Families Systems & Health最新文献

Introduction: Family caregivers serve vital functions in older adults' health care, but their own needs are not systematically assessed in routine care delivery. The present study employed a user-centered approach to develop and evaluate a pragmatic checklist to support proactive identification and discussion of caregivers' concerns in primary care.

Method: Checklist development proceeded according to a preestablished methodology involving domain identification, item generation, overall construction, and revision. The checklist subsequently underwent formal evaluation by 25 subject matter experts (SMEs), including primary care clinicians, family caregivers, and health services researchers who assessed the checklist's content validity and appraised its overall utility, ease of use, and mode of administration.

Results: The checklist showed excellent content validity. None of the items were found to be superfluous, indicating that the checklist covered relevant content domains. Subject matter experts reported that the checklist was easy to use, just the right length, and would be helpful in identifying and prompting a discussion about caregivers' needs. Their preferences regarding how the checklist should be administered were variable. Minor revisions to the checklist focused on enhancing its applicability to caregivers from low- and middle-income families and those from underrepresented backgrounds.

Discussion: Results indicate that the checklist is an appropriate tool for identifying caregivers' needs and concerns. Findings lay the groundwork for pilot testing in primary care to confirm the checklist's clinical feasibility and evaluate its preliminary impact on family-centered care quality and outcomes for primary care clinics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Hazardous drinking by fathers poses a significant risk for negative family interactions and child outcomes. The transition to parenthood may be a time when expectant parents are potentially motivated for health behavior change, suggesting that implementing preventive interventions during this period may be particularly effective. This article provides an overview of the rationale for an innovative prevention strategy incorporating alcohol-use intervention with a family-focused program.

Method: We describe the process of integration and adaptation of two evidence-based interventions beginning in pregnancy: (a) Family Foundations, a universal transition-to-parenthood intervention for couples to enhance coparenting and couple dyadic functioning, and (b) brief intervention to address alcohol use delivered using a couples-focused motivational interviewing style.

Results: Lessons learned from pilot testing (conducted October 2020-March 2021) included the importance of softened framing of the discussions and language used around alcohol use given that parents were not specifically seeking treatment for alcohol use and the program was described as a parenting program that included discussion of health behaviors, including drinking. In addition, we found that evoking discussion and communication within dyads and supporting autonomy in decision making regarding alcohol use also facilitated engagement.

Conclusion: Pilot testing demonstrated the acceptability and feasibility of an adapted, integrated intervention program designed to strengthen coparenting skills and dyadic functioning and promote lower risk levels of alcohol use among couples during the transition to parenthood. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Familism varies across cultures, with some societies placing greater emphasis on family ties and obligations than others. Despite its variability, the precise impact of familism on psychosocial functioning remains inconclusive and requires further exploration to clarify its effects in different cultural contexts. Understanding the role of familism in a cross-cultural context can help health care providers enhance patient care by considering familial influences on mental health and well-being.

Method: This study used World Values Survey data (Wave 7) to investigate familism's effects on psychological well-being, physical well-being, and life satisfaction across 48 countries. Hierarchical linear models were employed to analyze data from 69,578 adult participants (52.4% female, M_age = 42.59, SD = 16.28). The study examined the relationship between familism and well-being outcomes, with consideration of urbanization and individualism as moderators.

Results: Findings revealed a positive association between familism and well-being outcomes, indicating potential universality in this relationship across cultures. Urbanization and individualism did not significantly influence the relationship between familism and well-being, suggesting its stability across different societal contexts.

Discussion: These results suggest that familism may have universal benefits for well-being, as it fosters connections within families, providing individuals with a sense of purpose and meaning in life. This is particularly significant in the contemporary context of shrinking household sizes, epidemic of loneliness, and increasing social isolation. Integrating insights on familism can help health care providers better support patients and improve mental health and well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Integrating pain psychology in primary care has the potential to improve symptom burden; however, identifying those who may benefit is a challenge. The purpose of this study was to gather feedback from a multidisciplinary team to optimize digital screening and referral for psychological treatment of chronic pain distress within primary care.

