• Acute and Critical Care Nurses' Roles in Mass Shootings: An Integrative Review

  Carpenter, Dawn; Menard, Alexander; Isenberger, Johnny L.; Stevens, Gregg A; LaRock, Lisa (2024-10-01)

  Background: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care-associated shootings also increased. The role of acute and critical care nurses during shootings is not well defined in the literature. Objective: To identify roles of acute and critical care nurses during mass shooting incidents and provide best-practice recommendations for shooting incidents within a hospital. Methods: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, and Scopus databases were searched for publications related to acute and critical care nurses, mass shooting incidents, and hospital setting. Results: Of 13 589 articles retrieved, 27 were included; 63% were narrative reviews. The highest level of evidence was an expert consensus panel; next highest was a quasi-experimental study that simulated experiences to test mass casualty incident response. Third highest was a qualitative study that analyzed nurses' experiences during a mass casualty experience. Discussion: The evidence revealed 3 themes: prevention and preparedness, response to incident, and recovery phase. Education and training for acute and critical care nurses about mass shooting incidents are central to defining nurses' roles and best practices for these incidents. Nurses must know Stop the Bleed techniques and run-hide-fight protocols. Additionally, acute and critical care nurses need representation on hospital committees to develop and implement policies and procedures. Conclusions: Hospitals are not immune to mass shooting incidents. Acute and critical care nurses require education including simulations and drills on mass shooting incidents to ensure safety of nurses and patients.
• PhD nursing programs: Where are we headed?

  Fain, James A; Sullivan-Bolyai, Susan L; Bova, Carol A (2024-08-29)

  Thank you for your timely editorial, The PhD in Nursing - Questions about a Credential at a Crossroads. We agree that the future of PhD education in nursing is in peril and needs rapid solutions. Low enrollment and threats of PhD program closures are on the rise. As three former Directors of PhD Programs, we feel it is essential that we do not walk away from PhD education. Here are some of our thoughts.
• A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial

  Pbert, Lori; Druker, Sue; Crawford, Sybil; Frisard, Christine; Bram, Jennifer; Olendzki, Barbara; Andersen, Victoria; Hazelton, Jennifer; Simone, Dante; Trivedi, Michelle; et al. (2024-07-30)

  Objective: The American Academy of Pediatrics recommends that pediatric practices help families make lifestyle changes to improve BMI, but provider time and access to treatment are limited. This study compared the effectiveness of two pediatric practice-based referral interventions in reducing BMI. Methods: In this cluster-randomized clinical trial, 20 pediatric primary care practices were randomized to telephonic coaching (Fitline Coaching) or mailed workbook (Fitline Workbook). Parents and their 8- to 12-year-old children with BMI ≥ 85th percentile completed assessments at baseline and at 6 and 12 months post baseline. Primary outcomes were 12-month BMI percentile and z score. Results: A total of 501 children and their parents received Fitline Coaching (n = 243) or Fitline Workbook (n = 258); 26.8% had overweight, 55.4% had obesity, and 17.8% had severe obesity. Mean (SD) age was 10.5 (1.4), and 47.5% were female. BMI percentile improved in both groups; 12-month decline in continuous BMI z score was not statistically significant in either group. However, 20.8% of telephonic coaching participants and 12.4% of workbook participants achieved a clinically significant reduction of at least 0.25 in BMI z score, a significant between-group difference (p = 0.0415). Conclusions: Both low-intensity interventions were acceptable and produced modest improvements in BMI percentile. One in five children in the telephonic coaching condition achieved clinically meaningful BMI z score improvements. However, more research is needed before such a program could be recommended for pediatric primary care practice.
• Burnout Among Young Adults With Type 1 Diabetes

  Perez, Danielle; Sullivan-Bolyai, Susan L; Bova, Carol A; Fain, James A (2024-05-30)

  Purpose: The purpose of this qualitative descriptive study was to describe the experience of diabetes burnout in young adults with type 1 diabetes (T1DM). In addition, aims included participant perspectives of risk and protective factors associated with burnout and ways to balance everyday life with diabetes self-management (DSM). Methods: Young adults with T1DM (N = 11) were recruited through social media platforms and modified snowball sampling and interviewed. Informational redundancy was achieved. Qualitative thematic coding and analysis were conducted within and across transcripts. Results: Diabetes burnout was described as the willingness to put diabetes and DSM on the "back burner" and let things slide due to exhaustion, frustration, apathy, and the desire to be like everyone else for a while. Risk and protective factors were identified along with strategies to achieve balance of DSM in everyday life. Conclusions: This study identified a clear definition of diabetes burnout and acknowledges this concept as distinct and separate from other psychosocial conditions. Health care providers can utilize this information to identify individuals at risk for diabetes burnout and offer more effective support to lessen the overall burden associated with T1DM.
• Acute Care Advanced Practice Providers' Use of Telehealth During the COVID-19 Pandemic

