Journal articles on the topic 'Mental health; rural; mixed methods'
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Groh, Carla J., and Mitzi M. Saunders. "The Transition From Spousal Caregiver to Widowhood: Quantitative Findings of a Mixed-Methods Study." Journal of the American Psychiatric Nurses Association 26, no. 6 (May 4, 2020): 527–41. http://dx.doi.org/10.1177/1078390320917751.
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BACKGROUND: The number of persons diagnosed with dementia is projected to triple to 14 million by 2050. The significance of these projections is particularly relevant to older women (>65 years), who are more likely to provide dementia caregiving for a husband than vice versa. Research has identified consistent themes around the impact of caregiving during the caregiving experience, yet there is limited research exploring the ongoing impact during the transition to widowhood. Moreover, there is a paucity of research examining differences between rural and urban spousal dementia caregivers. AIMS: The aims were to compare differences between older rural and urban spousal caregivers on physical and mental health factors affecting the transition from caregiver to widow and to identify resources the women used during this transition over 12 months. METHOD: This mixed-methods longitudinal study recruited 13 urban and nine rural female spousal caregivers. Participants were interviewed three times over 12 months. The dependent variables were depression (measured using Center for Epidemiologic Studies Depression Scale), physical and mental functioning (measured using the 12-item Medical Outcomes Study–Short Form Health Survey Version 2). RESULTS: No statistically significant differences were detected between rural and urban female caregivers on the dependent variables. However, rural caregivers scored higher on depression and lower on both physical and mental functioning compared to their urban counterparts. CONCLUSIONS: The findings have clinical and research implications. Psychiatric nurses are well positioned to provide education related to dementia information deficits; implement interventions that facilitate bereavement, resilience, self-care, and identity; advocate for additional services; and conduct larger scale studies with a more diverse sample of female spousal caregivers.
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Heath, Olga, Elizabeth Church, Vernon Curran, Ann Hollett, Peter Cornish, Terrence Callanan, Cheri Bethune, and Lynda Younghusband. "Interprofessional mental health training in rural primary care: findings from a mixed methods study." Journal of Interprofessional Care 29, no. 3 (October 7, 2014): 195–201. http://dx.doi.org/10.3109/13561820.2014.966808.
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Rimal, Pragya, Nandini Choudhury, Pawan Agrawal, Madhur Basnet, Bhavendra Bohara, David Citrin, Santosh Kumar Dhungana, et al. "Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study." BMJ Open 11, no. 8 (August 2021): e048481. http://dx.doi.org/10.1136/bmjopen-2020-048481.
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IntroductionDespite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings.MethodsWe conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers’ behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period.ResultsProviders experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:−9, Q3:−2) decrease in PHQ-9 scores (p<0.0001).ConclusionUsing the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers’ positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.
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McKenzie, John W., Jo M. Longman, Ross Bailie, Maddy Braddon, Geoffrey G. Morgan, Edward Jegasothy, and James Bennett-Levy. "Insurance Issues as Secondary Stressors Following Flooding in Rural Australia—A Mixed Methods Study." International Journal of Environmental Research and Public Health 19, no. 11 (May 24, 2022): 6383. http://dx.doi.org/10.3390/ijerph19116383.
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Flood events can be dramatic and traumatic. People exposed to floods are liable to suffer from a variety of adverse mental health outcomes. The adverse effects of stressors during the recovery process (secondary stressors) can sometimes be just as severe as the initial trauma. Six months after extensive flooding in rural Australia, a survey of 2530 locals was conducted focusing on their flood experiences and mental health status. This mixed methods study analysed (a) quantitative data from 521 respondents (21% of total survey respondents) who had insurance coverage and whose household was inundated, 96 (18%) of whom reported an insurance dispute or denial; and (b) qualitative data on insurance-related topics in the survey’s open comments sections. The mental health outcomes were all significantly associated with the degree of flood inundation. The association was strong for probable PTSD and ongoing distress (Adjusted Odds Ratios (AORs) with 95% confidence intervals 2.67 (1.8–4.0) and 2.30 (1.6–3.3), respectively). The associations were less strong but still significant for anxiety and depression (AORs 1.79 (1.2–2.7) and 1.84 (1.2–2.9)). The secondary stressor of insurance dispute had stronger associations with ongoing distress and depression than the initial flood exposure (AORs 2.43 (1.5–3.9) and 2.34 (1.4–3.9), respectively). Insurance was frequently mentioned in the open comment sections of the survey. Most comments (78% of comments from all survey respondents) were negative, with common adverse trends including dispute/denial, large premium increases after a claim, inconsistencies in companies’ responses and delayed assessments preventing timely remediation.
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Ingram, Lucy Annang, Chiwoneso B. Tinago, Bo Cai, Louisiana Wright Sanders, Tina Bevington, Sacoby Wilson, Kathryn M. Magruder, and Erik Svendsen. "Examining Long-Term Mental Health in a Rural Community Post-Disaster: A Mixed Methods Approach." Journal of Health Care for the Poor and Underserved 29, no. 1 (2018): 284–302. http://dx.doi.org/10.1353/hpu.2018.0020.
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Shi, Yaojiang, Linxiu Zhang, Yue Ma, Hongmei Yi, Chengfang Liu, Natalie Johnson, James Chu, Prashant Loyalka, and Scott Rozelle. "Dropping Out of Rural China's Secondary Schools: A Mixed-methods Analysis." China Quarterly 224 (December 2015): 1048–69. http://dx.doi.org/10.1017/s0305741015001277.
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AbstractStudents in rural China are dropping out of secondary school at troubling rates. While there is considerable quantitative research on this issue, no systematic effort has been made to assess the deeper reasons behind student decision making through a mixed-methods approach. This article seeks to explore the prevalence, correlates and potential reasons for rural dropout throughout the secondary education process. It brings together results from eight large-scale survey studies covering 24,931 rural secondary students across four provinces, as well as analysis of extensive interviews with 52 students from these same study sites. The results show that the cumulative dropout rate across all windows of secondary education may be as high as 63 per cent. Dropping out is significantly correlated with low academic performance, high opportunity cost, low socio-economic status and poor mental health. A model is developed to suggest that rural dropout is primarily driven by two mechanisms: rational cost-benefit analysis or impulsive, stress-induced decision making.
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Garwood, Justin D., Margaret G. Werts, Cheryl Varghese, and Leanne Gosey. "Mixed-Methods Analysis of Rural Special Educators’ Role Stressors, Behavior Management, and Burnout." Rural Special Education Quarterly 37, no. 1 (November 29, 2017): 30–43. http://dx.doi.org/10.1177/8756870517745270.
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The researchers of this study used a mixed-methods approach to understand issues of rural special education teacher burnout. Results of survey responses ( n = 64) and follow-up focus group interviews ( n = 12) from rural special education teachers indicated several factors contributing to stress and burnout. Teachers noted that lack of clarity in their roles, too many facets to the roles, emotional exhaustion, and lack of accomplishment contributed to their perceptions. Good working relationships with colleagues and administrators, building relationships with students, and a high level of self-advocacy were noted as helping to maintain mental health and a work–life balance. Possible steps to alleviate risk factors of rural special education teacher burnout are discussed.
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O’Malley, Meagan, Staci J. Wendt, and Christina Pate. "A View From the Top: Superintendents’ Perceptions of Mental Health Supports in Rural School Districts." Educational Administration Quarterly 54, no. 5 (June 27, 2018): 781–821. http://dx.doi.org/10.1177/0013161x18785871.
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Purpose: A chasm exists between the expanding mental health needs of school-aged youth and the school resources available to address them. Education agencies must efficiently allocate their limited resources by adopting innovative public health models. The need for these effective approaches is acute in rural regions, where resources tend to be scarce. This mixed-methods study of school superintendents illuminates key opportunities to optimize access to care for students struggling with mental health needs in rural communities. Method: Superintendents serving rural California school districts were targeted for a web-based, mixed response–type, 53-item survey designed to examine their perceptions across three school mental health–related categories: (a) strengths and gaps in community ethos and district infrastructure, (b) school personnel groups’ knowledge and skills, and (c) predominant barriers. Of the targeted respondents, 16.7% completed the survey ( N = 62). Quantitative data were analyzed using a series of descriptive analyses and paired-sample t tests. Qualitative data were analyzed using a constant comparative method with an open-coding approach. Findings and Implications: Budget constraints and access to trained school-based and community-based mental health personnel are the most frequently cited barriers to addressing mental health in schools. Knowledge and skills related to mental health are perceived to be more pronounced in district and school leadership than in other personnel groups, including staff typically responsible for providing mental health services, such as school psychologists. Our findings suggest a need to improve superintendent knowledge of innovative public health models for delivering mental health services within the constraints of rural school district settings.
