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"We Live on an Island": Perspectives on Rural Family Caregivers for Adults with Alzheimer's Disease and Related Dementias in the United States. “我们生活在孤岛上”:对美国老年痴呆症和相关痴呆患者的农村家庭照顾者的看法。
IF 1.1 Q1 Social Sciences Pub Date : 2022-10-01 Epub Date: 2022-10-28 DOI: 10.46743/2160-3715/2022.5193
Heather J Williamson, Andria B Begay, Dorothy J Dunn, Rachel Bacon, Mark Remiker, Yolanda E Garcia, Michael J McCarthy, Julie A Baldwin

As the United States' aging population grows, there will be increased prevalence of individuals living with Alzheimer's Disease and related dementias (ADRD), who largely rely on the support of their family caregivers. Family caregivers residing in rural areas face additional challenges with managing caregiving responsibilities and navigating support services. The purpose of this multilevel phenomenological qualitative study was to explore the assets, unique needs, and resources of rural-residing ADRD caregivers from the caregiver, provider, and policy influencers' perspectives. The study took place between 2019 through 2021 in northern Arizona, a largely rural and geographically vast area home to caregivers from diverse backgrounds. Twenty-seven caregivers to a loved one with ADRD participated in focus groups. Twelve health and social services providers and twelve policy influencers, those involved in leadership positions for aging programs or advocacy groups, completed individual interviews. Caregivers demonstrate many assets which contribute to their ability to manage and cope with their caregiving role. However, caregivers face a series of issues related to their caregiving role and need early and ongoing education regarding ADRD. There is a lack of resources available in rural areas, in particular providers, making it challenging to obtain needed resources necessary to support their loved one with ADRD. Furthermore, there is a need for more providers trained in working with aging adults and those experiencing ADRD, and a need for more culturally relevant resources.

随着美国老龄化人口的增长,阿尔茨海默病和相关痴呆(ADRD)患者的患病率将会增加,他们在很大程度上依赖于家庭照顾者的支持。居住在农村地区的家庭照料者在管理照料责任和利用支助服务方面面临着额外的挑战。本研究旨在从照顾者、提供者和政策影响者的角度,探讨农村ADRD照顾者的资产、独特需求和资源。该研究于2019年至2021年在亚利桑那州北部进行,这是一个主要是农村和地理上广阔的地区,是来自不同背景的护理人员的家园。27名照顾患有ADRD的亲人的护理人员参加了焦点小组。12名健康和社会服务提供者和12名政策影响者,即那些参与老龄方案或倡导团体领导职位的人,完成了个人访谈。照护者展示了许多有助于他们管理和处理其照护角色的能力的资产。然而,照顾者面临着一系列与他们的照顾角色相关的问题,需要对ADRD进行早期和持续的教育。农村地区缺乏可用的资源,特别是提供者,因此很难获得必要的资源来支持患有ADRD的亲人。此外,还需要更多接受过与老年人和患有ADRD的人合作培训的提供者,并需要更多与文化相关的资源。
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引用次数: 0
Managing Student Suicidality on Campus: Perspectives from Diverse Student Affairs Staff. 管理校园学生自杀:不同学生事务人员的观点。
IF 1.1 Q1 Social Sciences Pub Date : 2020-09-01 Epub Date: 2020-09-05 DOI: 10.46743/2160-3715/2020.4388
Carla Chugani, Gabriel Kass, Elizabeth Miller

Suicidal behavior is a substantial public health issue faced by college campuses. College counseling professionals often interact with a variety of other student affairs professionals who may be involved in the management of suicidality on campus. However, research on their experiences and perspectives on this topic is scarce. In this study, we build on literature related to management of suicidality on campus, which is predominantly focused on campus counseling professionals. Fifteen semi-structured qualitative interviews were conducted with student affairs professionals to explore how professionals on campuses might better work together to prevent crises and support students at elevated risk for suicide. Recurrent and emerging themes included barriers impeding their ability to best serve suicidal students, their perceptions on what factors make students vulnerable to suicide, and suggestions for future research. We conclude with a discussion of options to increase quantity and quality of service provision on campus for suicidal students.