  Winterbottom, Fiona; Katz, Adam W; Skinner, Sarah; Carpenter, Dawn; Williams, Lisa-Mae; Kleinpell, Ruth (2023-12-15)

  Advanced practice registered nurses and physician assistants, collectively termed advanced practice providers (APPs), have been part of telehealth for many years. During the COVID-19 pandemic, APPs experienced the growth in roles, responsibilities, and tools used for telehealth care delivery. This article uses examples from 3 health systems to highlight the ways in which telehealth use was expanded due to the pandemic, how APP roles were altered across the United States during and after the pandemic, and implications for future practice.
• Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study

  Turner, Samantha L (2023-12-15)

  Purpose: Children face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers. Design and methods: Participants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses. Results: Participants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them. Conclusion: Though pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients. Practice implications: The results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.
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  In Our World: Uncovering the Meaning of Parent-Nurse Relationships in Childhood Cancer Care

  Costa, Jennifer (2023-12-14)

  Background: The diagnosis of cancer in a child thrusts parents into a complex healthcare system where they find themselves developing new relationships with pediatric oncology nurses. While parents and nurses acknowledge the meaningfulness and complexity of these relationships, many find it difficult to articulate. The purpose of this study was to understand the meaning and experience of the parent-nurse relationship in childhood cancer care. Methods: This study employed the tenets of Gadamerian hermeneutic philosophy. Data analysis looked to articulate meaningful interpretations of the interviews with parents and nurses of children with cancer through interpretive data analysis and utilized the hermeneutic circle as a way of conceptualizing and understanding the interpretive process. Results: Sixteen interviews (n = 8 parents, n = 8 nurses) were completed. The findings suggested that both parents and nurses of children with cancer navigate through an evolving inner world unique to the cancer experience. The parent-nurse relationships were mutually identified as dynamic, complex, and emotionally laden, and drew on the shared strength, trust, humanity, and interconnectedness of one another. The parent-nurse relationships played a significant role in traversing the challenges encountered with entry into and navigation through the pediatric cancer world. Discussion: The findings provide practical knowledge to inform and enhance relationship development at the clinical level, impact how relationship development is taught at the academic level, as well as inform professional development. This study contributes to the understanding of parent-nurse relationships and opens the door for integration of innovative practices in nursing education and clinical care.
• Self- and staff-reported pain in relation to contextual isolation in long-term nursing home residents with Alzheimer's disease and related dementias

  Jesdale, Bill M; Bova, Carol A; Mbrah, Attah K; Lapane, Kate L (2023-11-23)

  We evaluated the degree to which contextual isolation in nursing home residents with Alzheimer's disease and related dementias is associated with documented pain using the Minimum Data Set 3.0, a comprehensive resident assessment required of all nursing home residents in the United States. Contextual isolation was defined as having a socially salient characteristic (demographics, habits and interests, and clinical and care dimensions) shared by fewer than 20% of other residents in the same nursing home. Thirteen percent were contextually isolated on multiple characteristics. Among residents self-reporting pain, residents contextually isolated with respect to multiple characteristics were 8% more likely (95% confidence interval: 7% to 9%) to have pain relative to residents who were not contextually isolated on any characteristics. Long-stay nursing home residents with ADRD who live in settings where they were contextually isolated were more likely to have pain relative to those without contextually isolation on any characteristic.
• Application of Machine Learning Models to Biomedical and Information System Signals From Critically Ill Adults

  Lilly, Craig M; Kirk, David; Pessach, Itai M; Lotun, Gurudev; Chen, Ofer; Lipsky, Ari; Lieder, Iris; Celniker, Gershon; Cucchi, Eric W; Blum, James M (2023-11-01)

