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Guidelines for research recruitment of underserved populations (EERC)

Despite concerted efforts to establish health equity, significant disparities persist. One roadblock to eliminating health disparities is the inadequate recruitment of underserved populations, which prevents researchers from creating culturally-tailored interventions. To further develop the science of recruitment, we argue that a systematic approach should be applied to research participant recruitment. Given the lack of practical and comprehensive recruitment conceptual frameworks or guidelines in the literature, the authors propose newly synthesized guidelines for research recruitment of underserved populations: EERC (evaluate, engage, reflect, and carefully match)

Patient engagement in action: Timing and intensity of strategies used to engage low income depressed mothers of infants and toddlers

The purpose of this study was to illuminate the process of patient engagement and to determine how components of patient engagement were operationalized in the nurse-patient interpersonal relationship with low income, depressed mothers, a traditionally underserved population. Using a descriptive quantitative design, we examined how components of patient engagement were executed across three phases of the nurse-patient interpersonal relationship. We assessed for differences in engagement strategies used in different phases of the interpersonal relationship and with mothers with varying levels of engagement. Through this study, we observed that patient engagement has several dynamic components varying in intensity and frequency, depending on the phase of the nurse-patient relationship. Mothers varied in their degree of engagement. Lack of engagement by mothers limited the nurses’ use of engagement skills and strategies, thus underscoring the importance of effort and time spent in the orientation phase. Findings from this study can inform and advance the science of patient engagement by expanding the knowledge base and understanding as to the rhythm and flow of patient engagement in practice. Patient engagement requires persistence and variation of engagement strategies to establish an ongoing interpersonal relationship with patients. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Non-Pharmacological Interventions for Pain Management of Cognitively Impaired Nursing Home Residents: A Systematic Review

Background: Greater than 50% of nursing home (NH) residents are cognitively impaired, of which 45-80% experience pain on a daily basis. • Current evidence indicates suboptimal pain management of cognitively impaired older adults. • As residents with moderate to severe cognitive impairment are often unable to self-report pain, this subpopulation is at high risk for suffering. • This problem paired with age-related physiological changes that place older adults at risk for adverse reactions to pain medication suggests a need for non-pharmacological interventions. Purpose: In this systematic review, studies of non pharmacological interventions to reduce pain in cognitively impaired NH residents were reviewed. Study findings were assessed 1) to determine what interventions to reduce pain have been studied in cognitively impaired NH residents 2) to evaluate the effectiveness of these interventions, and 3) to assess the potential for these interventions to be implemented in NHs. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this systematic review. • Included studies were published in English after January 1, 2001, as JCAHO first established standards for pain assessment and treatment in 2001. • End of life interventions, single case studies, and dissertations were excluded. • PubMed, CINAHL, and Embase databases were searched on September 19, 2016. • A standardized data abstraction tool was utilized. • The quality of each study was evaluated regarding sample size, attrition, randomization, control, and blinding. • Data synthesis was conducted by using standardized vote counting within themes. Results: Across the 9 studies, there were 7 different measures of cognitive impairment and 8 different measures of pain. Studies reported 3 different categories of interventions: specialized dementia care units, training and tools to support pain assessment, and non-pharmacological therapies. Both studies of specialized dementia care units reported that residents on these units receive less pain medication than residents on open units. 2 of 4 interventions involving training and tools to support assessment were associated with deceased pain. The nonpharmacological therapies of reflexology, Passive Movement Therapy (PMT), and Namaste were all associated with a decrease in pain, but long-term maintenance of efficacy is unknown. The Namaste study was the only study to require nursing staff reorganization. In addition to the training required to implement pain assessment systems, interventionists of the 3 non-pharmacological therapies required training. No study noted the cost of implementation

Adapting the Family Management Style Framework for Families Caring for Older Adults With Dementia

This article presents an adaptation of the Family Management Style Framework (FMSF)-a well-established framework of family response to chronic condition care of children-to families caring for older adults with dementia. Using the FMSF to better understand how families manage dementia care can provide clinicians with insights on how to work effectively with families. Using data from interviews with eight female caregivers of older adults with dementia, this secondary analysis adapts the FMSF, and identifies new dimensions that apply specifically to families caring for older adults with dementia. The discussion draws comparisons between the family management of a child with chronic condition to management of an older adult with dementia. The article concludes with a discussion of how understanding how families manage care of an older adult with dementia informs assessment for management styles and the tailoring of interventions specific to family, caregiver, and older adult needs