Method: Team members in a primary care clinic were introduced to the proposed screening process and offered the opportunity to complete a feedback survey. The proposed workflow involved the customer service representative providing patients with digital screeners on an iPad, results transferring to the electronic health record, and a medical assistant (MA) returning the iPad. Positive screens would alert the MA to start the referral process in the electronic health record then signaling the physician to discuss the referral to the psychology team with the patient.

Results: Sixty-eight percent of individuals agreed or strongly agreed that screening for chronic pain and distress is important. Sixty six percent of the respondents selected the customer service representatives as the ideal team member to give the iPad to patients and 84% responded that MAs should be responsible for returning the iPad to the front desk. Some thought a positive screen should directly alert physicians (58%) whereas 40% indicated a preference for signaling the MAs to start the referral process.

Discussion: Team members had favorable opinions about integrating digital chronic pain distress screening. The logistics of the screening and referral process were finalized based on this feedback and will be integrated into the clinic. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: China's recent policy initiatives and dedication of resources to heighten the public's awareness of cancer risks have led to increased cervical cancer screening and testing for human papillomavirus (HPV) which has resulted in a greater number of people diagnosed with HPV. The psychological stress experienced by women of childbearing age who are infected with HPV is also felt by their spouses, as the close relationship between spouses results in intertwined psychological distress and health statuses. Therefore, this study aimed to explore the dyadic coping experience of HPV-infected patients of childbearing age and their spouses in China and to provide a research basis for marital interventions for the disease.

Method: From July 2022 to January 2023, we used a purposive sampling method to select 11 pairs of HPV-infected patients of childbearing age and their spouses from a tertiary hospital. We conducted in-depth interviews with the patients and their spouses and analyzed the data using Colaizzi's seven-step method.

Results: We identified three main themes and eight subthemes: (a) stress perception (including negative psychological reactions, emotional relationship deterioration, and family social role imbalance), (b) stress communication (including enhancing communication awareness and changing communication methods), and (c) stress adjustment (including supporting each other emotionally, facing the disease together, and seeking social support).

Conclusion: Health care professionals should assess the stress experienced by patients and their spouses. Moreover, they should encourage them to better cope with the disease as a team. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Targeting cardiovascular disease (CVD) and its associated risk factors is important not only in the general population, but also among those served by the military health care system. The primary care behavioral health model of integrating behavioral health consultants (BHCs) into a primary care setting is one method for enhancing how these modifiable risk factors are addressed; however, it is unknown how often BHCs are used to target those with biopsychosocial factors contributing to CVD and those with diagnosed CVD.

Method: The present study evaluated what percentage of primary care patients with diagnosed CVD risk factors (i.e., tobacco use, obesity, and depression) or diagnosed CVD were referred to BHCs. Data were drawn from electronic health records of U.S. military primary care clinics over the 3-year period from January 2017 to December 2019.

Results: A total of 1,321,072 unique individuals were included. Among the sample, 37.1% were active duty, 40.6% were married, 43.8% were female, and 30.9% were between 45 and 64 years old. The study revealed penetration rates of 1.5% (8,577 of 583,659 patients) for patients diagnosed with CVD, 5.3% (10,286 of 192,566 patients) of those demonstrating tobacco use, 3.4% (8,765 of 256,852 patients) of those demonstrating obesity, and 20.0% (31,125 of 155,656 patients) of those diagnosed with depression.

Discussion: These findings suggest that BHCs are underutilized for targeting CVD and some associated risk factors in military primary care clinics. Research should explore whether these findings replicate in other health care systems and implement methods to improve BHC utilization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The purpose of this qualitative study was to understand the needs of family caregivers (FCGs) from the perspectives of health care professionals delivering cancer care to American Indian and rural populations.

Method: A descriptive content analysis of 18 interviews with multidisciplinary health care professionals delivering cancer care at a rural cancer institute in the Great Plains region was conducted.