  Background: Machine learning (ML)-derived notifications for impending episodes of hemodynamic instability and respiratory failure events are interesting because they can alert physicians in time to intervene before these complications occur. Research question: Do ML alerts, telemedicine system (TS)-generated alerts, or biomedical monitors (BMs) have superior performance for predicting episodes of intubation or administration of vasopressors? Study design and methods: An ML algorithm was trained to predict intubation and vasopressor initiation events among critically ill adults. Its performance was compared with BM alarms and TS alerts. Results: ML notifications were substantially more accurate and precise, with 50-fold lower alarm burden than TS alerts for predicting vasopressor initiation and intubation events. ML notifications of internal validation cohorts demonstrated similar performance for independent academic medical center external validation and COVID-19 cohorts. Characteristics were also measured for a control group of recent patients that validated event detection methods and compared TS alert and BM alarm performance. The TS test characteristics were substantially better, with 10-fold less alarm burden than BM alarms. The accuracy of ML alerts (0.87-0.94) was in the range of other clinically actionable tests; the accuracy of TS (0.28-0.53) and BM (0.019-0.028) alerts were not. Overall test performance (F scores) for ML notifications were more than fivefold higher than for TS alerts, which were higher than those of BM alarms. Interpretation: ML-derived notifications for clinically actioned hemodynamic instability and respiratory failure events represent an advance because the magnitude of the differences of accuracy, precision, misclassification rate, and pre-event lead time is large enough to allow more proactive care and has markedly lower frequency and interruption of bedside physician work flows.
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  Prevalence and predictors of shared decision-making in goals-of-care clinician-family meetings for critically ill neurologic patients: a multi-center mixed-methods study

  Fleming, Victoria; Prasad, Abhinav; Ge, Connie; Crawford, Sybil; Meraj, Shazeb; Hough, Catherine L; Lo, Bernard; Carson, Shannon S; Steingrub, Jay; White, Douglas B; et al. (2023-10-21)

  Background: Shared decision-making is a joint process where patients, or their surrogates, and clinicians make health choices based on evidence and preferences. We aimed to determine the extent and predictors of shared decision-making for goals-of-care discussions for critically ill neurological patients, which is crucial for patient-goal-concordant care but currently unknown. Methods: We analyzed 72 audio-recorded routine clinician-family meetings during which goals-of-care were discussed from seven US hospitals. These occurred for 67 patients with 72 surrogates and 29 clinicians; one hospital provided 49/72 (68%) of the recordings. Using a previously validated 10-element shared decision-making instrument, we quantified the extent of shared decision-making in each meeting. We measured clinicians' and surrogates' characteristics and prognostic estimates for the patient's hospital survival and 6-month independent function using post-meeting questionnaires. We calculated clinician-family prognostic discordance, defined as ≥ 20% absolute difference between the clinician's and surrogate's estimates. We applied mixed-effects regression to identify independent associations with greater shared decision-making. Results: The median shared decision-making score was 7 (IQR 5-8). Only 6% of meetings contained all 10 shared decision-making elements. The most common elements were "discussing uncertainty"(89%) and "assessing family understanding"(86%); least frequent elements were "assessing the need for input from others"(36%) and "eliciting the context of the decision"(33%). Clinician-family prognostic discordance was present in 60% for hospital survival and 45% for 6-month independent function. Univariate analyses indicated associations between greater shared decision-making and younger clinician age, fewer years in practice, specialty (medical-surgical critical care > internal medicine > neurocritical care > other > trauma surgery), and higher clinician-family prognostic discordance for hospital survival. After adjustment, only higher clinician-family prognostic discordance for hospital survival remained independently associated with greater shared decision-making (p = 0.029). Conclusion: Fewer than 1 in 10 goals-of-care clinician-family meetings for critically ill neurological patients contained all shared decision-making elements. Our findings highlight gaps in shared decision-making. Interventions promoting shared decision-making for high-stakes decisions in these patients may increase patient-value congruent care; future studies should also examine whether they will affect decision quality and surrogates' health outcomes.
• Multicomponent Pharmacist Intervention Did Not Reduce Clinically Important Medication Errors for Ambulatory Patients Initiating Direct Oral Anticoagulants

  Kapoor, Alok; Patel, Parth; Mbusa, Daniel; Pham, Thu; Cicirale, Carrie; Tran, Wenisa; Beavers, Craig; Javed, Saud; Wagner, Joann; Swain, Dawn; et al. (2023-09-27)

