Multilevel interventions (MLIs) hold promise for reducing health inequities by intervening at multiple types of social determinants of health consistent with the socioecological model of health. In spite of their potential, methodological challenges related to study design compounded by a lack of tools for sample size calculation inhibit their development. We help address this gap by proposing the Multilevel Intervention Stepped Wedge Design (MLI-SWD), a hybrid experimental design which combines cluster-level (CL) randomization using a Stepped Wedge design (SWD) with independent individual-level (IL) randomization.
View Article and Find Full Text PDFOne way in which professional nursing organizations have chosen to address the social determinants of health (SDoH) is through policy work focused on diversity, health equity and anti-racism activities. The recent report, Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (FON 2020-2030), calls on professional nursing organizations and/or nursing coalitions to focus on addressing the SDoH to mitigate health inequities, including a focus on addressing racism and promoting practices to ensure the diversity of the nursing workforce. While these recommendations highlight issues of high importance to nursing and the broader society, they assume that professional nursing organizations or coalitions have not been sufficiently engaged in this work to date.
View Article and Find Full Text PDFCritical social scholarship highlights the power philanthropic foundations wield on the collective agency of groups, yet analyses specific to nursing are absent in the literature. In this second of a 2-part series, we employed critical discourse analysis to examine how control of enunciative privilege in Robert Wood Johnson Foundation's (RWJF) 2010 and 2020-2030 Future of Nursing (FON) initiatives challenge nursing's ability to enact its collective agency, particularly through professional nursing organizations. Findings are discussed within the context of nursing's self-regulatory privileges, history, and agentic obligations that are bestowed on the discipline by the greater public for the public good.
View Article and Find Full Text PDFIn this article, we examine external agents' effect on nursing's professional evolution and the consequences for the discipline's collective agency, social contract, and self-regulation. Situated within Foucault's theories of power, we review how the power of organizations reaches into the fabric of everyday life and explore how philanthropic foundations have influenced a diverse array of disciplines, including nursing. Through a genealogic lens, we examine nursing history and professionalization and conclude with concerns surrounding nursing's exercise of its collective agency during one of the most significant, discipline-shaping activities of modern times-Robert Wood Johnson Foundation's Future of Nursing initiatives.
View Article and Find Full Text PDFRecent national initiatives in nursing and public health have emphasized the need for a robust public health nursing (PHN) workforce. In this article, we analyze the extent to which recent national enumeration surveys base their counts of this workforce on the definitions, scope, and standards for practice and practice competencies of the PHN nursing specialty. By and large, enumeration surveys continue to rely on practice setting to define the PHN workforce, which is an insufficient approach for meeting the goals of major nursing and public health initiatives.
View Article and Find Full Text PDFBackground: Preventing and managing chronic illness necessitates multilevel, theory-based interventions targeting behaviors, environmental factors, and personal determinants that increase risk for illness onset, greater burden, and poorer outcomes.
Objectives: The purpose of this article is to provide the basis for multilevel interventions, describe community-engaged intervention mapping as an approach to designing theory-based interventions, and discuss potential benefits of applying community-engaged intervention mapping in preparing nurse scientists to build programs of interdisciplinary research in preventing and managing chronic illness.
Methods: Community-engaged intervention mapping integrates two methodological approaches: intervention mapping and community-engaged research.
Objectives: Mothers in lower social locations are particularly vulnerable to the syndemic conditions of substance abuse, violence, and HIV/AIDS (SAVA), yet few studies have examined the impact of upstream socioeconomic inequities as salient determinants of syndemic conditions in their lives. The purpose of this study was to investigate the influence of Temporary Assistance for Needy Families (TANF) receipt, TANF sanctions, and economic hardship (EH) on SAVA syndemic conditions that included indicators of substance use, HIV risk-taking behaviors, and intimate partner violence among mothers over time.
Methods: Using data from the Fragile Families and Child Wellbeing Study (n = 4,898), we investigated the longitudinal measurement invariance of a proposed measure of syndemic conditions among mothers over five waves and performed path analysis to investigate the relationships between TANF use, TANF sanctions, and EH with syndemic conditions.
The RWJF-sponsored 2010 report, The Future of Nursing: Leading Change, Advancing Health (FoN), fostered creation of the Campaign for Action (Campaign) as a mechanism to monitor and enact the FoN report's recommendations. Influenced by RWJF's Culture of Health initiative, Campaign efforts refocused to include the social determinants of health (SDOH), with an additional action area entitled "Building Healthier Communities" (BHC). This study describes nursing activities in the BHC action area relative to the six initial FoN core action areas and assesses the extent to which nursing actions in the BHC action area align with public health conceptions of the SDOH.