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Maulik, P. K., S. Devarapalli, S. Kallakuri, A. Tewari, S. Chilappagari, M. Koschorke, and G. Thornicroft. "Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach." Psychological Medicine 47, no. 3 (November 2, 2016): 565–75. http://dx.doi.org/10.1017/s0033291716002804.
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BackgroundStigma related to mental health is a major barrier to help-seeking resulting in a large treatment gap in low- and middle-income countries (LMIC). This study assessed changes in knowledge, attitude and behaviour, and stigma related to help-seeking among participants exposed to an anti-stigma campaign.MethodThe campaign, using multi-media interventions, was part of the SMART Mental Health Project, conducted for 3 months, across 42 villages in rural Andhra Pradesh, in South India. Mixed-methods evaluation was conducted in two villages using a pre-post design.ResultsA total of 1576 and 2100 participants were interviewed, at pre- and post-intervention phases of the campaign. Knowledge was not increased. Attitudes and behaviours improved significantly (p < 0.01). Stigma related to help-seeking reduced significantly (p < 0.05). Social contact and drama were the most beneficial interventions identified during qualitative interviews.ConclusionThe results showed that the campaign was beneficial and led to improvement of attitude and behaviours related to mental health and reduction in stigma related to help-seeking. Social contact was the most effective intervention. The study had implications for future research in LMIC.
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Evans, Emily C., Nancy L. Deutsch, Emily Drake, and Linda Bullock. "Nurse–Patient Interaction as a Treatment for Antepartum Depression: A Mixed-Methods Analysis." Journal of the American Psychiatric Nurses Association 23, no. 5 (April 29, 2017): 347–59. http://dx.doi.org/10.1177/1078390317705449.
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BACKGROUND: The U.S. Preventative Services Task Force guidelines recommend pregnant women be screened for depression and adequate systems be in place to treat this condition. OBJECTIVE: This study examines a nurse-delivered telephone support intervention provided to low-income, pregnant women living in rural settings. DESIGN: This study had a complementary mixed-methods design, using secondary data. Peplau’s theory of interpersonal relations was used as a framework to guide the study. RESULTS: The phases of Peplau’s theory of interpersonal relations were evident in the interactions. Underserved women at high risk for depression appreciated this type of support, with the women at highest risk for depression utilizing more of the nursing support provided. On average, Mental Health Index–5 scores improved from 45 to 66. CONCLUSION: A nurse-delivered telephone support intervention, modeled around Peplau’s theory of interpersonal relations, may be an effective way of providing support to underserved women and has the potential to treat or offset antepartum depression.
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MacFarlane, Elizabeth K., Renu Shakya, Helen L. Berry, and Brandon A. Kohrt. "Implications of participatory methods to address mental health needs associated with climate change: ‘photovoice’ in Nepal." BJPsych. International 12, no. 2 (May 2015): 33–35. http://dx.doi.org/10.1192/s2056474000000246.
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‘Photovoice’, a community-based participatory research methodology, uses images as a tool to deconstruct problems by posing meaningful questions in a community to find actionable solutions. This community-enhancing technique was used to elicit experiences of climate change among women in rural Nepal. The current analysis employs mixed methods to explore the subjective mental health experience of participating in a 4- to 5-day photovoice process focused on climate change. A secondary objective of this work was to explore whether or not photovoice training, as a one-time 4-to 5-day intensive intervention, can mobilise people to be more aware of environmental changes related to climate change and to be more resilient to these changes, while providing positive mental health outcomes.
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Gandy, Megan E., Kacie M. Kidd, James Weiss, Judith Leitch, and Xavier Hersom. "Trans*Forming Access and Care in Rural Areas: A Community-Engaged Approach." International Journal of Environmental Research and Public Health 18, no. 23 (December 2, 2021): 12700. http://dx.doi.org/10.3390/ijerph182312700.
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Research indicates that rural transgender and gender diverse (TGD) populations have a greater need for health services when compared with their urban counterparts, face unique barriers to accessing services, and have health disparities that are less researched than urban TGD populations. Therefore, the primary aim of this mixed-methods study (n = 24) was to increase research on the health care needs of TGD people in a rural Appalachian American context. This study was guided by a community-engaged model utilizing a community advisory board of TGD people and supportive parents of TGD children. Quantitative results indicate that travel burden is high, affirming provider availability is low, and the impacts on the health and mental health of TGD people in this sample are notable. Qualitative results provide recommendations for providers and health care systems to better serve this population. Integrated mixed-methods results further illustrate ways that rural TGD people and families adapt to the services available to them, sometimes at significant economic and emotional costs. This study contributes to the small but growing body of literature on the unique needs of rural TGD populations, including both adults and minors with supportive parents, by offering insights into strategies to address known disparities.
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Perkins, Alexandra, Jessica Clarke, Ashlee Smith, Frank Oberklaid, and Simone Darling. "Barriers and enablers faced by regional and rural schools in supporting student mental health: A mixed‐methods systematic review." Australian Journal of Rural Health 29, no. 6 (October 23, 2021): 835–49. http://dx.doi.org/10.1111/ajr.12794.
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Woodward, Aniek, Daniela C. Fuhr, Alexandra S. Barry, Dina Balabanova, Egbert Sondorp, Marjolein A. Dieleman, Pierre Pratley, et al. "Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East." Open Research Europe 3 (January 20, 2023): 14. http://dx.doi.org/10.12688/openreseurope.15293.1.
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Background: Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. Methods: A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results: We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided. Conclusions: All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.
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de Deuge, Josephine, Ha Hoang, Katherine Kent, Jonathon Mond, Heather Bridgman, Sarah Skromanis, Laura Smith, and Stuart Auckland. "Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia." International Journal of Environmental Research and Public Health 17, no. 6 (March 19, 2020): 2031. http://dx.doi.org/10.3390/ijerph17062031.
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Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. Four study communities were selected based on population size, rurality, access to local support services, history of suicide within the community, and maturity of the mental health promotion program. Data from self-report questionnaires (n = 245), including items of Communities Advancing Resilience Toolkit (CART) assessment, and qualitative (focus group and interview) data from key local stakeholders (n = 24), were pooled to explore the factors perceived to be influencing program implementation. Survey results indicate the primary community resilience strengths across the four sites were related to the ‘Connection and Caring’ domain. The primary community resilience challenges related to resources. Qualitative findings suggested lack of communication and leadership are key barriers to effective program delivery and identified a need to provide ongoing support for program staff. Assessment of perceived community resilience may be helpful in informing the implementation of mental health promotion programs in rural areas and, in turn, improve the likelihood of their success and sustainability.
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Newbigging, Karen, James Rees, Rebecca Ince, John Mohan, Doreen Joseph, Michael Ashman, Barbara Norden, Ceri Dare, Suzanne Bourke, and Benjamin Costello. "The contribution of the voluntary sector to mental health crisis care: a mixed-methods study." Health Services and Delivery Research 8, no. 29 (July 2020): 1–200. http://dx.doi.org/10.3310/hsdr08290.