  Background: Anticoagulants including direct oral anticoagulants (DOACs) are among the highest-risk medications in the United States. We postulated that routine consultation and follow-up from a clinical pharmacist would reduce clinically important medication errors (CIMEs) among patients beginning or resuming a DOAC in the ambulatory care setting. Objective: To evaluate the effectiveness of a multicomponent intervention for reducing CIMEs. Design: Randomized controlled trial. Participants: Ambulatory patients initiating a DOAC or resuming one after a complication. Intervention: Pharmacist evaluation and monitoring based on the implementation of a recently published checklist. Key elements included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests. Control: Coupons and assistance to increase the affordability of DOACs. Main measure: Anticoagulant-related CIMEs (Anticoagulant-CIMEs) and non-anticoagulant-related CIMEs over 90 days from DOAC initiation; CIMEs identified through masked assessment process including two physician adjudication of events presented by a pharmacist distinct from intervention pharmacist who reviewed participant electronic medical records and interview data. Analysis: Incidence and incidence rate ratio (IRR) of CIMEs (intervention vs. control) using multivariable Poisson regression modeling. Key results: A total of 561 patients (281 intervention and 280 control patients) contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs (0.95 per 100 person-days). Failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs were the most common anticoagulant-related CIMEs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients (IRR 1.17; 95% CI 0.98-1.42) or non-anticoagulant-related CIMEs (IRR 1.05; 95% CI 0.80-1.37). Conclusion: A multi-component intervention in which clinical pharmacists implemented an evidence-based DOAC Checklist did not reduce CIMEs. Nih trial number: NCT04068727.
• Evaluating nursing students’ outcomes in an educational escape room: Escape a night of rapids!

  Malatesta, Thin Zar; Hebert, Danielle; Cornine, Amanda; Amoah, Rita (2023-09-19)

  An educational escape room (EER) was developed as an innovative strategy for summative evaluation at the end of the first semester in a medical/surgical course within an accelerated nursing program. Learning outcomes were focused on recognizing abnormal vital signs of a decompensating patient, prioritizing nursing interventions, role-playing as a rapid response nurse, collaborating with peers to complete each puzzle, interpreting findings, and discovering medication errors. Debriefing allowed faculty to provide feedback on the achievement of the learning outcomes. Most students agreed that the EER allowed them to meet each learning outcome. This project supported the usefulness of EERs for the evaluation of student learning outcomes in a fast-paced program that may be similar to the speed at which associate degree programs prepare students.
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  Nurses with Physical Disabilities Experiences During Pre-licensure Education

  Mantlow, Kimberly D. (2023-08-15)

  PURPOSE: To describe the pre-licensure nursing educational experience of integration and inclusion among RNs with a physical disability during their education. SPECIFIC AIMS: 1) Describe the access RNs with a physical disability had to academic and social opportunities during their prelicensure education program that contributed to academic and social integration (inclusion). 2). Explore perceptions of RNs with a physical disability regarding inclusion and acceptance of their disability as a valued component of student diversity during their prelicensure education program. 3). Describe the contextual factors and key aspects of connection during the pre-licensure educational experiences of RNs who had a physical disability as positive (Disability-Diversity Connect) or negative and disintegrated (Disability-Diversity Disconnect). FRAMEWORK: This study was guided by The Disability-Diversity Disconnect (DDDM) by Aquino (2016). DESIGN: This study design used was qualitative description. It included semi-structured interviews using an interview guide based on the DDDM. RESULTS: 16 individuals with 14 different physical disabilities participated in this study. During data analysis four themes emerged: I Saved My Energy for Learning, Determination, Wanting to Find My People and Secrets, Living a Double Life which has a subtheme, Fear of Judgement. CONCLUSION: : Identification of factors related to inclusion within the academic environment provides insight for future work to examine the needs of prelicensure nursing students with physical disabilities and the potential to improve their future educational experiences.
• Prognostic Language in Critical Neurologic Illness: A Multicenter Mixed-Methods Study

  Goss, Adeline; Ge, Connie; Crawford, Sybil; Goostrey, Kelsey; Buddadhumaruk, Praewpannanrai; Hough, Catherine L; Lo, Bernard; Carson, Shannon; Steingrub, Jay; White, Douglas B; et al. (2023-06-08)