Public Health Nursing Case Management for Women Receiving Temporary Assistance for Needy Families: A Randomized Controlled Trial Using Community-Based Participatory Research

Objectives. We evaluated the effectiveness of a community-based participatory research–grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. Methods. We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months. Results. Medicaid knowledge and skills improved (P<.001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR]=1.92; P=.007), and this likelihood increased in higher-risk subgroups (OR=2.03 and 2.83; P=.04 and .006, respectively). Depression and functional status improved in the intervention group over time (P=.016 for both). No differences were found in routine or preventive care, or general health. Conclusions. Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population

Supporting the Mental Health of Mothers Raising Children in Poverty: How Do We Target Them for Intervention Studies?

Poverty increases maternal stress by heightening exposure to negative life events, job loss, chronic strains, poor housing, dangerous neighborhoods, and conflict with partners, culminating in crippling depressive symptoms, the most prevalent mental health threat. Depressive symptoms interfere with the provision of the strong maternal support needed to counter the hardships of poverty, thus placing infants and toddlers at risk for delayed language, social, and emotional development. Initial clinical trials in high-risk mothers have shown promise, and successive tests of interventions will be strengthened if mothers who have mental health risks can be accurately targeted for inclusion. This article reports on a sequential, data-driven process by which high-risk mothers were targeted for intervention in two trials currently in progress to reduce depressive symptoms. An iterative process of using data to identify at-risk mothers and validate the presence of risk factors helped hone the recruitment and design of the intervention trials. This report also offers guidance for further study

Patterns of Distress in African American Mothers of Preterm Infants

Objective: To examine inter-relationships among stress due to infant appearance and behavior in the NICU, parental role alteration stress in the NICU, depressive symptoms, state anxiety, posttraumatic stress symptoms, and daily hassles exhibited by African American mothers of preterm infants and to determine whether there were sub-groups of mothers based on patterns of psychological distress. Method: 177 African American mothers completed questionnaires on their psychological distress at enrollment during infant hospitalization and 2, 6, 12, 18, and 24 months after term. Results: Psychological distress measures were inter-correlated. There were four latent classes of mothers: the low distress class with low scores on all measures; the high NICU-related stress class with high infant appearance and parental role stress and moderate scores on other measures; the high depressive symptoms class with high depressive symptoms and state anxiety and moderately elevated scores on NICU-related stress and post-traumatic stress symptoms; the extreme distress class with the highest means on all measures. Infants in the high stress class were sicker than infants in the other classes. The extreme distress class mothers averaged the lowest educational level. The classes differed on distress measures, worry about the child, and parenting stress through 24 months with the extreme distress class having the highest values. Conclusion: Although different types of maternal psychological distress were substantially related, there were distinct sub-groups of mothers that were identifiable in the NICU. Moreover, these sub-groups continued to differ on trajectories of distress and on their perceptions of the infants and parenting through 24 months after term. Originally published Journal of Developmental and Behavioral Pediatrics, Vol. 30, No. 3, June 200

Rules of engagement: Strategies used to enlist and retain underserved mothers in a mental health intervention

Patient engagement has been identified as both a goal and strategy to lower health care costs and improve health care outcomes. However, a lack of consensus and clarity exists as to how the process of patient engagement is implemented in clinical practice. Research addressing the underlying and crucial components of effective patient engagement is limited, leaving a significant gap as to how providers engage patients as active collaborators in their health and health care. This study provides specific, detailed insight and description into the processes through which advanced practice mental health nurses engaged low-income depressed mothers in a mental health intervention. The Interactive Care Model (ICM), a patient engagement framework, was used to examine and illuminate the key processes and partnership roles of patient engagement. Using a directed content analysis approach, we completed a secondary analysis of nursing narrative data using the 5 key processes and 7 partnership roles of the ICM to guide our analysis. The ICM demonstrated great utility in capturing the processes through which advanced practice nurses enlisted, engaged, and retained low-income depressed mothers in the mental health intervention. Additionally, the nursing narrative data provided specific detail and description as to how the ICM’s components were operationalized in practice. The ICM was validated by the nursing narrative data and provided sound organizational structure for the specific verbal and non-verbal engagement interventions nurses employed. Findings from this study can expand the knowledge base and understanding of the process of patient engagement and can help guide providers in executing behaviors that engage traditionally unengaged patients as active collaborators in their health and health care