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

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

An anxiety management intervention for people with substance use disorders (ITASUD): An intervention mapping approach based on Peplau's theory

Background The comorbidity of anxiety and drug use disorders complicates treatment prognosis, and one of the greatest challenges is to address the environmental and behavioral factors involved. The aim of this study was to describe the uses of intervention mapping in the design of a theory and evidence-based complex intervention to develop skills around the management of anxiety for cocaine users in outpatient addiction treatment. Methods The six steps of the intervention mapping approach, which are needs assessment, creation of matrices of performance objectives, selection of methods and practical strategies, program development, adoption and implementation, and evaluation were applied to develop the Interpersonal Theory of nursing to Anxiety management in people with Substance Use Disorders (ITASUD) intervention. The theory used for the conceptual model was interpersonal relations theory. All theory-based methods and practical applications were developed at the individual level, acting in behavioral, interpersonal, organizational and community environments. Results The intervention mapping provided a broad overview of the problem and outcome expectations. The ITASUD intervention consists of five consecutive sessions of 110-min targeting individual determinants of anxiety (knowledge, triggers, relief behaviors, self-efficacy and relations), delivered by a trained nurse using Peplau's concepts of interpersonal relations. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change. Conclusions The intervention mapping approach increases the effectiveness of the intervention since the matrices provide a broad view of all factors that affect the problem and facilitate replication through transparency of the determinants, methods, and applications used. ITASUD addresses all factors that play an important role in substance use disorders based on a theoretical basis, which provides the translation of evidence from research into effective practice, policy, and public health improvements

Maternal Depressive Symptoms and Healthcare Expenditures for Publicly Insured Children with Chronic Health Conditions

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004–2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03–1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66–0.98) and total expenditures (OR 0.71; 95 % CI 0.51–0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending

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

Parenting Enhancement, Interpersonal Psychotherapy to Reduce Depression in Low-Income Mothers of Infants and Toddlers: A Randomized Trial

Depressive symptoms and clinical depression are highly prevalent in low-income mothers and negatively affect their infants and toddlers

Short-term in-home intervention reduces depressive symptoms in early head start Latina mothers of infants and toddlers

Depressive symptoms may compromise the ability of low-income Latina mothers with limited English language proficiency to parent their infants or toddlers. Eighty Early Head Start Latina mothers with limited English language proficiency were randomized to an advanced practice nurse-delivered, culturally tailored, in-home psychotherapy intervention, or to usual care. Repeated measures regression analysis showed a significantly greater decrease in depressive symptoms for intervention mothers compared to the usual care group at 22 and 26 weeks (4 weeks post intervention). Intervention mothers’ reports of their child's aggression diminished significantly from T1 to T4 compared to usual care mothers (p= .03). Self-efficacy appeared to only partially mediate the intervention effect, and maternal health moderated the intervention impact. Results indicate that the intervention reduced depressive symptoms and, compared to previous studies in this population, retention of mothers in both intervention and control conditions was improved

Caring as a Facilitator of Sensitive Research Studies with Immigrant Latino Families

Although caring is a fundamental concept in nursing, it is underutilized in our research with underserved populations and communities. Disch's definition of patient-centered care was adapted to define the elements of caring in research work with underserved communities. The study's purpose was to demonstrate how to conceptualize and operationalize caring in the research process. Demonstrating caring in our attitudes and actions is essential to the success of our research work. The proposed research process aids in applying caring into our engagement with community stakeholders and recruitment of minority participants, whether we conduct community-based participatory research or clinical trials

A Refined Model of Stress–Diathesis Relationships in Mothers With Significant Depressive Symptom Severity

BACKGROUND: Mothers’ depressive symptoms affect their children’s growth as well as physical and mental well-being. Moreover, mothers of young children with developmental delay or disability (DD) tend to have higher depressive symptoms. AIMS: The purpose of this study was to examine associations between maternal depressive symptoms and number of children with DD among mothers with significant levels of depressive symptoms, while accounting for maternal diathesis factors and family stress factors. METHOD: This study was a secondary analysis of pooled baseline data collected from 2004 to 2012 in the northeastern and southeastern United States from three intervention studies to reduce depressive symptoms of mothers with young children ( n = 364). Multiple regression analyses were conducted to examine associations between maternal depressive symptoms and number of children with DD, followed by the post hoc pairwise comparison. RESULTS: In the model including family stress factors, we found a significant test for linear trend in the mean for maternal depressive symptoms across the number of children with DD ( F[1] = 4.3, p = .0388). CONCLUSIONS: Mothers who have multiple children with DD tend to experience higher depressive symptoms; thus, interventions are needed to help prevent these mothers from experiencing higher depressive symptoms or to reduce their current depressive symptoms. Both theory-based and strength-based interventions can target conflict management at the family level, reducing maternal depressive symptoms while improving mothers’ self-efficacy, which would help mothers care for their own health, manage family conflict, and seek appropriate support to manage the children’s medical and developmental needs