  Background and objectives: There are no evidence-based guidelines for discussing prognosis in critical neurologic illness, but in general, experts recommend that clinicians communicate prognosis using estimates, such as numerical or qualitative expressions of risk. Little is known about how real-world clinicians communicate prognosis in critical neurologic illness. Our primary objective was to characterize prognostic language clinicians used in critical neurologic illness. We additionally explored whether prognostic language differed between prognostic domains (e.g., survival, cognition). Methods: We conducted a multicenter cross-sectional mixed-methods study analyzing deidentified transcripts of audio-recorded clinician-family meetings for patients with neurologic illness requiring intensive care (e.g., intracerebral hemorrhage, traumatic brain injury, severe stroke) from 7 US centers. Two coders assigned codes for prognostic language type and domain of prognosis to each clinician prognostic statement. Prognostic language was coded as probabilistic (estimating the likelihood of an outcome occurring, e.g., "80% survival"; "She'll probably survive") or nonprobabilistic (characterizing outcomes without offering likelihood; e.g., "She may not survive"). We applied univariate and multivariate binomial logistic regression to examine independent associations between prognostic language and domain of prognosis. Results: We analyzed 43 clinician-family meetings for 39 patients with 78 surrogates and 27 clinicians. Clinicians made 512 statements about survival (median 0/meeting [interquartile range (IQR) 0-2]), physical function (median 2 [IQR 0-7]), cognition (median 2 [IQR 0-6]), and overall recovery (median 2 [IQR 1-4]). Most statements were nonprobabilistic (316/512 [62%]); 10 of 512 prognostic statements (2%) offered numeric estimates; and 21% (9/43) of family meetings only contained nonprobabilistic language. Compared with statements about cognition, statements about survival (odds ratio [OR] 2.50, 95% CI 1.01-6.18, p = 0.048) and physical function (OR 3.22, 95% 1.77-5.86, p < 0.001) were more frequently probabilistic. Statements about physical function were less likely to be uncertainty-based than statements about cognition (OR 0.34, 95% CI 0.17-0.66, p = 0.002). Discussion: Clinicians preferred not to use estimates (either numeric or qualitative) when discussing critical neurologic illness prognosis, especially when they discussed cognitive outcomes. These findings may inform interventions to improve prognostic communication in critical neurologic illness.
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  Matching medical staff to long term care facilities to respond to COVID-19 outbreak

  Zarei, Hamid Reza; Ghanbarpour Mamaghani, Mahsa; Ergun, Ozlem; Yu, Patricia; Winchester, Leanne; Chen, Elizabeth (2023-06-07)

  Background: Staff shortage is a long-standing issue in long term care facilities (LTCFs) that worsened with the COVID-19 outbreak. Different states in the US have employed various tools to alleviate this issue in LTCFs. We describe the actions taken by the Commonwealth of Massachusetts to assist LTCFs in addressing the staff shortage issue and their outcomes. Therefore, the main question of this study is how to create a central mechanism to allocate severely limited medical staff to healthcare centers during emergencies. Methods: For the Commonwealth of Massachusetts, we developed a mathematical programming model to match severely limited available staff with LTCF demand requests submitted through a designed portal. To find feasible matches and prioritize facility needs, we incorporated restrictions and preferences for both sides. For staff, we considered maximum mileage they are willing to travel, available by date, and short- or long-term work preferences. For LTCFs, we considered their demand quantities for different positions and the level of urgency for their demand. As a secondary goal of this study, by using the feedback entries data received from the LTCFs on their matches, we developed statistical models to determine the most salient features that induced the LTCFs to submit feedback. Results: We used the developed portal to complete about 150 matching sessions in 14 months to match staff to LTCFs in Massachusetts. LTCFs provided feedback for 2,542 matches including 2,064 intentions to hire the matched staff during this time. Further analysis indicated that nursing homes and facilities that entered higher levels of demand to the portal were more likely to provide feedback on the matches and facilities that were prioritized in the matching process due to whole facility testing or low staffing levels were less likely to do so. On the staffing side, matches that involved more experienced staff and staff who can work afternoons, evenings, and overnight were more likely to generate feedback from the facility that they were matched to. Conclusion: Developing a central matching framework to match medical staff to LTCFs at the time of a public health emergency could be an efficient tool for responding to staffing shortages. Such central approaches that help allocate a severely limited resource efficiently during a public emergency can be developed and used for different resource types, as well as provide crucial demand and supply information in different regions and/or demographics.
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  Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program

  Tjia, Jennifer; Pugnaire, Michele; Calista, Joanne; Eisdorfer, Ethan; Hale, Janet Fraser; Terrien, Jill; Valdman, Olga; Potts, Stacy E; Garcia, Maria; Yazdani, Majid; et al. (2023-06-05)

