=82) completed a questionnaire that assessed their level of acculturation to the U.S. (Americanism), their maintenance of the Hispanic culture (Hispanicism), binge drinking, drug use, sexual intercourse, condom use and physical dating violence victimization. Multiple logistic regression was conducted. Hispanicism was associated with a decrease in odds of reporting physical dating violence victimization. Drug use and not using a condom were associated with an increase in odds of reporting physical dating violence victimization.

Perceptions of adolescents, parents, and school personnel from a predominantly Cuban American community regarding dating and teen dating violence prevention.

The purpose of this study was to explore perceptions of dating relationships and teen dating violence prevention within a predominantly Cuban American community in Miami-Dade County. Eight focus groups (n = 74 participants) with adolescents of Hispanic origin (n = 29), their parents (n = 29), and school personnel (n = 16) were conducted and analyzed using content analysis. Four themes characterized the nature and context of dating relationships among adolescents of Hispanic origin: YOLO -You Only Live Once, cultural unity but social division, dating is not going out, and the social environment challenges healthy relationships. The information generated from this study can be used to develop culturally tailored teen dating violence prevention programs targeting youth of Hispanic origin.