自杀行为是大学校园面临的一个重大公共卫生问题。大学咨询专业人员经常与其他各种学生事务专业人员互动,这些专业人员可能涉及校园自杀管理。然而,关于他们在这方面的经验和观点的研究却很少。在本研究中,我们建立在与校园自杀管理相关的文献基础上,这些文献主要集中在校园咨询专业人员身上。研究人员对学生事务专业人员进行了15次半结构化定性访谈,以探讨校园内的专业人员如何更好地合作,预防危机,并为自杀风险较高的学生提供支持。反复出现和新出现的主题包括阻碍他们最好地为有自杀倾向的学生服务的障碍,他们对什么因素使学生容易自杀的看法,以及对未来研究的建议。最后,我们讨论了增加校园自杀学生服务的数量和质量的选择。
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引用次数: 3
Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind. 视力丧失前后获得眼保健:一项调查失明者眼保健的定性研究。
IF 1.1 Q1 Social Sciences Pub Date : 2020-06-01
Tosha Zaback, Stephanie Lam, Joan Randall, Teresa Field, Mitchell V Brinks

Navigating access to eye care requires that patients recognize the need for screening and care, employ limited financial and social resources, manage complex health insurance policies, and access specialty clinical care. We investigated the experience of patients through the progression of vision loss to blindness, utilizing qualitative methods. We conducted structured telephone interviews with 28 persons with blindness throughout Oregon. Utilizing closed and open-ended questions, we explored patient experience on the events preceding avoidable blindness. Coding for emergent themes was conducted independently by two researchers using a constant comparative method. Participants described important barriers to accessing eye care: at the systems level, lack of access to providers and treatment; at the community level, available social support and services; and at the individual level, readiness to act and trust in providers. These findings suggest that important barriers to accessing preventive eye care, early diagnosis and treatment, vocational rehabilitation, and social services often occur at multiple levels. Access to eye care should be prioritized in efforts to reduce preventable visual impairment.

获得眼科护理需要患者认识到筛查和护理的必要性,利用有限的财政和社会资源,管理复杂的健康保险政策,并获得专业的临床护理。我们用定性的方法调查了患者从视力丧失到失明的经历。我们对俄勒冈州的28位盲人进行了结构化的电话采访。利用封闭式和开放式的问题,我们探讨了患者在可避免失明之前的经历。突现主题的编码是由两位研究人员独立进行的,采用恒定的比较方法。与会者描述了获得眼科保健的重要障碍:在系统层面,缺乏获得提供者和治疗的机会;在社区一级,现有的社会支助和服务;在个人层面,准备好采取行动并信任提供者。这些发现表明,获得预防性眼科保健、早期诊断和治疗、职业康复和社会服务的重要障碍往往存在于多个层面。在减少可预防的视力损害的努力中,应优先考虑获得眼科保健。
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引用次数: 0
Medication Exposure Patterns in Primary Care Patients Prescribed Pharmacogenetically Actionable Opioids. 开具可药理作用阿片类药物处方的初级保健患者的药物暴露模式。
IF 1.1 Q1 Social Sciences Pub Date : 2018-08-01 Epub Date: 2018-08-07
Mitchell R Knisely, Janet S Carpenter, Marion E Broome, Ann M Holmes, Diane Von Ah, Todd Skaar, Claire Burke Draucker

Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study's purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups had one of five opioid prescription patterns (i.e., singular, episodic, switching, sustained, multiplex), and one of three types of primary foci of medical care (i.e., pain, comorbidities, both). The findings reveal medication exposure patterns that are dynamic, multidimensional, and complex, and the typology offers an innovative approach to assessing medication exposure.

