A community perspective on the role of fathers during pregnancy: a qualitative study

BACKGROUND: Defining male involvement during pregnancy is essential for the development of future research and appropriate interventions to optimize services aiming to improve birth outcomes. Study Aim: To define male involvement during pregnancy and obtain community-based recommendations for interventions to improve male involvement during pregnancy. METHODS: We conducted focus groups with mothers and fathers from the National Healthy Start Association program in order to obtain detailed descriptions of male involvement activities, benefits, barriers, and proposed solutions for increasing male involvement during pregnancy. The majority of participants were African American parents. RESULTS: The involved “male” was identified as either the biological father, or, the current male partner of the pregnant woman. Both men and women described the ideal, involved father or male partner as present, accessible, available, understanding, willing to learn about the pregnancy process and eager to provide emotional, physical and financial support to the woman carrying the child. Women emphasized a sense of “togetherness” during the pregnancy. Suggestions included creating male-targeted prenatal programs, enhancing current interventions targeting females, and increasing healthcare providers’ awareness of the importance of men’s involvement during pregnancy. CONCLUSIONS: Individual, family, community, societal and policy factors play a role in barring or diminishing the involvement of fathers during pregnancy. Future research and interventions should target these factors and their interaction in order to increase fathers’ involvement and thereby improve pregnancy outcomes

Developing Novel Approaches to Improve Participant Comprehension of a HIV Vaccine Trial Informed Consent Protocol

Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Translational Biomedical Sciences Program, 2015.In preventative HIV vaccine trials, there is a fundamental need to improve volunteer understanding of information provided in the informed consent process, given the complex concepts associated with HIV vaccination. HIV disproportionately affects economically and socially disadvantaged persons, who are most needed in these trials; the current gap in volunteer understanding may be even greater for persons in these groups and prove prohibitive to their participation. Thus, the overall objective of this study was to develop a culturally tailored informed consent process that can improve the understanding for economically and socially disadvantaged persons at the University of Rochester HIV Vaccine Trial Network Clinical Research Site (UR-HVTN-CRS). In this vein a quantitative evaluation instrument was developed using feedback from focus groups with former vaccine participants (n = 10), HIV vaccine trial staff members (n = 7) and a review of the literature. Community members (n = 51) were recruited to undergo the standard consenting process, and evaluate their experience using the developed instrument, which examined several factors including knowledge of vaccine concepts, willingness to participate, overall satisfaction and suggestions for improvement. This evaluation revealed a need for greater use of mixed media mode of information presentation, additional HIV vaccine related content and an overall knowledge score of 2 (Max. = 4, 95% C.I. 1.83, 2.36). Based on this evaluation, educational materials geared towards various learning style formats (props, large posters, graphical brochure) and a shorter consent form were developed to modify the standard process. A further 25 community members were recruited to undergo the modified process and comparisons made with participants that experienced the standard consent for the key outcomes understanding (knowledge score), and willingness to participate. With the exception of age, participants in the two groups had no statistically significant differences in demographics assessed. Multiple Regression analyses controlling for age, gender, educational level, wealth gradient and race revealed that the modified process resulted in an approximate one point (25%) increase in overall knowledge scores which was statistically significant (Max. points = 4, Mean difference = 0.795, p = 0.001, 95% C.I. of difference 0.286,1.259, Power 91.0 %). Mean score for modified consent group was approximately 3 (Std. Error = 0.190, 95% C.I. 2.498, 3.254). Overall satisfaction with the process did not appear to increase significantly with the modified consent. The study reveals key lessons that can be used to improve the consenting process in HIV vaccine trials as well clinical trials on a broader scale. Tailoring to various learning styles, more concise consent forms, emphasis on strong one on one interactions between participant and trial staff members, and key concepts being depicted across multiple media formats for reinforcement are all crucial to improving understanding particularly for those of lower income brackets. Findings from this study can also be used to guide the continuum of institutional review board policy on informed consent

A Qualitative Analysis of Family Dynamics and Motivation in Sessions With 15 Women in Drug Treatment Court

Women with substance use disorders (SUDs) often experience inadequate health care, mental and physical health problems, trauma, lack of social support, and undermining of support for psychological needs of autonomy, competence, and relatedness needed for motivation and well-being. For women with SUD trying to reclaim sobriety and a healthy life, family can present both barriers and support. The aim of this study is to gain a deeper understanding of the intersection of family relationships with motivation of women in Drug Treatment Court (DTC) to attain their health goals. Data consist of transcribed intervention sessions between trained peer interventionists and 15 DTC participants from The Women’s Initiative Supporting Health DTC Intervention Study. This analysis uses a qualitative framework approach to analyze the data. The Self-determination Theory of human motivation and Family Systems Theory provide the conceptual framework to understand how participants’ expressions of motivation-related basic needs of autonomy, competence, and relatedness and change-related behaviors interfaced with family support. Analysis revealed more mentions of family in motivation-supportive contexts than in motivation-thwarting contexts, but highlighted complex roles families can play in health of women in recovery from SUD. Providers may be able to incorporate this knowledge to address the needs of this challenging population

Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness

OBJECTIVE: We evaluate the impact of the Healthy Start intervention program on feto-infant morbidity within a community setting. METHODS: Prospective data from 2002 to 2007 within the ongoing Federally funded Healthy Start intervention project in Central Hillsborough County were merged with corresponding birth outcomes data from the Florida Department of Health. The impact of the project on the following feto-infant morbidity indices was assessed among service recipients: low birth weight (LBW), very low birth weight (VLBW), preterm, very preterm, small for gestational age (SGA) and a composite feto-infant morbidity outcome. Program effectiveness and impact were measured using odds ratios from logistic regression models and number needed to treat (NNT). RESULTS: The risk for low birth weight (OR = 0.7; 95% CI = 0.5-1.0), preterm (OR = 0.7; 95% CI = 0.5-0.9) and the composite feto-infant morbidity outcome (OR = 0.8; 95% CI = 0.6-0.9) was reduced among service recipients (N = 536) as compared to non-recipients (N = 2,815). A clinically important level of risk reduction was also noted for very low birth weight (OR = 0.5; 95% CI = 0.2-1.1) and very preterm (OR = 0.6; 95% CI = 0.3-1.2) although these did not reach statistical significance. The adjusted NNT was lowest for the composite feto-infant morbidity outcome (18), preterm birth (21) and low birth weight (24), and highest for very preterm (86) and very low birth weight (74) events. CONCLUSIONS: In a disadvantaged community setting, the Healthy Start intervention program was found to reduce the risk for very low birth weight and preterm births by about one-third

OBESITY RESEARCH AND THE FORGOTTEN AFRICAN AMERICAN CHILD

Background/Objectives: Obesity/overweight is the most prevalent nutritional problem in adult and pediatric populations in the United States. We review up-to-date data on obesity in general, with emphasis on research findings in children. We also focus on non-Hispanic Blacks, an ethnic group that is relatively underresearched, despite having higher rates of obesity than Whites. Methods: An electronic search of MEDLINE/ PubMed and several other bibliographic databases, including JSTOR, EBSCO, and Pro- Quest, was conducted, and all relevant articles in English were retrieved. Results: Risk factors for childhood obesity are attributable to a combination of genetic and environmental factors. Literature has focused on the general population and genetic transmission from parents to children. Researchers agree that although genetics plays a major role, the risk of a child becoming obese is highly correlated with environment, as well. Relatively little research has been conducted to delineate obesity risk factors among Blacks, and virtually nothing is known on the determinants of obesity and obesity phenotype acquisition in the Black child. Conclusions: Genetic and environmental factors play a role in the development of childhood obesity. Despite the rich body of work on the topic, data that specifically address childhood obesity in Blacks are scanty. We need more information on childhood obesity in Blacks so that evidence-based prevention measures can be formulated to reduce the high prevalence of obesity in that population

House Ball Community Leaders’ Perceptions of HIV and HIV Vaccine Research

Background or Objectives: Worldwide, men who have sex with men (MSM) and Transgender persons are vulnerable to psychosocial factors associated with high risk for HIV, and suffer disproportionately high rates of HIV/AIDS. In the United States (US), the House Ball Community (HBC) is a social network comprised predominantly of Black and Hispanic MSM and Transgender persons who reside in communal settings. This study explores Western New York HBC leaders’ perceptions of HIV in their communities and their knowledge of HIV prevention strategies, including HIV vaccine trials. Methods: The project was conducted using an exploratory approach based on the principles of Community-Based Participatory Research (CBPR) methods. An HIV behavioral risk assessment provided descriptive data, while qualitative measures explored psychosocial and behavioral factors. Results: Behavioral assessments indicated high levels of risky sexual behaviors and experiences of violence. Interviews with 14 HBC leaders revealed that knowledge of HIV and local HIV vaccines trials was limited. Barriers to HIV knowledge included fear of peer judgment, having inaccurate information, and lack of formal education. Experiencing violence was identified as barrier to positive health behavior. Nevertheless, the HBC was described as a safe and creative space for marginalized MSM and Transgender youth. Conclusion and Global Health Implications: Findings suggest that the interrelation between health problems and social context amplify HIV risk in the HBC. The organizational structure and resources of the HBC, and MSM/Transgender communities worldwide can be instrumental in informing interventions to address HIV-related risk behaviors and create appropriate recruitment tools to ensure their representation in HIV research. Key words: • LGBT • HIV • MSM • Transgender populations • MSM/Transgender psychosocial • HIV risk factors • HIV and black/Latino MSM • Syndemic factors • MSM/Transgender communities   Copyright © 2020 Alio et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited