Kea Turner

Exploring the Social and Community Context of African American Adolescents’ HIV Vulnerability

There is an increasing call for HIV prevention programs that target social determinants of HIV. The purpose of this study was to examine the experiences and perceptions of 12 African American adolescents to identify important social and community targets for HIV prevention. We used photovoice methodology to engage adolescents in a critical analysis of their experiences to arrive at a deeper understanding of the social determinants of HIV and determine specific action steps to reduce HIV risk. Analyses revealed a variety of social and environmental factors that affect the lives of African American adolescents by creating conditions that put them at greater risk for HIV. Study findings support mobilizing community action through raising awareness and advocating for increased neighborhood resources and institutional support. We conclude with research and practice implications for community-relevant HIV prevention among African American youth.

Organizational theory for dissemination and implementation research

BackgroundEven under optimal internal organizational conditions, implementation can be undermined by changes in organizations’ external environments, such as fluctuations in funding, adjustments in contracting practices, new technology, new legislation, changes in clinical practice guidelines and recommendations, or other environmental shifts. Internal organizational conditions are increasingly reflected in implementation frameworks, but nuanced explanations of how organizations’ external environments influence implementation success are lacking in implementation research. Organizational theories offer implementation researchers a host of existing, highly relevant, and heretofore largely untapped explanations of the complex interaction between organizations and their environment. In this paper, we demonstrate the utility of organizational theories for implementation research.DiscussionWe applied four well-known organizational theories (institutional theory, transaction cost economics, contingency theories, and resource dependency theory) to published descriptions of efforts to implement SafeCare, an evidence-based practice for preventing child abuse and neglect. Transaction cost economics theory explained how frequent, uncertain processes for contracting for SafeCare may have generated inefficiencies and thus compromised implementation among private child welfare organizations. Institutional theory explained how child welfare systems may have been motivated to implement SafeCare because doing so aligned with expectations of key stakeholders within child welfare systems’ professional communities. Contingency theories explained how efforts such as interagency collaborative teams promoted SafeCare implementation by facilitating adaptation to child welfare agencies’ internal and external contexts. Resource dependency theory (RDT) explained how interagency relationships, supported by contracts, memoranda of understanding, and negotiations, facilitated SafeCare implementation by balancing autonomy and dependence on funding agencies and SafeCare developers.SummaryIn addition to the retrospective application of organizational theories demonstrated above, we advocate for the proactive use of organizational theories to design implementation research. For example, implementation strategies should be selected to minimize transaction costs, promote and maintain congruence between organizations’ dynamic internal and external contexts over time, and simultaneously attend to organizations’ financial needs while preserving their autonomy. We describe implications of applying organizational theory in implementation research for implementation strategies, the evaluation of implementation efforts, measurement, research design, theory, and practice. We also offer guidance to implementation researchers for applying organizational theory.

Process Evaluation of an Intervention to Increase Provision of Adolescent Vaccines at School Health Centers

Background. Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We conducted a process evaluation of an intervention to increase SHC-located vaccination to better understand the feasibility and challenges of such interventions. Method. Four SHCs participated in an intervention to increase provision of recommended vaccines to 2,975 adolescents. We reviewed program materials and SHC staff reports, and interviewed parents to assess implementation fidelity and reactions to materials. Results. Ten percent of parents returned forms with consent to at least one vaccine. Of these, 79% checked the box consenting for “all recommended” vaccines, rather than indicating individual vaccines. SHCs sent supplemental mailings to some parents that clarified (a) vaccination costs or (b) human papillomavirus vaccine recommendation for boys and required parents to reconsent. This process resulted in loss of initial consent, primarily due to nonresponse. In interviews, parents who consented to vaccination indicated that intervention materials were clear and persuasive, but needed greater detail about costs and clinic processes. Conclusions. With limited additional investment, it appears feasible for SHCs to achieve a modest increase in the number of vaccinated adolescents. Providing a checkbox to indicate global consent for all recommended vaccinations, and close collaboration among individuals involved in intervention development, may facilitate vaccination efforts.

Prevalence of Perinatal Depression in the Military: A Systematic Review of the Literature

Objectives Perinatal depression (PND) has been widely studied in the general population, but has been under studied in military populations. This literature review evaluates studies of PND in military service women and spouses of military servicemen. Methods Articles from peer-reviewed journals published from January 2005 to September 2015 were included if they reported on US military women and/or spouses of military servicemen who were screened for PND symptoms during the prenatal and/or postpartum periods; and were available in English. Qualitative studies were excluded. Studies were compared and contrasted by screening instrument, screening time-period, study population, deployment status as a unique risk factor, and results. Results Ten articles were included. Studies varied greatly in methodology and use of screening instruments and screening time-period, but collectively indicate a wide prevalence range of PND symptoms in military populations. Studies also indicate deployment status as a unique risk factor associated with PND symptoms. Common methodological issues include excluding women at high risk for PND, and not reporting if adequate clinical resources were readily available to ensure appropriate diagnostic and therapeutic services treatment for women who screened positive for PND. Conclusions for Practice PND is receiving increasing attention and military populations should be studied more closely to identify this condition, and understand the complex interactions of unique risk factors associated with a military way of life in order to implement more rigorous screening and early, appropriate intervention strategies.

Personal health records for people living with HIV: a review

ABSTRACT Personal health records have the potential to improve patient outcomes, but the state of the literature on personal health record usage by people living with the human immunodeficiency virus (HIV) is unclear. The purpose of this review is to examine the impact of personal health records on HIV-related health beliefs and behaviors. We used the Health Belief Model to guide a review of studies examining the impact of electronic personal health records on the health beliefs and behaviors among people living with HIV. The search yielded 434 results. Following abstract review, 19 papers were selected for full-text review, and 12 were included in the review. A limited number of studies in this review found a positive impact of personal health records on HIV-related beliefs and behaviors. Additional research is needed to identify which personal health record features are most influential in changing health behaviors and why adoption rates remain low, particularly for groups at greatest risk for poor HIV outcomes. Theory-informed interventions are needed to identify which patients are likely to benefit from using personal health records and how to reduce barriers to personal health record adoption for people living with HIV.

The role of network ties to support implementation of a community pharmacy enhanced services network

BACKGROUND Limited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients. OBJECTIVES The aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network. METHODS Using a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies. RESULTS The study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services. CONCLUSIONS Community pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).

Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study

OBJECTIVE This study identifies community and hospital characteristics associated with adoption of telestroke among acute care hospitals in North Carolina (NC). METHODS Our sample included 107 hospitals located in NC. Our analytic dataset included variables from the American Hospital Association (AHA) annual survey, AHA Health IT supplement, Healthcare Cost Report Information System, and Centers for Disease Control and Preventions WONDER online database. We supplemented our secondary sources with data on telestroke adoption and market-level variables developed for NC. We used the Consolidated Framework for Implementation Research and previous telehealth studies to guide selection of variables. We conducted a multivariate logistic regression to determine associations with telestroke adoption. RESULTS Proportion of discharges that are Medicare (odds ratio [OR] = 1.93, P < .04) and total operating margin (OR = 2.89, P = .00) were positively associated with telestroke adoption. Critical access hospital status was positively associated with telestroke adoption, although not at P < .05 (OR = 5.61, P = .07). Distance to the nearest hospital with a telestroke program (OR = .91, P = .01) and volume of emergency department visits (OR = .98, P < .05) were both negatively associated with telestroke adoption. CONCLUSIONS Our study is novel in its focus on telestroke adoption and use of variables not included in previous telehealth analyses. Our findings suggest some hospitals have neither the financial resources nor the ability to pool resources for acquiring needed technology, and differences in adoption may result in geographic inequities in access to telestroke services.

You Still Got to See Where She's Coming From: Using Photovoice to Understand African American Female Adolescents' Perspectives on Sexual Risk.

African Americans have the highest rate of new HIV infection in the United States. This photovoice study explored the perspectives and experiences of African American female youth and sought to understand how adolescent development impacts HIV risk. This study used the photovoice methodology with seven African American or Biracial female youth, in Grades 8 through 12, residing in North Carolina. Study findings indicate that African American female adolescents struggle to navigate adolescence, specifically in coping with race- and gender-related stressors. The photovoice study demonstrated that African American early adolescent females face unique challenges that influence sexual health and HIV risk. There is a need for HIV prevention programs that support positive racial and gender identity development and teach early adolescents how to cope with race- and gender-related stressors. Our findings suggest it is important for youth to be sources of positive support for their peers.

Providers’ preferences for pediatric oral health information in the electronic health record: a cross-sectional survey

BackgroundThe majority of primary care physicians support integration of children’s oral health promotion and disease prevention into their practices but can experience challenges integrating oral health services into their workflow. Most electronic health records (EHRs) in primary care settings do not include oral health information for pediatric patients. Therefore, it is important to understand providers’ preferences for oral health information within the EHR. The objectives of this study are to assess (1) the relative importance of various elements of pediatric oral health information for primary care providers to have in the EHR and (2) the extent to which practice and provider characteristics are associated with these information preferences.MethodsWe surveyed a sample of primary care physicians who conducted Medicaid well-child visits in North Carolina from August – December 2013. Using descriptive statistics, we analyzed primary care physicians’ oral health information preferences relative to their information preferences for traditional preventive aspects of well-child visits. Furthermore, we analyzed associations between oral health information preferences and provider- and practice-level characteristics using an ordinary least squares regression model.ResultsFewer primary care providers reported that pediatric oral health information is “very important,” as compared to more traditional elements of primary care information, such as tracking immunizations. However, the majority of respondents reported some elements of oral health information as being very important. Also, we found positive associations between the percentage of well child visits in which oral health screenings and oral health referrals are performed and the reported importance of having pediatric oral health information in the EHR.ConclusionsIncorporating oral health information into the EHR may be desirable for providers, particularly those who perform oral health screenings and dental referrals.