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Background Weaknesses in the provision of mental health crisis support are evident and improvements that include voluntary sector provision are promoted. There is a lack of evidence regarding the contribution of the voluntary sector and how this might be used to the best effect in mental health crisis care. Aim To investigate the contribution of voluntary sector organisations to mental health crisis care in England. Design Multimethod sequential design with a comparative case study. Setting England, with four case studies in North England, East England, the Midlands and London. Method The method included a scoping literature review, a national survey of 1612 voluntary sector organisations, interviews with 27 national stakeholders and detailed mapping of the voluntary sector organisation provision in two regions (the north and south of England) to develop a taxonomy of voluntary sector organisations and to select four case studies. The case studies examined voluntary sector organisation crisis care provision as a system through interviews with local stakeholders (n = 73), eight focus groups with service users and carers and, at an individual level, narrative interviews with service users (n = 47) and carers (n = 12) to understand their crisis experience and service journey. There was extensive patient and public involvement in the study, including service users as co-researchers, to ensure validity. This affected the conduct of the study and the interpretation of the findings. The quality and the impact of the involvement was evaluated and commended. Main findings A mental health crisis is considered a biographical disruption. Voluntary sector organisations can make an important contribution, characterised by a socially oriented and relational approach. Five types of relevant voluntary sector organisations were identified: (1) crisis-specific, (2) general mental health, (3) population-focused, (4) life-event-focused and (5) general social and community voluntary sector organisations. These voluntary sector organisations provide a range of support and have specific expertise. The availability and access to voluntary sector organisations varies and inequalities were evident for rural communities; black, Asian and minority ethnic communities; people who use substances; and people who identified as having a personality disorder. There was little evidence of well-developed crisis systems, with an underdeveloped approach to prevention and a lack of ongoing support. Limitations The survey response was low, reflecting the nature of voluntary sector organisations and demands on their time. This was a descriptive study, so evaluating outcomes from voluntary sector organisation support was beyond the scope of the study. Conclusions The current policy discourse frames a mental health crisis as an urgent event. Viewing a mental health crisis as a biographical disruption would better enable a wide range of contributory factors to be considered and addressed. Voluntary sector organisations have a distinctive and important role to play. The breadth of this contribution needs to be acknowledged and its role as an accessible alternative to inpatient provision prioritised. Future work A whole-system approach to mental health crisis provision is needed. The NHS, local authorities and the voluntary sector should establish how to effectively collaborate to meet the local population’s needs and to ensure the sustainability of the voluntary sector. Service users and carers from all communities need to be central to this. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 29. See the NIHR Journals Library website for further project information.
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Leet, A., S. Dennis, J. Muller, S. Walsh, H. Bowen-Salter, and J. Kernot. "Demonstrating the processes and outcomes of a rural Community Mental Health Rehabilitation Service: A realist evaluation." PLOS ONE 16, no. 11 (November 23, 2021): e0260250. http://dx.doi.org/10.1371/journal.pone.0260250.
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Background As part of significant mental health reform, the Community Mental Health Rehabilitation Service (CMHRS) was implemented in rural South Australia. The CMHRS is a 10-bed mental health residential program offering rehabilitative mental health support to rural residents. Aim To analyse the CMHRS service delivery model and its impact on recovery outcomes for consumers. Methods A mixed method, realist evaluation approach was utilised. A purposive sample of CMHRS staff (n = 6) and consumers (n = 8) were recruited. Consumer recovery was measured using the RAS-DS (on admission and discharge). Participants’ perspectives of the service were gained via one staff focus group (n = 6) and individual semi-structured interviews (consumers n = 6; staff n = 2). Pre-post RAS-DS scores were analysed using paired t-tests/Wilcoxon paired-signed rank test, with qualitative data analysed thematically. Results Significant positive increases in RAS-DS total scores were observed at discharge, supported by the qualitative themes of (re)building relationships and social connections and recovering health and wellbeing. Contextual factors (e.g. staffing) and program mechanisms (e.g. scheduling) impacting on service implementation were identified. Conclusion Maintaining a rehabilitation recovery-focused approach, balanced with an appropriately trained multi-disciplinary team, are vital for maximising positive consumer outcomes. Significance This realist evaluation identifies critical factors impacting rural mental health rehabilitation service delivery.
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Nolte, Kerry, Aurora L. Drew, Peter D. Friedmann, Eric Romo, Linda M. Kinney, and Thomas J. Stopka. "Opioid initiation and injection transition in rural northern New England: A mixed-methods approach." Drug and Alcohol Dependence 217 (December 2020): 108256. http://dx.doi.org/10.1016/j.drugalcdep.2020.108256.
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Fekadu, Abebaw, Charlotte Hanlon, Girmay Medhin, Atalay Alem, Medhin Selamu, Tedla W. Giorgis, Teshome Shibre, et al. "Development of a scalable mental healthcare plan for a rural district in Ethiopia." British Journal of Psychiatry 208, s56 (January 2016): s4—s12. http://dx.doi.org/10.1192/bjp.bp.114.153676.
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BackgroundDeveloping evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority.AimsTo outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia.MethodA mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation).ResultsThe community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability.ConclusionsThe MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC.
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Scelzo, Anna, Salvatore Di Somma, Paola Antonini, Lori P. Montross, Nicholas Schork, David Brenner, and Dilip V. Jeste. "Mixed-methods quantitative–qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits." International Psychogeriatrics 30, no. 1 (December 12, 2017): 31–38. http://dx.doi.org/10.1017/s1041610217002721.
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ABSTRACTObjective:This was a study of positive psychological traits in a group of rural Italians aged 90 to 101 years, and their children or other family members.Design:Mixed-methods quantitative (standardized rating scales) and qualitative (semi-structured interviews) study.Setting:Study participants’ homes in nine villages in the Cilento region of southern Italy.Participants:Twenty-nine nonagenarians and centenarians and 51 family members aged 51–75 years, selected by their general practitioners as a part of a larger study called CIAO (Cilento Initiative on Aging Outcomes).Methods:We used published rating scales of mental and physical well-being, resilience, optimism, anxiety, depression, and perceived stress. Qualitative interviews gathered personal narratives of the oldest-old individuals, including migrations, traumatic events, and beliefs. Family members described their impressions about the personality traits of their older relative.Results:Participants age ≥90 years had worse physical health but better mental well-being than their younger family members. Mental well-being correlated negatively with levels of depression and anxiety in both the groups. The main themes that emerged from qualitative interviews included positivity (resilience and optimism), working hard, and bond with family and religion, as described in previously published studies of the oldest old, but also a need for control and love of the land, which appeared to be unique features of this rural population.Conclusions:Exceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life.
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Cleofas, Jerome Visperas. "Social media disorder during community quarantine: A mixed methods study among rural young college students during the COVID-19 pandemic." Archives of Psychiatric Nursing 40 (October 2022): 97–105. http://dx.doi.org/10.1016/j.apnu.2022.06.003.
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Smith, Stephanie L., Claire Nancy Misago, Robyn A. Osrow, Molly F. Franke, Jean Damascene Iyamuremye, Jeanne D'Arc Dusabeyezu, Achour A. Mohand, Manzi Anatole, Yvonne Kayiteshonga, and Giuseppe J. Raviola. "Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol." BMJ Open 7, no. 2 (February 2017): e014067. http://dx.doi.org/10.1136/bmjopen-2016-014067.
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Maulik, Pallab K., Sudha Kallakuri, and Siddhardha Devarapalli. "Operational challenges in conducting a community-based technology-enabled mental health services delivery model for rural India: Experiences from the SMART Mental Health Project." Wellcome Open Research 3 (April 18, 2018): 43. http://dx.doi.org/10.12688/wellcomeopenres.14524.1.
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Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational strategies used to facilitate the implementation of the intervention. Method: Key components of the SMART Mental Health Project included delivering an anti-stigma campaign, training of primary health workers in screening, diagnosing and managing stress, depression and increased suicide risk and task sharing of responsibilities in delivering care; and using mobile technology based electronic decision support systems to support delivery of algorithm based care for such disorders. The intervention was conducted in 42 villages across two sites in the state of Andhra Pradesh in south India. A pre-post mixed methods evaluation was done, and in this paper operational challenges are reported. Results: Both quantitative and qualitative results from the evaluation from one site covering about 5000 adults showed that the intervention was feasible and acceptable, and initial results indicated that it was beneficial in increasing access to mental health care and reducing depression and anxiety symptoms. A number of strategies were initiated in response to operational challenges to ensure smoother conduct of the project and facilitated the project to be delivered as envisaged. Conclusions: The operational strategies initiated for this project were successful in ensuring the delivery of the intervention. Those, coupled with other more systematic processes have informed the researchers to understand key processes that need to be in place to develop a more robust study, that could eventually be scaled up.
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Baker, Matthew, Katie A. Berens, Shanna Williams, Kaila C. Bruer, Angela D. Evans, and Heather L. Price. "The Impact of COVID-19 on Social Work Practice in Canada." Journal of Comparative Social Work 16, no. 2 (December 21, 2021): 141–71. http://dx.doi.org/10.31265/jcsw.v16i2.382.