  Objectives: To describe the development and refinement of an implicit bias recognition and management training program for clinical trainees. Methods: In the context of an NIH-funded clinical trial to address healthcare disparities in hypertension management, research and education faculty at an academic medical center used a participatory action research approach to engage local community members to develop and refine a "knowledge, awareness, and skill-building" bias recognition and mitigation program. The program targeted medical residents and Doctor of Nursing Practice students. The content of the two-session training included: didactics about healthcare disparities, racism and implicit bias; implicit association test (IAT) administration to raise awareness of personal implicit bias; skill building for bias-mitigating communication; and case scenarios for skill practice in simulation-based encounters with standardized patients (SPs) from the local community. Results: The initial trial year enrolled n = 65 interprofessional participants. Community partners and SPs who engaged throughout the design and implementation process reported overall positive experiences, but SPs expressed need for greater faculty support during in-person debriefings following simulation encounters to balance power dynamics. Initial year trainee participants reported discomfort with intensive sequencing of in-person didactics, IATs, and SP simulations in each of the two training sessions. In response, authors refined the training program to separate didactic sessions from IAT administration and SP simulations, and to increase safe space, and trainee and SP empowerment. The final program includes more interactive discussions focused on identity, race and ethnicity, and strategies to address local health system challenges related to structural racism. Conclusion: It is possible to develop and implement a bias awareness and mitigation skills training program that uses simulation-based learning with SPs, and to engage with local community members to tailor the content to address the experience of local patient populations. Further research is needed to measure the success and impact of replicating this approach elsewhere.
• From COVID-19 Vaccine Hesitancy to Vaccine Acceptance: Results of a Longitudinal Survey

  Fisher, Kimberly A; Nguyen, Ngoc; Fouayzi, Hassan; Crawford, Sybil; Singh, Sonal; Dong, May; Wittenberg, Ruth; Mazor, Kathleen M (2023-05-27)

  Objectives: COVID-19 vaccines are widely available, but uptake is suboptimal. To develop strategies to increase vaccination rates, we sought to (1) characterize adults initially hesitant to be vaccinated for COVID-19 who later received the vaccine and (2) identify factors associated with their vaccination decision. Methods: In January 2021, we conducted an online survey of US adults via Prolific that assessed vaccination intent, COVID-19-related knowledge and attitudes, and demographic characteristics. In May 2021, we recontacted respondents to assess vaccination status and factors influencing their vaccination decision. We used χ2 statistics and t tests to examine associations between respondents' vaccination status and their characteristics, knowledge, and attitudes. We analyzed reasons for vaccination using thematic analysis. Results: Of 756 initially vaccine-hesitant respondents, 529 (70.0%) completed the follow-up survey. Nearly half of those initially not sure about vaccination (47.3%, 112 of 237) were vaccinated at follow-up, while 21.2% (62 of 292) of those initially planning not to be vaccinated were vaccinated at follow-up. Of those initially not sure, higher educational attainment, greater knowledge of COVID-19, and a doctor's recommendation were associated with vaccination. Of those initially intending not to be vaccinated, male sex, Democratic political affiliation, receipt of an influenza shot within 5 years, being more worried about COVID-19, and having greater COVID-19 knowledge were associated with increased likelihood of being vaccinated. Of 167 respondents who gave reasons for vaccination, protecting oneself and others (59.9%), practical issues (29.9%), social influences (17.4%), and vaccine safety (13.8%) were the main reasons. Conclusion: Providing information on the protective value of vaccination, implementing rules that make remaining unvaccinated burdensome, making vaccination easy, and providing social support may influence vaccine-hesitant adults to accept vaccination.
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  Ready for Action: A National Study of Pediatric Healthcare Professionals' Attitudes and Beliefs About Weight Stigma

  Turner, Samantha L (2023-05-26)