目前评估药物暴露的方法未能捕捉到药物暴露现象的复杂性及其发生的背景。本研究的目的是对具有共同药物暴露模式的患者亚群进行分类。为了建立这种类型学,我们使用了一个大型公共医疗系统中的 30 名患者作为样本,这些患者都曾被处方过具有药物基因作用的阿片类药物可待因或曲马多。与药物接触相关的数据来自大型数据存储库。采用以人为本的定性方法,确定了八个具有共同药物暴露模式的患者亚组。这些亚组具有五种阿片类药物处方模式(即单一、偶发性、转换、持续、多重)中的一种,以及三种主要医疗重点(即疼痛、合并症、两者兼有)中的一种。研究结果揭示了动态、多维和复杂的药物暴露模式,该类型学为评估药物暴露提供了一种创新方法。
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引用次数: 0
Medication Exposure Patterns in Primary Care Patients Prescribed Pharmacogenetically Actionable Opioids. 初级保健患者的药物暴露模式处方药理学上可操作的阿片类药物。
IF 1.1 Q1 Social Sciences Pub Date : 2018-08-01 DOI: 10.46743/2160-3715/2018.3364
Mitchell R. Knisely, J. Carpenter, M. Broome, A. Holmes, Diane Von Ah, T. Skaar, C. Draucker
Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study's purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups had one of five opioid prescription patterns (i.e., singular, episodic, switching, sustained, multiplex), and one of three types of primary foci of medical care (i.e., pain, comorbidities, both). The findings reveal medication exposure patterns that are dynamic, multidimensional, and complex, and the typology offers an innovative approach to assessing medication exposure.
目前评估药物暴露的方法未能捕捉到这种现象的复杂性及其发生的背景。本研究的目的是发展一个亚组的患者谁共享药物暴露的共同模式的类型。为了创建类型学,我们使用了一个大型公共医疗保健系统中30名患者的样本,这些患者被开了药理学上可行的阿片类药物可待因或曲马多。与药物暴露相关的数据来自大型数据库。采用以人为本的定性方法,确定了具有共同药物暴露模式的8个患者亚组。这些亚组具有五种阿片类药物处方模式中的一种(即,单一,发作,转换,持续,多重),以及三种主要医疗护理类型中的一种(即,疼痛,合并症,两者)。研究结果揭示了药物暴露模式是动态的、多维的和复杂的,类型学为评估药物暴露提供了一种创新的方法。
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引用次数: 0
Training Impact on Novice and Experienced Research Coordinators. 培训对新手和有经验的研究协调员的影响。
IF 1.1 Q1 Social Sciences Pub Date : 2017-12-01 Epub Date: 2017-12-03
Linda S Behar-Horenstein, JoNell Efantis Potter, Alena Prikhidko, Stephanie Swords, Stephen Sonstein, H Robert Kolb

Competency-based training and professional development is critical to the clinical research enterprise. Understanding research coordinators' perspectives is important for establishing a common core curriculum. The purpose of this study was to describe participants' perspectives regarding the impact of online and classroom training sessions. 27 participants among three institutions, completed a two-day classroom training session. 10 novice and seven experienced research coordinators participated in focus group interviews. Grounded theory revealed similarities in novice and experienced coordinator themes including Identifying Preferences for Instruction and Changing Self Perceptions. Differences, seen in experienced participants, focused on personal change, in the theme of Re-Assessing Skills. Infrastructure and cultural issues were evident in their theme, Promoting Leadership and Advocacy. Novice participants recommended ways to improve training via their theme of Making Programmatic Improvements. Participants reported a clear preference for classroom learning. Training played an influential role in changing participants' self-perceptions by validating their experiences. The findings provided guidance for developing a standardized curriculum. Training must be carefully tailored to the needs of participants while considering audience needs based on work experience, how technology can be used and offering content that is most urgently needed.

基于能力的培训和专业发展对临床研究企业至关重要。了解研究协调员的观点对于建立共同的核心课程很重要。本研究的目的是描述参与者对在线和课堂培训课程影响的看法。来自三个机构的27名参与者完成了为期两天的课堂培训。10名新手和7名经验丰富的研究协调员参加了焦点小组访谈。扎根理论揭示了新手和经验丰富的协调员在识别教学偏好和改变自我感知等主题上的相似性。在经验丰富的参与者中,差异集中在个人变化上,在重新评估技能的主题上。基础设施和文化问题在其主题“促进领导和宣传”中得到了明显体现。新参加者以“有计划的改进”为主题,提出改善培训的方法。参与者报告了对课堂学习的明显偏好。培训通过验证参与者的经验,在改变他们的自我认知方面发挥了重要作用。调查结果为制定标准化课程提供了指导。培训必须根据参与者的需求精心定制,同时根据工作经验考虑受众的需求,如何使用技术并提供最迫切需要的内容。
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引用次数: 0
Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy. 辩证行为疗法对边缘型人格障碍的康复。
IF 1.1 Q1 Social Sciences Pub Date : 2017-11-01 Epub Date: 2017-11-26 DOI: 10.46743/2160-3715/2017.3008
Carla D Chugani, Ashley R Seiler, Tina R Goldstein

This article presents a qualitative investigation of the perspectives and experiences of recovery from borderline personality disorder from six individuals who were treated with comprehensive dialectical behavior therapy. Data were collected via semi-structured interviews, transcribed, and coded using a six-step analysis process. Six primary themes emerged: (1) belief about recovery, (2) current experience of self, (3) facets of recovery, (4) motivating factors, (5) external supports to recovery, and (6) characteristics required for recovery. Overall, the findings took a dialectical form in which participants often described conflicting experiences (e.g., feeling recovered while also continuing to experience heightened emotional sensitivity). We conclude that the themes presented in this article represent broad domains related to the meaning of recovery from BPD, and recognize that the relative importance of each domain is best determined by the individual.

本文对6例接受综合辩证行为疗法的边缘型人格障碍患者的康复观点和经验进行了定性研究。数据收集通过半结构化访谈,转录,并使用六步分析过程编码。六个主要主题:(1)关于康复的信念,(2)当前的自我体验,(3)康复的各个方面,(4)激励因素,(5)康复的外部支持,以及(6)康复所需的特征。总的来说,研究结果采取了辩证的形式,参与者经常描述相互矛盾的经历(例如,感觉恢复了,同时也继续体验到高度的情绪敏感性)。我们得出的结论是,本文中提出的主题代表了与BPD恢复意义相关的广泛领域,并且认识到每个领域的相对重要性最好由个人决定。
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引用次数: 3
Difficult Dialogues: Negotiating Faculty Responses to a Gender Bias Literacy Training Program. 困难的对话:协商教师对性别偏见扫盲培训计划的回应。
IF 1.1 Q1 Social Sciences Pub Date : 2016-07-01 Epub Date: 2016-07-11 DOI: 10.46743/2160-3715/2016.2205
Carol Isaac, Linda Baier Manwell, Patricia G Devine, Cecilia Ford, Jennifer T Sheridan, Angela Byars-Winston, Evelyn Fine, Molly Carnes

Diversity training is challenging and can evoke strong emotional responses from participants including resistance, shame, confusion, powerlessness, defensiveness, and anger. These responses create complex situations for both presenters and other learners. We observed 3 experienced presenters as they implemented 41 gender bias literacy workshops for 376 faculty from 42 STEMM (science, technology, engineering, mathematics, medicine) departments at one Midwestern university. We recorded questions and answers as well as participants' non-verbal activity during each 2.5-hour workshop. Employing content analysis and critical incident technique, we identified content that elicited heightened activity and challenging dialogues among presenters and faculty. Results from analysis of this observational data found three important findings: (1) presenters continually reinforced the idea that implicit bias is ordinary and pervasive, thus avoiding participant alienation by allowing participants to protect their self-worth and integrity; (2) difficult dialogues were managed calmly without verbal sparring or relinquishing control; (3) the presenters created an environment where individuals were more likely to accept threatening information.