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Social workers involved in child maltreatment investigations faced considerable challenges during the COVID-19 pandemic. Interactions with children and families carried new restrictions and risks, which resulted in changes in practice. We conducted a two-phase, mixed-methods study which examined the impact of the COVID-19 pandemic on social workers who work with maltreated children from both urban and rural areas across Canada. More specifically, we examined changes in service delivery, as well as perceptions of safety, stress, worry, and how support differed between urban and rural social workers. Fifty social workers (62% urban, 38% rural) responded to the Phase 1 survey, disseminated in May 2020, with 34 (76% urban, 24% rural) responding to the Phase 2 survey in November 2020. Quantitative and qualitative data revealed that rural social workers reported more worry, stress and a greater need for mental health support, in addition to receiving less support than urban social workers during the first wave of COVID-19 cases. However, during the second wave of cases, urban social workers reported more stress, a greater need for mental health support, and receiving less support than rural social workers. Additional research is needed to further uncover the nature of the differences between rural and urban social workers, and to identify the prolonged effects of the COVID-19 pandemic on social workers.
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Romero-Acosta, Kelly, Elena Marbán-Castro, Katy Arroyo-Alvis, Germán Arrieta, and Salim Mattar. "Perceptions and Emotional State of Mothers of Children with and without Microcephaly after the Zika Virus Epidemic in Rural Caribbean Colombia." Behavioral Sciences 10, no. 10 (September 25, 2020): 147. http://dx.doi.org/10.3390/bs10100147.
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Zika virus (ZIKV) infection during pregnancy can cause neurological manifestations such as microcephaly. The aim of this study was to explore perceptions of ZIKV and mental health in women exposed to ZIKV during pregnancy in Colombia. This was a mixed-methods study based on structured interviews and psychological tests. Structured interviews were transcribed and analysed with Atlas Ti software. A grounded theory approach was applied. Quantitative analysis was performed with Statistical Package for Social Science, SPSS, V. 20. The study was approved by the Ethics Committee of the Universidad de Córdoba, Montería. Seventeen women participated in the study; nine of them were mothers of children with microcephaly. Maternal age ranged from 16 to 41 years old. The main themes discussed during interviews were: feelings, support, sources of information, and consequences on children’s health. Women with children affected by microcephaly showed worse mental health compared to women with normocephalic children. Maternal mental health worsened after 24 months from giving birth. Perceptions regarding disease severity and lack of knowledge were considered to affect maternal mental health. Social support and spirituality were key determinants for caregivers. Future research is needed to further study coping mechanisms and mental health outcomes over time by affected populations.
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Fiske, Amelia, Antonius Schneider, Stuart McLennan, Siranush Karapetyan, and Alena Buyx. "Impact of COVID-19 on patient health and self-care practices: a mixed-methods survey with German patients." BMJ Open 11, no. 9 (September 2021): e051167. http://dx.doi.org/10.1136/bmjopen-2021-051167.
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ObjectiveThis study aimed to examine German patients’: (1) self-estimation of the impact of the pandemic on their health and healthcare; and (2) use of digital self-care practices during the pandemic.DesignCross-sectional mixed-methods survey.Setting and participantsGeneral practice patients from four physicians’ offices located in urban and rural areas of Bavaria, Germany, between 21 July 2020 and 17 October 2020. A total of 254 patients participated (55% response rate); 57% (262 of 459) identified as female and participants had an average age of 39.3 years. Patients were eligible to participate if they were 18 years or older and spoke German, and had access to the internet.Results(1) Healthcare for patients was affected by the pandemic, and the mental health of a small group of respondents was particularly affected. The risk of depression and anxiety disorder was significantly increased in patients with quarantine experience. (2) Self-care practices have increased; more than one-third (39%) of participants indicated that they started a new or additional self-care practice during the pandemic, and about a quarter (23%) of patients who were not previously engaged in self-care practices started new self-care activities for the first time; however, such practices were not necessarily digital.ConclusionsFurther investigation is required to understand the relationship between digital self-care and public health events such as the COVID-19 pandemic, and to develop strategies to alleviate the burden of the quarantine experience for patients.
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Clark, Angela, Jennifer Lanzillotta-Rangeley, and Jack Stem. "“If You Could Wave a Magic Wand”: Treatment Barriers in the Rural Midwest." Substance Abuse: Research and Treatment 15 (January 2021): 117822182110533. http://dx.doi.org/10.1177/11782218211053343.
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Introduction: The multigenerational health considerations and negative economic impacts related to the opioid epidemic are many. Increasing numbers of opioid-related fatalities are bolstered by barriers related to access to evidence-based treatment. Ohio is ranked second in the country for number of opioid-related deaths, and for many their treatment needs remain unmet due to impaired access to effective treatment, in rural, medically underserved areas of the state. Purpose: The goal of this study was to assess opioid use disorder treatment barriers in order to increase access to evidence-based treatment, wrap around services, and harm reduction efforts to support the reintegration of persons with substance use disorder back into society and subsequently reduce opioid fatalities in a rural, medically underserved region of Ohio. Methods: As part of a larger mixed-methods study design where a community health survey was randomly distributed to residents in a rural county in Ohio, this study used qualitative methods to triangulate findings. To supplement the data received from the surveys, 20persons with a diagnosed opioid use disorder (OUD) took part in focus group sessions guided by trained researchers. The sessions were transcribed, and the data was analyzed using Braun and Clarke’s thematic analysis method. Results: Three major themes emerged from the data: epigenetics and exposure, management of disease including re-integration into society, and disease process. The participant data created insight regarding the need to recognize OUD as a chronic condition that must be addressed with integrated components of medical, behavioral, and mental health morbidities throughout the lifespan and across generations. Conclusions: Findings from this study support the need for targeted interventions for integrated care and improved wrap around services such as transportation, sober living, and employment.
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Filips, Julie, Chalise Carlson, Ana Alfaro, Ranak Trevedi, Anita Savell, and Christine Gould. "Virtual Geriatric Mental Health Care Offered Where Needed Most: An Evaluation of a Telehealth Consultation Model." Innovation in Aging 5, Supplement_1 (December 1, 2021): 30. http://dx.doi.org/10.1093/geroni/igab046.109.
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Abstract Many VA facilities serving large rural populations do not have geriatric mental health specialists available to assist with managing the aging Veteran population’s complex medical and behavioral comorbidities. We applied mixed-methods to evaluate an innovative model utilizing a geriatric psychiatrist who provides cross-facility consultation in a 5-state region. During a 3-month period, the consultant completed 135 consults and 20 e-consults to settings ranging from outpatient to long-term care. Leadership stakeholder and provider interviews highlight the importance of the availability of the consultant, collaboration with local care teams, staff education, person-centered approach, and work ethic/passion. The core challenges that the consultant helps manage include complex comorbidities, medication questions, and dementia with behavioral disturbance. Initial provider survey responses (n = 11) show high satisfaction with services (100%) and strong agreement (80%) that providers could follow through with recommendations. Next steps include replication of this model in other VA facilities.
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Mulenga, David. "Research Article: Impact of Cooking Fuel Choices on Maternal Lung Functions in Selected Rural and Urban Areas of Copperbelt Province, Zambia." General Medicine and Clinical Practice 1, no. 3 (July 11, 2018): 01–09. http://dx.doi.org/10.31579/2639-4162/012.
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Background: Considering the respiratory health risk of exposure to biomass cooking fuel emissions, this study was conducted to elucidate the relationship between cooking fuel choices and declined pulmonary function in rural and urban population in the Copperbelt Province of Zambia. Methods: We carried out a cross-sectional study of 1,170 healthy nonsmoking pregnant women from Masaiti and Ndola predominantly using biomass fuel for cooking. Questionnaire based data was acquired along with standardized measures of lung function. MIR Spirobank G (Italy) was used in spirometry based on American Thoracic Standards. Results: The present study found that over two thirds (69.2%) of pregnant women in the study population use biomass for cooking and only 12.4 % use electricity only. Declined lung function was found to be statistically significantly associated with cooking fuel choices (p – value 0.005) and a weak association was observed with gravida at a p-value of 0.056. Pregnant women using crop residues as cooking fuel were two times more likely to have a declined lung function [AOR 2.33 (1.27, 4.30)] compared with pregnant women using mixed fuel type (biomass and electricity) and those using electricity only were 57% less likely to have a declined lung function [AOD 0.43 (0.26, 0.69)]. Conclusion: Use of biomass for cooking among pregnant women is a strong determinant of declined lung function. Interventions to improve maternal respiratory health outcomes in Zambia and other countries in sub-Saharan Africa should involve making cleaner cooking fuel energy options available and accessible by ordinary women from both rural and urban areas.