View Article and Find Full Text PDFIntroduction: Low- and middle-income, middle-aged adults have high rates of disease and death from chronic disease, yet their participation in self-management programs is low. This may be because advertisements for such programs often target elderly, predominantly white, affluent adults. Our study used data from a parent randomized controlled trial to identify theoretically driven advertisement cues to engage low- and middle-income, middle-aged adults in the Chronic Disease Self-Management Program (CDSMP).
View Article and Find Full Text PDFAdolescent girls and young women (AGYW) ages (15-24 years old) in Southern and Eastern Africa account for nearly 30% of all new HIV infections. We conducted a systematic review of studies examining the effectiveness of behavioral, structural, and combined (behavioral + structural) interventions on HIV incidence and risky sexual behaviors among AGYW. Following PRISMA guidelines, we searched PubMed, CINAHL, Web of Science, and Global Health.
View Article and Find Full Text PDFBackground: To describe how pediatric cancer-induced financial distress and perceptions of their social role affected fathers' psychological responses to this distress, and quality of life (QOL) for them and their families.
Procedure: We analyzed father-only responses from a larger cross-sectional survey study about the impact of pediatric cancer-induced financial distress on parents. Our analytic sample was n = 87 fathers who participated in the larger study.
Background: Increasing the diversity of the nursing workforce is a high priority for addressing the nursing shortage and for developing a workforce capable of meeting the cultural needs of an increasingly diverse population. The purpose of this study was to identify student perspectives on the (1) influence of family, friends and others on nursing as a career choice and (2) optimal recruitment strategies to enhance diversity in schools of nursing.
Method: Twenty-two diverse, underrepresented baccalaureate nursing students (including underrepresented ethnic minorities, economically disadvantaged students, and men) participated in two focus groups.
J Nurse Pract
February 2020
One in five U.S. women have migraine.
View Article and Find Full Text PDFBackground: Pediatric cancer-induced financial burden is source of stress for parents, particularly mothers, single parents, and parents with lower incomes. This financial burden has been linked to poorer family quality of life (QOL) in terms of new onset material hardships, and could also affect individual QOL in terms of parents' stress-related symptoms. Our purpose was to describe pediatric cancer-induced financial burden among parents of children with that diagnosis, its effects on their stress-related symptoms (distress, anxiety, cognition impairment, sleep impairment), and associations between select risk factors (relationship to the child, marital status, income) and the extent that financial burden affected parents' symptoms.
View Article and Find Full Text PDFPurpose: To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use.
Participants & Setting: 27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States.
Methodologic Approach: This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews.
Background: Although the Chronic Disease Self-Management Program (CDSMP) improves chronic disease outcomes, little is known about CDSMP participation in populations less than 65 years of age. We explore study and CDSMP participation rates by demographic characteristics with younger (40-64 years old), lower-to-middle wage workers with chronic disease in a randomized clinical trial (RCT) conducted in North Carolina.
Methods: Descriptive statistics and regression models were used to examine associations between demographic, chronic disease burden, and employment variables, and time-dependent study enrollment and intervention participation outcomes that ranged from initiating consent (n = 1,067) to CDSMP completion (n = 41).
The purpose of this article is to explicate a conceptual framework for financial toxicity in pediatric oncology to guide nursing practice and research. The framework is based on one for financial outcomes of severe illness attributed to Scott Ramsey and adapted by the National Cancer Institute to describe relationships between preexisting factors, a cancer diagnosis, financial distress, and health outcomes for adult cancer patients and survivors. The adaption for pediatric oncology was informed by the results of a systematic scoping review to identify advances and gaps in the recent literature about the personal costs of illness to parents in the pediatric oncology context.
View Article and Find Full Text PDFPurpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults.
Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT).
Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017.
Background: A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine-a debilitating neurobiological condition without cure that disproportionately disables vulnerable women.
Objective: The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations.
Methods: Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management.
Background: The theoretical landscape of health disparities research now emphasizes health inequities and the role that social determinants of health (SDOH) play in creating and perpetuating them. Whether National Institutes of Health (NIH) funding patterns reflect this theoretical shift is unknown.
Objectives: The aim of this study was to examine the National Institute of Nursing Research's (NINR) funding for research focused on health disparities, health inequities, and SDOH, relative to other key NIH institutes.