  PURPOSE: To quantify pediatric healthcare professionals’ (HCPs’) attitudes and beliefs about weight stigma and levels of implicit and explicit weight bias and describe interventions that are most supported by pediatric HCPs. SPECIFIC AIMS: 1) Determine the distribution of weight bias among pediatric HCPs and identify associations between characteristics and weight bias. 2) Examine attitudes and beliefs of pediatric HCPs about weight stigma and identify associations between characteristics and attitudes/beliefs. 3) Investigate the relationship between HCPs’ weight bias and attitudes/beliefs. 4) Identify interventions most supported by pediatric HCPs. Framework: The Health Stigma Discrimination Framework guided this study. DESIGN: This study utilized a cross-sectional survey of pediatric HCPs. Participants completed the Implicit Association Test (IAT), the Crandall Anti-Fat Attitudes Questionnaire (CAAQ), a researcher-designed questionnaire (BAWSQ), and demographic questions. RESULTS: The sample exhibited a moderate implicit bias (M=0.59, SD=0.41) and explicit bias (M=38.95, SD=10.9). Participants generally agreed with BAWSQ statements and broadly supported interventions. The most-supported intervention was continuing education units (CEUs) for anti-weight bias activities (n=144, 81.36%). Implicit bias was associated with more years in practice, occupation, and age. Explicit bias was associated with practice setting. As explicit bias increased, so did agreement with BAWSQ question 1 (r=0.208, p=0.005), and disagreement with BAWSQ questions 3 and 4 (r=-0.237, p<0.005; r=-0.394, p<0.001, respectively). CONCLUSION: Weight bias is prevalent in pediatric healthcare and pediatric HCPs are invested in approaches to reduce weight bias. Future interventions should be brief, concise, and should aim to broaden awareness of pediatric HCPs about the consequences of weight bias.
• Population-level policy recommendations for the prevention of disordered weight control behaviors: A scoping review

  Raffoul, Amanda; Turner, Samantha L; Salvia, Meg G; Austin, S Bryn (2023-04-25)

  Objective: The aim of this scoping review was to identify recommendations and gaps in knowledge surrounding the prevention of disordered weight control behaviors (DWCBs) through policy. Method: A search was conducted in several databases to identify English language articles that described an active policy, recommendation, guideline, or educational curriculum that could be implemented by governments or regulatory bodies to prevent DWCBs or related constructs (e.g., weight stigma, body dissatisfaction). Two researchers independently screened articles with oversight from a third researcher. Data were extracted from the final sample (n = 65) and analyzed qualitatively across all articles and within the domains of education, public policy, public health, industry regulation, and media. Results: Only a single empirical evaluation of an implemented policy to reduce DWCBs was identified. Over one-third of articles proposed recommendations relating to industry regulation and media (n = 24, 36.9%), followed by education (n = 21, 32.3%), public policy (n = 19, 29.2%), and public health (n = 10, 15.4%). Recommendations included school-based changes to curricula, staff training, and anti-bullying policies; legislation to ban weight discrimination; policies informed by strategic science; collaboration with researchers from other fields; de-emphasizing weight in health communications; diversifying body sizes and limiting modified images in media; and restricting the sale of weight-loss supplements. Discussion: The findings of this review highlight gaps in empirically evaluated policies to reduce DWCBs but also promising policy recommendations across several domains. Although some policy recommendations were supported by empirical evidence, others were primarily based on experts' knowledge, highlighting the need for greater research on population-level DWCBs prevention through policy. Public significance: Our scoping review of the evidence on policies for the prevention of disordered weight control behaviors identified several recommendations across the domains of education, public policy, public health, and industry regulation and media. Although few empirical investigations of implemented policies have been conducted, expert recommendations for policies to prevent disordered weight control behaviors among populations are plentiful and warrant future consideration by researchers and policymakers alike.
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  Hope for the Future: Key Informants’ Perspectives on HIV Prevention in Dominican Republic Batey Communities

  Filiau, Alaina (2023-04-18)

  Purpose: The purpose of this study, was to understand the interlocking spheres of cultural identity and health behaviors relating to HIV prevention within the batey communities. Specific Aims: Explore key informants’ perceptions of cultural identity that influence HIV prevention including relationships, expectations, and cultural empowerment among persons, extended family, and neighborhoods. Explore key informants’ perceptions of the cultural factors that enable and nurture protective health behaviors relating to HIV prevention among the DR batey communities. Describe key informants’ perceptions of the positive, existential, and negative dimensions of DR batey culture empowerment with the goal of promoting healthy behaviors for HIV prevention in batey communities. Framework: The PEN-3 Model by Airhihenbuwa provided the theoretical framework as a culture-centered approach to understanding cultural context relating to health behaviors. Design: A qualitative descriptive design with maximum variation was utilized, and data was analyzed using qualitative content analysis. Semi-structured qualitative interviews were completed with key informants within the La Romana region of the Dominican Republic. Results: Semi-structured qualitative interviews were conducted with 12 individuals.

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