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Arnouk, MK, GS Marquis, and ND Dodoo. "Predictors and consequences of overweight and obesity in the household: A mixed methods study on rural Ghanaian women and men farmers." African Journal of Food, Agriculture, Nutrition and Development 23, no. 116 (January 23, 2023): 22221–47. http://dx.doi.org/10.18697/ajfand.116.23015.
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Overweight/obesity (OW/OB) rates are increasing in Ghana. This study aims to identify the predictors of OW/OB in women, men, and at the household level (having at least one person as OW/OB in the household) in rural Ghana and examine local perceptions of the consequences of having an OW/OB person in the household. This was a cross-sectional mixed methods study. The quantitative data was a secondary analysis of the baseline data from the LinkINg Up (LU) project; a nutrition-sensitive agriculture intervention in eight rural communities in the Eastern Region of Ghana (ClinicalTrials.gov NCT03869853). The sample included 331 women and 205 men, 19-90 years old; there were 196 households that had both a participating woman and man (spouse, son, brother, or father). Logistic regression was used to assess variables associated with OW/OB in women (n=322), men (n=205), and households (n=196). Exposure variables included age, social support, mental health, self-efficacy, food security, the other family members’ OW/OB status, and others. Qualitative data included six focus group discussions (FGDs) (three with women and three with men, aged 22-69 years and recruited from the comparison arm of the LU project) were conducted in February-March 2022 in three of the eight project communities. A structured guide and a body figure instrument were used. The FGD recordings were translated and transcribed from Krobo to English. The analysis used an inductive thematic approach. Both women and men’s OW/OB were positively associated with age and wealth. Women’s OW/OB was negatively associated with age squared, and the score for mental health symptoms. Men’s OW/OB was negatively associated with being Krobo compared to other ethnicities. Households in the highest wealth tertile were 2.5-fold more likely to have at least one person who is OW/OB as compared to households in a lower wealth tertile. Participants expressed positive social consequences of having an OW/OB person for their families (for example respect). A person’s size was concerning only when it affected one’s ability to farm or make money, which would harm the household unit (for example lead to food insecurity, children dropping out of school). Having money was seen as a modifier for the negative effects. No negative consequences were perceived for OW people. The implications of the interruption of an OB person’s work on their family are worrisome and call for interventions that address poverty and food insecurity along with nutrition. Key words: Africa, farmer, household, social norms, perceptions, body image, overweight, obesity, predictors
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Bhat, Amritha, Susan Reed, Johnny Mao, Mindy Vredevoogd, Joan Russo, Jennifer Unger, Roger Rowles, and Jürgen Unützer. "Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness." Journal of Psychosomatic Obstetrics & Gynecology 39, no. 4 (September 7, 2017): 273–80. http://dx.doi.org/10.1080/0167482x.2017.1367381.
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Fitzpatrick, Scott J., Bronwyn K. Brew, Donna M. Y. Read, Kerry J. Inder, Alan Hayes, and David Perkins. "Rethinking Suicide in Rural Australia: A study Protocol for Examining and Applying Knowledge of the Social Determinants to Improve Prevention in Non-Indigenous Populations." International Journal of Environmental Research and Public Health 16, no. 16 (August 16, 2019): 2944. http://dx.doi.org/10.3390/ijerph16162944.
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Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains hampered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. The two-phased study will use a mixed-methods design informed by intersectionality theory. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated.
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Te’o, Dayna T., Cervantée E. K. Wild, Esther J. Willing, Lisa E. Wynter, Niamh A. O’Sullivan, Paul L. Hofman, Sarah E. Maessen, José G. B. Derraik, and Yvonne C. Anderson. "The Impact of a Family-Based Assessment and Intervention Healthy Lifestyle Programme on Health Knowledge and Beliefs of Children with Obesity and Their Families." Nutrients 14, no. 20 (October 18, 2022): 4363. http://dx.doi.org/10.3390/nu14204363.
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Objective: To determine the impact of a family-based assessment-and-intervention healthy lifestyle programme on health knowledge and beliefs of children and families affected by obesity. Second, to compare the health knowledge of the programme cohort to those of a national cohort in Aotearoa/New Zealand (NZ). Design: This mixed-methods study collected health knowledge and health belief data in a questionnaire at baseline and 12-, 24-, and 60-month follow-up assessments. Health knowledge over time was compared with baseline knowledge and with data from a nationally representative survey. A data-driven subsumption approach was used to analyse open-text responses to health belief questions across the study period. Setting: Taranaki region, a mixed urban–rural setting in NZ. Participants: Participants (caregiver/child dyads) from the Whānau Pakari randomised trial. Results: A greater proportion of the cohort correctly categorised foods and drinks as healthy or unhealthy at 12 months compared to baseline for most questionnaire items. Retention of this health knowledge was evident at 24- and 60-month follow-ups. More than twice as many participants correctly reported physical activity recommendations at follow-up compared to baseline (p < 0.001). Health knowledge of participants was similar to the national survey cohort at baseline, but surpassed it at 12 and 24 months. Participant beliefs around healthy lifestyles related to physical functioning, mental and emotional wellbeing, and enhancement of appearance, and gained greater depth and detail over time. Conclusions: This study demonstrates the important role that community-level healthy lifestyle programmes can have in knowledge-sharing and health promotion.
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Raja, S., F. Soomro, B. Junejo, R. Wagan, and S. S. Afghan. "Evaluation of a home treatment approach to schizophrenia in rural Pakistan: the SOUL Programme." European Psychiatry 65, S1 (June 2022): S613. http://dx.doi.org/10.1192/j.eurpsy.2022.1570.
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Introduction Psychiatric services in LEDCs face a tripartite challenge: (i) limited financial capital; (ii) scarcity of professionals; (iii) restrictive health beliefs. Inevitably, services developed for the first-world are ill-suited here. Psychiatric services must be designed from the ground up: inspired by but not a replica of best practices in the developed world. The SOUL project in Larkana, Pakistan provides home based assessment by a psychiatrist and fortnightly treatment by a mobile nursing team for schizophrenic patients. Psychoeducation of carers and the community as well as facilitation of work for patients are core aims. This mixed-methods study evaluates the experiences of primary stakeholders - patients and their carers. Objectives 1.Are patients and carers satisfied with the care received? 2.Has SOUL been successful in changing health beliefs? 3.How could the programme be improved? Methods The principal investigator accompanied the team for 4-weeks. Purposive sampling was employed. Satisfaction was assessed quantitatively using the likert based PSQ-18 questionnaire. Thereafter, qualitative data was gathered using semi-structured interviews and analysed using a grounded theory approach. A total of 27 interviews were conducted before data saturation. Results 100% of interviewees answered ’Satisfied’ or ’Very’ Satisfied to all elements of the PSQ-18. Above all, stakeholders valued that treatment was free and highly accessible (home visits), promoting treatment adherence. They felt psychoeducation events significantly reduced community stigma and made families more likely to seek psychiatrists over faith healers. Provision of respite care was suggested as a future improvement. Conclusions SOUL is highly valued by stakeholders and offers an excellent example of LEDC psychiatric care. Disclosure No significant relationships.
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Mumu, Shirin Jahan, A. K. M. Fazlur Rahman, Paul P. Fahey, Liaquat Ali, and Dafna Merom. "Lifestyle risk factors and metabolic markers of cardiovascular diseases in Bangladeshi rural-to-urban male migrants compared with their non-migrant siblings: A sibling-pair comparative study." PLOS ONE 17, no. 9 (September 27, 2022): e0274388. http://dx.doi.org/10.1371/journal.pone.0274388.