Results: We identified three themes: access, support, and awareness with six subthemes. Consideration of these core needs, coupled with the individual cultural circumstance, is critical in addressing disparities faced by American Indian/Alaska Native and rural FCGs.

Conclusions: The availability of specialized health care services, like palliative care, can positively impact the experience of FCGs providing care. However, access is limited. The needs and challenges faced by American Indian/Alaska Native and rural FCGs described in this study can inform the development of a culturally responsive palliative care intervention. Nurses are well positioned to develop and lead this intervention, which will be the first of its kind. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Community ambassadors (CAs) are advocates that build trust with communities on behalf of service systems and facilitate access to resources. Whether and how CAs can support community engagement within a large initiative to build capacity to address the impact of trauma is unclear. This study explores how a Community Ambassador Network supported community engagement with "Innovations 2 Initiative" (INN 2), a 5-year initiative that addressed trauma across nine communities in Los Angeles County.

Method: CAs were recruited from nine community-based partnerships to participate in a focus group, which explored their roles and experiences with INN 2 and their impact on community engagement. Data were collected in 2022 and were analyzed using a pragmatic two-phase strategy for efficient qualitative data analysis. Twenty-six CAs participated in six focus groups. Participants mostly spoke English (82%), identified as Latinx (50%) or Black (23%) and as cisgender female (48%); average age was 40 years.

Results: CAs implemented workshops and provided health education to the community. They reported being the community's first point of contact with INN 2 and believed they improved credibility of the human service sector. While CAs felt supported by the Department of Mental Health, some wanted more trust from their supervisors.

Discussion: CAs described various ways that they engaged historically excluded communities in INN activities and the organizational supports that facilitated this work. Training in trauma informed principles and support from their supervisors were regarded essential to this work. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: The opioid syndemic presents a critical need for effective interprofessional training in health care, especially in behavioral health disciplines. Addressing this need, the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Health care (ITA) was developed to provide adaptable educational experiences for emerging behavioral health professionals. This study, reflecting years 2020-2023, explored the experiences and perspectives of ITA fellows regarding interprofessional collaboration and opioid workforce development, focusing on how these elements are integrated.

Method: After conducting focus groups, we employed applied thematic analysis to qualitatively analyze the experiences of ITA fellows (11 women and six men; 41% Hispanic/Latino and 59% White; 14 Master of Social Work students and three psychology postdoctoral fellows). This method allowed for a detailed exploration of their perceptions and the nuances of their learning process within the context of opioid workforce development.

Results: The findings indicated that fellows' learning processes were adaptive, evolving over time to meet their changing needs. Initially, fellows faced challenges related to role clarity and process understanding. However, they reported significant professional growth as the program progressed, highlighting the effectiveness of the ITA's interprofessional approach in a remote learning setting.

Discussion: The study emphasizes the need for ongoing research to identify and overcome barriers to effective interprofessional collaboration. The results contribute insights into the role of remote field education in preparing future health care professionals to address complex health crises effectively. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Integrated behavioral health programs bring strong benefits to patients and health organizations including reductions in overall costs. However, obstacles to funding prevent the implementation and maintenance of these programs across the country.

Method: The Psychiatric Health, Life Skills and Opportunities for Wellness (PHLOW) Program is based on the collaborative care model and seeks to provide psychiatric care through an integrated model that is financially sustainable for the organization. This pilot observational study included patients who received psychiatric care indirectly via consultations with primary care providers and directly through brief episodes of care.

Results: Patient outcomes were demonstrated by score changes on the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder 7 before and after participation in brief episodes of care. Overall cost of care savings was demonstrated through change over time in risk-adjusted per-member-per-month.

Discussion: Patients participating in the PHLOW program showed potential drops in anxiety and depression ratings, coinciding with a reduction in mental health claims. In addition, participation in the program involved a small number of patient visits and prevented referrals to long-term psychiatry, preserving access for higher acuity presentations. This demonstration of the value of the PHLOW program has led to additional financial support of the program through the primary regional Medicaid payor, enhancing sustainability, and potentially modeling a collaboration that may be feasible for other organizations implementing integrated behavioral health programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).