"Invisible in the Most Tragic of Ways": Exploring Internalized Transphobia and Coping Through Photovoice.

Transgender and gender diverse (TGD) individuals experience minority stress that includes internalizing the negative attitudes that exist in society about those whose identities rest outside of the gender binary. The purpose of this study was to gain a better understanding of the experience of internalized stigma and associated coping methods among six TGD adults utilizing photovoice. Thematic and iconographic analysis of 35 works produced by the participants revealed themes involving metaphors for internalized transphobia, internalized social messages, the psychological debt or emotional cost of internalized transphobia, and a range of coping strategies. Specifically, invisibility was a common metaphor used to suggest that a TGD person's experience may be associated with actively hiding, masking their identity, or failing to be seen as their true self. Participants expressed concern with being accepted by others and noted anxiety about outward expressions of their gender and personal characteristics. The results also revealed that participants experienced loneliness, fear of rejection, and low self-esteem related to internalized transphobia and their TGD identities. Participants reported receiving messages that TGD individuals are often viewed negatively and generally lack support from society and close relations. Coping strategies utilized by participants included withdrawing from others, hiding their TGD identity to avoid rejection or violence, self-exploration, accepting self and others, and connecting to a community of TGD persons and/or allies. Focus group feedback revealed benefits to participants, including an enhanced sense of community and self-esteem, as well as recommendations for future group structure. Implications and future research directions are discussed.

The barriers and facilitators to serious mental illness: Recovery postincarceration.

Although there are effective treatments that promote recovery and improve quality of life for serious mental illness in nonincarcerated populations, more research is needed to understand the recovery process for individuals with a history of incarceration. A qualitative, grounded theory study was conducted with 17 men and women who have serious mental illness (SMI) and a history of incarceration. Findings revealed barriers and facilitators to the recovery process in the areas of identity, treatment, relationships, community, and institutions. The findings suggested that incarceration had harmful effects on the recovery process for individuals with SMI, although these individuals, at times, found ways to turn this challenging experience into an opportunity for personal growth. The clinical implications of these findings include the importance of the prevention of incarceration for people with SMI, as well as the provision of multidisciplinary care, such as medical, mental health, and substance use treatment, during and after incarceration, to reduce barriers and increase recovery outcomes. Additionally, factors related specifically to incarceration should be addressed during delivery of treatment and accessibility of community resources. Advocacy and policy change for prison reform will also be discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study.

BACKGROUND: Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. OBJECTIVES: The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as "S4E"). METHODS: A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. RESULTS: A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app. CONCLUSIONS: There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.