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Background The increasing prevalence of cardiovascular diseases (CVDs) in developing countries like Bangladesh has been linked to progressive urbanisation. Comparisons of rural and urban populations often find a higher prevalence of CVD risk factors in the urban population, but rural-to-urban migrants might have different CVD risk profiles than either rural or urban residents. This study aimed to describe differences in CVD risk factors between migrants and non-migrants siblings and to determine whether acculturation factors were associated with CVD risk factors among migrants. Methods Using a sibling-pair comparative study, 164 male migrant who migrated from Pirganj rural areas to Dhaka City and their rural siblings (total N = 328) were assessed by interview, anthropometric measurement, blood pressure and blood samples. Comparisons were made using linear or logistic mixed effects models. Findings Physical inactivity, inadequate intake of fruit and vegetables and possible existence of a mental health disorder had 3.3 (1.73; 6.16), 4.3 (2.32; 7.92) and 2.9 (1.37; 6.27) times higher odds among migrants than their rural siblings, respectively. Migrants watched television on average 20 minutes (95% CI 6.17–35.08 min/day) more per day than the rural sibling group whereas PUFA intake, fruit and vegetable and fish intake of the migrants were -5.3 gm/day (-6.91; -3.70), -21.6 serving/week (-28.20; -15.09), -14.1 serving/week (-18.32; -9.87), respectively, lower than that of the rural siblings. No significant difference was observed for other variables. After adjusting, the risk of physical inactivity, inadequate fruit and vegetable intake, a mental health disorder and low HDL were significantly higher in migrants than in rural siblings and tended to be higher for each increasing tertile of urban life exposure. Conclusion The findings suggest that migration from rural-to-urban environment increases CVD risk which exacerbate with time spent in urban area due to acculturation. This study gives new insights into the increased CVD risk related with migration and urbanization in Bangladesh.
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Green, Brandn, Danielle Christine Rhubart, and Matthew R. Filteau. "Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana." Substance Abuse: Research and Treatment 15 (January 2021): 117822182110397. http://dx.doi.org/10.1177/11782218211039781.
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Purpose: Access to medication for opioid use disorder (MOUD) varies across the rural-urban continuum. The Hub & Spoke Model (H&S) emerged to address these gaps in service whereby hubs with staff expertise in MOUD support delivery of specialized care to a network of spoke locations, often located in rural communities with workforce shortages. This paper presents a case study of efforts to implement the hub and spoke model in a frontier and rural (FAR) state: Montana. Methods: The primary data are structured interviews with 65 MOUD program staff in hub and spoke locations within Montana. Both inductive and deductive coding were used to analyze the transcripts. Findings: Using the H&S structure to expand access to MOUD in Montana led to mixed results. There were consistent themes identified in the interviews about the reasons why hubs struggled to successfully recruit spokes, including (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model, and (5) a preference for informal technical assistance rather than a formal H&S relationship. In addition to these 5 themes, efforts to implement H&S across different medical systems were unsuccessful, whereas the H&S model worked more effectively when H&S locations were within the same organization. Conclusion: This case study identified limits to the H&S model utility in supporting states’ abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. We conclude with recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana.
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Manthorpe, Jill, Kritika Samsi, Louise Joly, Maureen Crane, Heather Gage, Ann Bowling, and Ramin Nilforooshan. "Service provision for older homeless people with memory problems: a mixed-methods study." Health Services and Delivery Research 7, no. 9 (February 2019): 1–184. http://dx.doi.org/10.3310/hsdr07090.
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Background Early or timely recognition of dementia is a key policy goal of the National Dementia Strategy. However, older people who are homeless are not considered in this policy and practice imperative, despite their high risk of developing dementia. Objectives and study design This 24-month study was designed to (1) determine the prevalence of memory problems among hostel-dwelling homeless older people and the extent to which staff are aware of these problems; (2) identify help and support received, current care and support pathways; (3) explore quality of life among older homeless people with memory problems; (4) investigate service costs for older homeless people with memory problems, compared with services costs for those without; and (5) identify unmet needs or gaps in services. Participants Following two literature reviews to help study development, we recruited eight hostels – four in London and four in North England. From these, we first interviewed 62 older homeless people, exploring current health, lifestyle and memory. Memory assessment was also conducted with these participants. Of these participants, 47 were included in the case study groups – 23 had ‘memory problems’, 17 had ‘no memory problems’ and 7 were ‘borderline’. We interviewed 43 hostel staff who were participants’ key workers. We went back 3 and 6 months later to ask further about residents’ support, service costs and any unmet needs. Findings Overall, the general system of memory assessment for this group was found to be difficult to access and not patient-centred. Older people living in hostels are likely to have several long-term conditions including mental health needs, which remain largely unacknowledged. Participants frequently reported experiences of declining abilities and hostel staff were often undertaking substantial care for residents. Limitations The hostels that were accessed were mainly in urban areas, and the needs of homeless people in rural areas were not specifically captured. For many residents, we were unable to access NHS data. Many hostel staff referred to this study as ‘dementia’ focused when introducing it to residents, which may have deterred recruitment. Conclusions To the best of our knowledge, no other study and no policy acknowledges hostels as ‘dementia communities’ or questions the appropriateness of hostel accommodation for people with dementia. Given the declining number of hostels in England, the limits of NHS engagement with this sector and growing homelessness, this group of people with dementia are under-recognised and excluded from other initiatives. Future work A longitudinal study could follow hostel dwellers and outcomes. Ways of improving clinical assessment, record-keeping and treatment could be investigated. A dementia diagnosis could trigger sustained care co-ordination for this vulnerable group. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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Bolinski, Rebecca S., Suzan Walters, Elizabeth Salisbury-Afshar, Lawrence J. Ouellet, Wiley D. Jenkins, Ellen Almirol, Brent Van Ham, et al. "The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings." International Journal of Environmental Research and Public Health 19, no. 4 (February 16, 2022): 2230. http://dx.doi.org/10.3390/ijerph19042230.
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Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.
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Bowen, Anna, Y. Michael Chen, Ruth Sally Kodam, Julius Amesimeku Odoi, and Martina Anto-Ocrah. "“At Least Somebody Sees You as a Hero”: Fatherhood Stress and Well-Being in Ghana." American Journal of Men's Health 16, no. 6 (November 2022): 155798832211381. http://dx.doi.org/10.1177/15579883221138185.
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Fathers’ mental health and behaviors influence child development and partner well-being, yet paternal stress and well-being are frequently overlooked; especially in non-Western settings. The aim of this mixed-methods study was to quantitatively assess the impact of parenting stress on fathers’ overall well-being in Ghana, West Africa; while qualitatively delving into their lived experiences as fathers. We used a qual/quant mixed-methods approach in this study. The study was conducted in three distinct locations in Ghana (a) Ada, a rural community on the Southeastern coast; (b) Kumasi, an urban setting in upper Southern Ghana; and (c) Sunyani, a peri-urban setting in West-central Ghana. Paternal stress was measured with the Aggravation in Parenting Scale (APS) and well-being was assessed using the Secure Flourishing Index (SFI). Textual data from focus group interviews were sorted using inductive coding and aggregated into overarching themes. Thirty-eight Ghanaian fathers ages 21 to 74 years participated in the study, average age 43 (±12.12 SD), median 39.5. Correlation analyses showed a strong, negative association between paternal stress and well-being ( R = −0.63; p < .0001), which was supported in linear regression models (β = −1.04; 95% CI: −1.62, −0.45; p<.0001). Emergent themes of fatherhood stress included financial (employment, food, education, and health care), social (norms and expectations), and psychological (mental work, discipline, relationships, and coping strategies) stressors. A fourth overarching theme of pride and joy in parenting permeated the interviews. Ghanaian fathers with higher parenting stress experience lower overall well-being. Identified stressors could guide interventions that bolster the well-being of fathers and their families.
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Seiger, Emily, Heather Wasser, Grace Foster, Ruwaydah Sideek, Stephanie Hutchinson, and Stephanie Martin. "Facilitators and Barriers to Providing Breastfeeding and Lactation Support to Families in Appalachia: A Mixed-Methods Study With Lactation Professionals and Supporters." Current Developments in Nutrition 5, Supplement_2 (June 2021): 816. http://dx.doi.org/10.1093/cdn/nzab046_113.
