Objectives In the United States, sexually transmitted infections (STIs) disproportionately affect men who have sex with men (MSM) and transwomen of color. Partner services can prevent STI transmission by facilitating testing and treatment for partners of individuals diagnosed with an STI. Understanding client perspectives towards partner services is critical to their acceptance and uptake. This study examined perceptions, experiences, and preferences for partner services among Black and Latino MSM and transwomen in North Carolina.Design We conducted seven audio-recorded focus groups in English (n = 5) and Spanish (n = 2). The audio was transcribed verbatim and we inductively analyzed data using field notes, systematic coding, and thematic comparison.Results Black MSM reported the most exposure and experiences with partner services, and most perceived partner services negatively. Feeling supported and having flexibility characterized positive experiences with partner services among Black MSM; feeling judged or harassed characterized negative experiences. Black transwomen had less exposure to partner services and had a mix of positive reactions to the approach, along with concerns about client confidentiality. Most Latino participants were unaware of partner services and expressed openness to their potential. All participants preferred self-notifying and wanted flexible, discreet, supportive partner services with linkages to other wellness resources.Conclusion Building off positive partner services experiences and responding to client preferences can enhance trust, acceptability, and service use.
Objectives As type 2 diabetes prevalence increases across Latin America, understanding local approaches to coping with diabetes stress is essential to providing care that incorporates patients’ values and preferences. This study explored a local phenomenon, “ no le doy mente” (I don’t think about it), used by adults with type 2 diabetes in the Dominican Republic to cope with diabetes stress. Methods We conducted 19 qualitative in-depth interviews with adults with type 2 diabetes (10 men, 9 women) recruited from one rural clinic. Using an inductive analytic approach including iterative coding, memos, and matrices, we identified reasons, strategies, and perceived benefits of not thinking about type 2 diabetes among participants. Results Participants described not thinking about diabetes as an active process to maintain a sense of normalcy despite significant life changes following diagnosis. They avoided thinking about diabetes by staying busy, proactively managing type 2 diabetes through diet and medication, and turning to their faith. Participants perceived that enacting no le doy mente helped to protect their overall health and well-being. Discussion Future research should investigate provider perceptions of no le doy mente to align patient and provider communication and mindfulness-based stress reduction as a way to support people with type 2 diabetes avoid dwelling on negative thoughts about diabetes.
Abstract Background Long-acting injectable antiretroviral therapy (LAI-ART) has been approved as an alternative to daily oral ART for people living with HIV (PLWH). Amidst the promise and potential challenges of LAI-ART, acceptability of this new therapeutic option remains largely unexplored beyond clinical trials. The aim of this study is to characterize perceptions and preferences related to LAI-ART among HIV care providers (HCPs). Methods We conducted qualitative in-depth interviews with 32 HCPs from three distinct geographic areas (Boston, MA; Chapel Hill, NC; Washington, DC) between November 2019 to March 2021. HCPs included: physicians, nurse practitioners, physician assistants, registered nurses, clinical pharmacists, social workers, medical assistants, and HIV navigators. We developed narrative summaries to understand individual perspectives and then systematically coded transcripts using Dedoose to identify recurring themes across participants. Results HCPs felt LAI-ART could be the “golden ticket” for patients who struggle with adherence or worry about HIV status disclosure. However, they perceived patient interest in LAI-ART would vary based on several factors. HCPs expected older patients who have lived with HIV longer and are reluctant to changing regimens, those who live far from clinic, or have a fear of needles to be less interested in LAI-ART. A recurring concern among HCPs was that LAI-ART will require frequent clinic visits, making it more burdensome to both patients and clinics. HCPs overwhelmingly preferred an 8-week over a 4-week dose schedule. To support introduction of LAI-ART, HCPs wanted: 1) clinic-wide trainings; 2) recommendations for optimal viral suppression status at LAI-ART initiation; 3) protocols for managing missed/late doses; and 4) implementation guidance to manage staff time tracking patients on LAI-ART. Conclusion Findings highlight the importance of understanding HCP perceptions, expectations, and concerns as these are likely to influence treatment discussions with PLWH and integration of LAI-ART. HCPs’ concerns and uncertainty regarding implementation, highlight the need for provider resources to support decision-making around LAI-ART. Additionally, clinic level guidance for the logistics of roll-out are urgently needed. Disclosures Kenneth H. Mayer, MD, Gilead: Advisor/Consultant|Merck: Advisor/Consultant|ViiV: Advisor/Consultant David A. Wohl, M.D., Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Janssen: Advisor/Consultant|Lilly: Grant/Research Support|Merck: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Grant/Research Support.
The emotional burden of type 2 diabetes mellitus (T2D) can complicate self-management. Exploring the feasibility of mental and physical health co-management in limited-resourced settings is needed. Thus, we assessed providers' awareness of the emotional burden their patients experience and their roles in supporting their patients with T2D. We conducted a formative qualitative study using in-depth interviews with 14 providers, including physicians, nurses, and community health workers recruited at two rural health clinics in the Dominican Republic. We coded transcripts using inductive and deductive codes and developed themes through iterative comparative analysis. All providers recognized that patients experience an emotional burden managing life with T2D. Some providers viewed the provision of emotional support as integral to their role and believed that they could do so. Others viewed it as the responsibility of the family or expressed the need for additional guidance on how to provide emotional support. Providers also identified several barriers to integrating emotional support into routine clinical care including personality characteristics, lack of training, and insufficient staffing. While providers recognize the need for emotional support, they identified individual, clinical, and systems-level barriers. Strategies to address these barriers include training specific providers on emotional support provision, balancing workload, and building or strengthening referral systems.
Growing naturally in the arid and semi-arid zones of Mexico and the United States Yucca serves as an important source of fibers for inhabitants of this region. Besides, its flowers and fruits are also consumed by the local people. Flowers are also used as feed for livestock. However, over-exploitation of this natural resource poses a threat to the desert eco-system and subsistence of inhabitants of arid lands. This paper provides an insight into the distribution, ecology, morphology, reproduction, growth, method of fiber extraction and processing, etc. of Yucca with future areas of research for effective conservation and management of this valuable slow-growing natural resource.
Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women's experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women's care experience and what women mean by satisfaction in two Ethiopian regions.Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women's experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction.Maternal and newborn survival and safety were central to women's descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as 'satisfactory'. The texture behind this 'satisfaction', however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider's interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility's amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women's experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women's overall satisfaction, even in the context of poor-quality facilities and limited resources.Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women's satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women's care experience.
Abstract Background: Postnatal care is recommended as a means of preventing maternal mortality during the postpartum period, but many women in low- and middle-income countries (LMICs) do not access care during this period. We set out to examine sociocultural preferences that have been portrayed as barriers to care. Methods: We performed an abductive analysis of 63 semi-structured interviews with women who had recently given birth in three regions of Ethiopia using the Health Equity Implementation Framework (HEIF) and an inductive-deductive codebook to understand why women in Ethiopia do not use recommended postnatal care. Results: We found that, in many cases, health providers do not consider women’s cultural safety a primary need, but rather as a barrier to care. However, women’s perceived refusal to participate in postnatal visits was, for many, an expression of agency and asserting their needs for cultural safety. Trial registration: n/a Conclusions: We propose adding cultural safety to HEIF as a process outcome, so that implementers consider cultural needs in a dynamic manner that does not ask patients to choose between meeting their cultural needs and receiving necessary health care during the postnatal period.
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