多元化培训具有挑战性,可能会引起学员强烈的情绪反应,包括抵触、羞愧、困惑、无力感、防卫和愤怒。这些反应会给主讲人和其他学员造成复杂的局面。我们观察了 3 位经验丰富的主讲人在一所中西部大学为来自 42 个 STEMM(科学、技术、工程、数学、医学)系的 376 名教师举办 41 场性别偏见扫盲研讨会的过程。我们记录了每次 2.5 小时研讨会期间的问答以及参与者的非语言活动。通过内容分析和关键事件技术,我们确定了哪些内容会引起演讲者和教师之间的激烈活动和具有挑战性的对话。对这些观察数据的分析结果发现了三个重要发现:(1) 主讲人不断强化 "隐性偏见是普通且普遍存在的 "这一观点,从而通过让参与者保护自我价值和人格完整来避免参与者的疏远;(2) 在没有口角或放弃控制的情况下,平静地处理了困难的对话;(3) 主讲人创造了一种环境,让个人更有可能接受具有威胁性的信息。
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引用次数: 0
Qualitative Contributions to a Randomized Controlled Trial Addressing HIV/AIDS-Stigma in Medical Students. 针对医学生中HIV/ aids污名的随机对照试验的定性贡献。
IF 1.1 Q1 Social Sciences Pub Date : 2015-12-01 DOI: 10.46743/2160-3715/2015.2427
M. Marzán-Rodríguez, N. Varas-Díaz, T. Neilands
Specialized training for healthcare professionals (HCP) in order to reduce HIV/AIDS related stigma must be part of a public health model for HIV/AIDS. Tested interventions to reduce HIV/AIDS related stigma among HCP have been mostly absent from these efforts. A qualitative approach was used to assess stigma reduction within a traditional randomized controlled design in order to better understand how our current stigma intervention worked and was understood by 2nd year medical students. After conducting a quantitative follow up survey one-year post intervention we conducted 20 in-depth qualitative interviews with a subsample of our intervention group participants as part of the overall evaluation process. Once the interviews were finished, we transcribed them and used NVivo (v.8) to organized the qualitative data. In the process of analyzing the qualitative data we identified core intervention areas participants described as useful for their training and development: (1) acquiring more HIV/AIDS-related knowledge, (2) increased skills for management of high stigma situations, and (3) the ability to identify socio-structural factors that foster HIV infection among clients. The gathered information is important in order to have a deep understanding of how attitudinal change happens as part of our intervention strategies.
为减少与艾滋病毒/艾滋病有关的耻辱,对保健专业人员(HCP)进行专门培训必须成为艾滋病毒/艾滋病公共卫生模式的一部分。在这些努力中,大多没有经过测试的干预措施来减少HCP中与艾滋病毒/艾滋病相关的耻辱感。为了更好地理解我们当前的病耻感干预措施是如何起作用的,以及二年级医学生是如何理解的,我们使用了一种定性方法来评估传统随机对照设计中的病耻感减少。在干预一年后进行定量跟踪调查后,我们对干预组参与者的子样本进行了20次深入的定性访谈,作为整体评估过程的一部分。访谈结束后,我们对访谈内容进行转录,并使用NVivo (v.8)对定性数据进行整理。在分析定性数据的过程中,我们确定了参与者描述的对他们的培训和发展有用的核心干预领域:(1)获得更多的艾滋病毒/艾滋病相关知识,(2)提高管理高耻辱情况的技能,以及(3)识别促进客户感染艾滋病毒的社会结构因素的能力。收集到的信息对于深入了解态度变化是如何发生的很重要,这是我们干预策略的一部分。
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引用次数: 4
Qualitative Contributions to a Randomized Controlled Trial Addressing HIV/AIDS-Stigma in Medical Students. 对一项针对医学生的艾滋病毒/艾滋病污名化随机对照试验的定性贡献。
IF 1.1 Q1 Social Sciences Pub Date : 2015-12-01 Epub Date: 2015-12-21
Melissa Marzán-Rodríguez, Nelson Varas-Díaz, Torsten Neilands

Specialized training for healthcare professionals (HCP) in order to reduce HIV/AIDS related stigma must be part of a public health model for HIV/AIDS. Tested interventions to reduce HIV/AIDS related stigma among HCP have been mostly absent from these efforts. A qualitative approach was used to assess stigma reduction within a traditional randomized controlled design in order to better understand how our current stigma intervention worked and was understood by 2nd year medical students. After conducting a quantitative follow up survey one-year post intervention we conducted 20 in-depth qualitative interviews with a subsample of our intervention group participants as part of the overall evaluation process. Once the interviews were finished, we transcribed them and used NVivo (v.8) to organized the qualitative data. In the process of analyzing the qualitative data we identified core intervention areas participants described as useful for their training and development: (1) acquiring more HIV/AIDS-related knowledge, (2) increased skills for management of high stigma situations, and (3) the ability to identify socio-structural factors that foster HIV infection among clients. The gathered information is important in order to have a deep understanding of how attitudinal change happens as part of our intervention strategies.

对医疗保健专业人员(HCP)进行专门培训,以减少与艾滋病毒/艾滋病相关的耻辱感,必须成为艾滋病毒/艾滋病公共卫生模式的一部分。在这些工作中,大部分都没有采用经过测试的干预措施来减少医护人员中与艾滋病相关的耻辱感。为了更好地了解我们目前的污名化干预措施是如何发挥作用的,以及二年级医学生是如何理解的,我们采用了一种定性方法来评估传统随机对照设计中的污名化减少情况。在对干预一年后的情况进行定量跟踪调查后,我们对干预组的部分参与者进行了 20 次深入的定性访谈,作为整体评估过程的一部分。访谈结束后,我们对访谈内容进行了转录,并使用 NVivo(v.8)对定性数据进行了整理。在分析定性数据的过程中,我们确定了参与者认为对其培训和发展有用的核心干预领域:(1) 获取更多与艾滋病相关的知识,(2) 提高处理高度污名化情况的技能,(3) 识别助长客户感染艾滋病的社会结构因素的能力。收集到的信息对于深入了解作为我们干预战略一部分的态度转变是非常重要的。
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引用次数: 0
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Qualitative Report
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