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Abstract Objectives Breastfeeding rates in Appalachia are lower than the rest of the United States and contribute to poor health outcomes in the region. Lactation professionals and supporters are critical to improving low breastfeeding rates, but there is a lack of research on their experiences providing support to families, particularly in Appalachia. This implementation research explored the facilitators and barriers that lactation professionals and supporters in Appalachia experience when supporting breastfeeding. Methods This mixed-methods study included a survey with members of the Appalachian Breastfeeding Network and in-depth interviews with a sub-sample of survey participants. Survey data were descriptively analyzed in Stata and interview transcripts were analyzed thematically using an inductive approach in ATLAS.ti. Data from both phases were analyzed according to certification type and participants who worked in WIC vs. non-WIC settings. Results The survey was completed by 89 lactation professionals and supporters from 14 states; 33% were International Board Certified Lactation Consultants (IBCLCs) and 47% had other lactation certifications; 24% worked at WIC. Twenty participants from 7 states participated in in-depth interviews. Barriers identified in both phases included being the only lactation professional or supporter in several counties, cross-cultural communication, racism, feeling like their expertise is undervalued and counseling clients around drug use, with negative views of breastfeeding, or who lack family support. The qualitative phase revealed counseling around mental health/trauma, chest feeding, and re-lactation as issues they need more information about. Facilitators included the support from other lactation professionals and supporters, being able to refer clients to the Appalachian Breastfeeding Network help line, and including other family members in lactation counseling. Social media and telehealth were discussed as both barriers and facilitators. Conclusions More lactation professionals and supporters that reflect the population served are needed in rural areas. Additional training for providing support around mental health, chest feeding, drug use, etc. is essential. Lactation professionals and supporters must be included in future efforts to solve these challenges. Funding Sources N/A.
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Poudyal, Anubhuti, Alastair van Heerden, Ashley Hagaman, Sujen Man Maharjan, Prabin Byanjankar, Prasansa Subba, and Brandon A. Kohrt. "Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal." JMIR Research Protocols 8, no. 8 (September 11, 2019): e14734. http://dx.doi.org/10.2196/14734.
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Background There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression. Objective This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment. Methods This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives. Results To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019. Conclusions Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/14734
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Kim, BoRin, Sojung Park, Casey Golomsky, Marguerite Corvini, Allison Wilder, John Wilcox, and Allysha Winburn. "Multilevel Factors for Life Satisfaction Among Residents in Non-Urban Subsidized Senior Housing." Innovation in Aging 4, Supplement_1 (December 1, 2020): 109. http://dx.doi.org/10.1093/geroni/igaa057.360.
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Abstract Although a quarter of HUD-assisted properties for older adults are located in rural/non-metropolitan areas, there is limited understanding of the population living in these locations. Advanced age and low income are known risk factors for poor physical and mental health. Older adults in rural subsidized housings may be at increased risk for poor health and social isolation due to their isolated locations and small-scale housing complexes. This presents the additional challenge of service provision for the residents’ needs. This study aims to explore multi-level factors affecting life satisfaction among residents in subsidized senior housing. Data were collected for five subsidized senior housings in New Hampshire: two in Coos county (rural, population=33,055) and three in Strafford county (suburban, population=128,613). Mixed-methods approaches were used: Community/organizational-level data were collected using semi-structured interviews conducted with the directors of senior housings. At the individual level, quantitative survey data were collected from 82 residents of five senior housings. Contrary to expectations, we found that residents in rural senior housings were likely to report better life satisfaction (Coef.=0.597, p<.01) than those in suburban areas despite controlling for individual-level factors such as age, gender, education, marital status, health, social relations, and service use. The most salient terms used in the interviews with directors of rural senior housings include limited resources, tight community, and emotional support. The last two may be protective factors positively influencing life satisfaction among their residents. Our results contribute to development strategies to improve quality of life among residents in rural/non-metropolitan subsidized senior housing.
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Rohatinsky, N., B. Russell, I. Boyd, A. Dickson, S. Fowler, J. N. Peña-Sánchez, C. L. Quintin, T. Risling, K. Wicks, and M. Wicks. "N13 Living in rural communities with Inflammatory Bowel Disease: Perspectives on healthcare use and access to care from patients and providers in one Canadian province." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S614. http://dx.doi.org/10.1093/ecco-jcc/jjab074.827.
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Abstract Background Living with Inflammatory Bowel Disease (IBD) requires lifelong, repeated interactions with the healthcare system. Individuals with IBD living in rural areas are often disadvantaged with limited access to IBD-related healthcare services in their local communities which can result in poor health outcomes. Furthermore, these individuals encounter additional out of pocket expenses to travel to urban centres for care. There is limited information about the experiences of access to IBD-related care from the perspectives of patients and providers living in rural communities. The purpose of this study was to examine healthcare utilization and access to care in individuals with IBD who reside in rural areas within one Canadian province. Methods The qualitative results from a larger patient-oriented, mixed methods study will be reported. Seventeen individuals residing in rural communities from one Canadian province were recruited to participate. Fourteen individuals living with IBD and three healthcare providers were interviewed and shared their experiences on IBD-related access to care and healthcare use. Data was collected prior to the pandemic. Interview data was analyzed using thematic analysis to identify common themes. Results Many participants identified access to care challenges associated with living in rural communities. Communication, stressors and support systems, and coordination of care were identified as themes. Participants described disconnects in communication with and between healthcare providers. They suggested virtual technology was underutilized and was a cost-effective means to enhance communication. Participants experienced feelings of isolation and identified stressors while living in rural areas. They recommended the integration of formal and informal supports to ease stressors and promote mental well-being. Participants reported gaps in care and described a lack of accessible, multidisciplinary rural healthcare providers to optimize their IBD-related care and health outcomes. This lack of access to rural care resulted in frequent travel to access a variety of services. Recruitment and retention of rural care providers was identified as a strategy to enhance access to care. Conclusion Participants offered many suggestions to improve rural IBD-related care access within the healthcare system. These initiatives have great potential to increase quality of care, enhance quality of life, and reduce health system costs.
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Yuhas, Maryam, Kathleen J. Porter, Donna-Jean P. Brock, Annie Loyd, Brittany A. McCormick, and Jamie M. Zoellner. "Development and Pilot Testing of Text Messages to Help Reduce Sugar-Sweetened Beverage Intake Among Rural Caregivers and Adolescents: Mixed Methods Study." JMIR mHealth and uHealth 7, no. 7 (July 30, 2019): e14785. http://dx.doi.org/10.2196/14785.
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Background A high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. Objective By targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. Methods A convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. Results In phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). Conclusions Spending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors.
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Indrawati, Mega, Cahyo Prihadi, and Ayu Siantoro. "The Covid-19 Pandemic Impact on Children’s Education in Disadvantaged and Rural Area Across Indonesia." International Journal of Education (IJE) 8, no. 4 (December 30, 2020): 19–33. http://dx.doi.org/10.5121/ije.2020.8403.
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This study used a mixed methods approach to capture key findings on COVID-19 impacts on education and challenges that hinder continued education particularly in disadvantaged and rural areas. The respondents were 900 parents, 943 children, 15 teachers and education officials in 594 villages in 9 provinces of Indonesia. The results showed that 1 out of 3 children stopped learning and children learned less. Children had limited access to widely supported online learning. While the offline method was more applicable, still it had some challenges. Children’s mental health was affected and they experienced excessive emotions of fear and anxiety. Many parents were not ready to support children in learning school subjects while doing livelihood activities at the same time. Some children experienced domestic violence. Parents did not have a spare budget to provide distance learning facilities and had to sacrifice education over basic needs. The risk of drop out of school was heightened.
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Lin, Hsiao-Hsien, Kuo-Chiang Ting, Jen-Min Huang, I.-Shen Chen, and Chin-Hsien Hsu. "Influence of Rural Development of River Tourism Resources on Physical and Mental Health and Consumption Willingness in the Context of COVID-19." Water 14, no. 12 (June 7, 2022): 1835. http://dx.doi.org/10.3390/w14121835.
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This study took the Three Gorges Dam as an example and discussed the influence of river regulation decisions on the sustainable development of surrounding villages. The study used mixed research methods, snowball sampling, and convenience sampling to obtain samples. The questionnaire samples were analyzed by basic statistical tests, t-test, and structural equation modeling (SEM). The respondents’ opinions were collected through semi-structured interviews and finally the results were discussed by multivariate analysis. The findings were that even though the villages were not well developed in terms of economy, environment, and natural ecology, as long as the community security could be stable, the living could be safe and convenient, people’s daily life patterns and leisure behaviors could be maintained, and people could stabilize their minds and emotions and maintain physical and mental health in order to meet their living needs and reduce the burden. There would be time and funds to invest in leisure, tourism activities, and consumption behavior. If the above consumption patterns are continued, people will gain positive perceptions, stimulating people’s willingness to invest in property purchases or to make travel plans again.
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McFarlane, Shamiel Alexis. "P2-491: UNDERSTANDING THE ROLE OF PRIMARY CARE IN SOCIALLY ISOLATED OLDER ADULTS IN RURAL JAMAICA: A MIXED METHODS STUDY." Alzheimer's & Dementia 15 (July 2019): P806. http://dx.doi.org/10.1016/j.jalz.2019.06.2898.
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Cadet, PhD, Tamara, Cindy Davis, PhD, Patricia Wilson, MHealth, BCouns, RN, and Jacinta Elks, RN. "The Experiences of Touch Therapies in Symptom Management of Rural and Regional Cancer Patients in Australia." International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 15, no. 1 (March 2, 2022): 66–71. http://dx.doi.org/10.3822/ijtmb.v15i1.687.
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Introduction: Cancer patients are increasingly combining touch therapies (e.g., remedial massage, lymphatic massage, and/or reflexology) with conventional treatments to deal with the impact of their cancer and treatments on their physical and mental well-being. To understand the impact of integrative oncology services on cancer patients, it is essential to explore the impact that various types of integrative oncology services have on cancer patients. Aims: This paper presents cancer patients’ experiences with touch therapies in a community-based cancer support center and to identify opportunities for better access to these practices and service provision in Australia. Methods: A random selection of cancer patients (n=36) receiving touch therapies at a rural/regional community cancer center completed mixed-methods mail surveys regarding the use of touch therapies, their satisfaction, and the impact on pain, fatigue, nausea and overall well-being. Results: Findings indicated that these services helped manage both physical and emotional symptoms. Of the participants experiencing pain and fatigue, findings revealed that touch therapies assisted with pain in 90% of participants and with fatigue in 70%. Conclusion: Given the increased and continued use of touch therapies by individuals with cancer, cancer centers should consider establishing touch therapy services or provide referrals to touch therapy services that can assist with symptom management and improve quality care. By more clearly understanding the benefits of the different types of integrative oncology interventions, patients with cancer receive more tailored and effective interventions throughout of their cancer journey.
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Dorsey, Shannon, Christopher F. Akiba, Noah S. Triplett, Leah Lucid, Haley A. Carroll, Katherine S. Benjamin, Dafrosa K. Itemba, et al. "Consumer perspectives on acceptability of trauma-focused cognitive behavioral therapy in Tanzania and Kenya: A mixed methods study." Implementation Research and Practice 3 (January 2022): 263348952211099. http://dx.doi.org/10.1177/26334895221109963.
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Background There is a substantial mental health treatment gap globally. Increasingly, mental health treatments with evidence of effectiveness in western countries have been adapted and tested in culturally and contextually distinct countries. Findings from these studies have been promising, but to better understand treatment outcome results and consider broader scale up, treatment acceptability needs to be assessed and better understood. This mixed methods study aimed to examine child and guardian acceptability of trauma-focused cognitive behavioral therapy (TF-CBT) in two regions in Tanzania and Kenya and to better understand how TF-CBT was perceived as helpful for children and guardians. Methods Participants were 315 children (7–13), who experienced the death of one or both parents and 315 guardians, both of whom participated in TF-CBT as part of a randomized controlled trial conducted in Tanzania and Kenya. The study used mixed methods, with quantitative evaluation from guardian perspective ( N=315) using the Treatment Acceptability Questionnaire (TAQ) and the Client Satisfaction Questionnaire-8 (CSQ-8). Acceptability was assessed qualitatively from both guardian and child perspectives. Qualitative evaluation involved analysis using stratified selection to identify 160 child and 160 guardian interviews, to allow exploration of potential differences in acceptability by country, setting (urban/rural), and youth age (younger/older). Results Guardians reported high acceptability on the TAQ and, using an interpretation guide from U.S.-based work, medium acceptability on the CSQ-8. Guardians and children noted high acceptability in the qualitative analysis, noting benefits that correspond to TF-CBT’s therapeutic goals. Analyses exploring differences in acceptability yielded few differences by setting or child age but suggested some potential differences by country. Conclusion Quantitative and qualitative data converged to suggest high acceptability of TF-CBT from guardian and child perspectives in Tanzania and Kenya. Findings add to accumulating evidence of high TF-CBT acceptability from Zambia and other countries (United States, Norway, Australia). Plain Language Summary: Evidence-based treatments have been shown to be effective in countries and regions that are contextually and culturally distinct from where they were developed. But, perspectives of consumers on these treatments have not been assessed regularly or thoroughly. We used open-ended questions and rating scales to assess guardian and youth perspectives on a group-based, cognitive behavioral treatment for children impacted by parental death, in regions within Tanzania and Kenya. Our findings indicate that both guardians and youth found the treatment to be very acceptable. Nearly all guardians talked about specific benefits for the child, followed by benefits for the family and themselves. Eighty percent of youth mentioned benefits for themselves and all youth said they would recommend the program to others. Benefits mentioned by guardians and youth corresponded to treatment goals (improved mood/feelings or behavior, less distress when thinking about the parent/s’ death). Both guardians and children named specific aspects of the treatment that they liked and found useful. Dislikes and challenges of the treatment were less frequently mentioned, but point to areas where acceptability could be further improved. Recommendations from participants also offer areas where acceptability could be improved, namely guardians’ recommendation that the treatment also address non-mental health needs and offer some follow-up or opportunity to participate in the program again. Our study provides an example of how to assess acceptability and identify places to further enhance acceptability.
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Palmer, Cara, and Benjamin Oosterhoff. "701 Daily Associations Between Adolescent Sleep and Mental Health During the COVID-19 Pandemic." Sleep 44, Supplement_2 (May 1, 2021): A274. http://dx.doi.org/10.1093/sleep/zsab072.699.
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Abstract Introduction Sleep disturbances after a trauma forecast mental health difficulties such as post-traumatic stress symptoms (PTSS). COVID-19 has resulted in numerous stressors for youth (e.g., school closures, social isolation) that directly disrupt sleep and may have negative mental health consequences. However, investigations of sleep and adverse events in youth have primarily been limited to months or years after a trauma has occurred. How adolescent sleep patterns and mental health intersect during an ongoing adverse experience is unknown. Methods Adolescents from the United States (N = 503; 80.9% female; 13–18 years) participated in an online daily diary study within 3 weeks after COVID-19 was declared a national emergency. Participants completed one week of twice daily reports (5406 observations) on their nightly sleep (sleep timing, sleep quality, sleep onset difficulties, and nightmares) and daytime mental health symptoms (COVID-19 PTSS, positive affect, negative affect, and loneliness). Results Mixed models adjusting for age, sex, and socioeconomic status indicated that cyclical, bidirectional effects emerged, with daytime mental health symptoms predicting same-night sleep disturbances, and sleep disturbances predicting next-day mental health. Greater PTSS predicted sleep onset difficulties (Estimate = .02, SE = .004, t = 5.56 p < .001) and sleep onset difficulties predicted next-day PTSS (Estimate = .35, SE = .17, t = 2.04, p < .05). Greater daytime negative affect predicted greater nightmares (Estimate = .07, SE = .01, t = 4.97, p < .001), and nightmares predicted marginally more next-day negative affect (Estimate = .07, SE = .04, t = 1.66, p = .09). PTSS (Estimate = .01, SE = .003, t = 3.47, p < .001) and negative affect (Estimate = .05, SE = .03, t = 2.06, p < .05) both predicted poorer sleep quality the following night. Conclusion Findings suggest that mental health symptoms during the onset of the COVID-19 pandemic are associated with increased sleep disturbances. In turn, these sleep disturbances predict increased mental health symptoms. Overall, results provide a greater understanding of youth sleep patterns during COVID-19 and how sleep disturbances may inhibit resilience in the context of an ongoing stressor. Support (if any) Center for American Indian and Rural Health Equity