Postpartum Depression: A Sociocultural Quantitative and Qualitative Analysis of Adolescent and Adult Hispanic Mothers

This dissertation is a mixed methods analysis investigating postpartum depression as it is experienced by self-reported depressed Mexican American adolescent and adult mothers. The qualitative portion of this study explores pregnancy and motherhood to better understand meanings attached to depression. Six adolescent and six adult mothers, were recruited from the Dallas/Fort-Worth area. Each was interviewed twice, using semi-structured interview guides. The quantitative phase utilizes a national sample of self-reported depressed Hispanic mothers to identify breastfeeding behavior and mothers' perceptions of the physical health of their babies. Specifically, a secondary analysis of the National Survey of Children's Health, 2003 was used to supplement the qualitative data. This study provides a theoretical framework of fragmented identity to explain socio-cultural factors contributing to postpartum depression among Mexican American adolescent and adult mothers. Common themes leading to a fragmented identify were indentified. Contributors to postpartum depression include: unplanned pregnancy, internal struggle between cultures, body image and family conflict. Stigma associated with teen motherhood also contributed to depression among adolescent mothers while the medicalization of childbirth was a contributing factor of depression among the adult mothers. Additionally, the duration of breastfeeding and mothers' perceptions of their babies' physical health were impacted by depression, but breastfeeding initiation was not

Health-Related Quality of Life After Lobectomy for Lung Cancer: Conceptual Framework and Measurement

BackgroundLung cancer surgery has a significant impact on health-related quality of life (HRQOL). In prior studies of HRQOL after lung cancer surgery, researchers selected the HRQOL domains of interest. To increase the patient-centeredness of these studies, we conducted a qualitative study to ascertain which aspects of HRQOL are most relevant to them postoperatively and to identify Patient-Reported Outcome Measurement Information System measures most germane to patients undergoing lobectomy for lung cancer.MethodsWe conducted in-depth semistructured interviews with 25 patients after lobectomy for lung cancer to solicit input regarding the physical, social, and emotional HRQOL domains relevant after surgery. Interviews were transcribed verbatim, and a thematic content analysis to identify HRQOL themes was performed. Themes were integrated to create a conceptual framework to guide outcome measurement selection.ResultsQualitative analysis indicated that within the physical health domain, patients were most concerned about general physical function (100% of participants), pain (96%), fatigue (96%), and dyspnea (76%). Neuropathic pain was reported by 28% of participants. Instrumental (100%) and emotional social support (88%) and positive emotions/relief/hope (96%) were also important. Two cross-cutting themes were the desire to maintain independence (32%) and preparing for surgery/expectations (92%).ConclusionsOur results indicate that a number of physical, social, and emotional HRQOL domains are relevant after lobectomy for lung cancer. These domains are currently represented by Patient-Reported Outcome Measurement Information System measures and can be readily assessed for clinical or research purposes

Perceptions of Postpartum Depression among Adolescent Mothers and the Social Construction of Related Stigma

Six serial focus groups were used to explore the perceptions of postpartum depression among nine adolescent mothers. The discussions were tape recorded, transcribed and analyzed using symbolic interaction theory, specifically Goffman's concept of stigma. Participants identified major stigma themes in relation to postpartum depression, teenage pregnancy and motherhood, all of which were portrayed negatively in the media. Several key causes of adolescent postpartum depression were also found including self esteem relating to poor body image and social support. The findings indicate a much needed change in the way adolescent mothers are identified and treated for postpartum depression. Additionally, the importance of social support in preventing and treating adolescent postpartum depression is highlighted and programs addressing such concerns must be implemented

Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their childs needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. OBJECTIVE: Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. METHODS: This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. RESULTS: Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. CONCLUSIONS: ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format

Missing link: a qualitative analysis of community-based organisations contributions to partnered collaborative care to treat late-life depression.

OBJECTIVE: Extending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing patients social needs; however, little is known about how CBOs contribute to such partnered depression care. We explored how six primary care clinic and CBO partnerships came together to provide late-life depression care through the Care Partners funded in 2014. DESIGN: 43 key informant interviews and 15 focus groups were conducted with care managers, administrators and primary care providers partnering to provide late-life depression care. Data were coded and analysed iteratively using qualitative thematic analysis. SETTING: Six primary care clinic-CBO sites across California. PARTICIPANTS: Care managers, administrators and primary care providers participated in this study. RESULTS: Three unique contributions of CBOs to depression care in these clinic-CBO partnerships were identified: (1) CBOs added new services that focus on social needs and enhanced depression care; (2) CBOs strengthened core aspects of collaborative care for depression; (3) CBOs provided new avenues for building connections and trust with underserved patients. CONCLUSIONS: CBOs, when partnered with clinics, enhanced both medical and social aspects of depression treatment for older adults. CBOs are well positioned to assist primary care clinics in treating the complex health needs of older adults by providing new and strengthening existing aspects of partnered depression care while building patient trust among culturally diverse populations

Pilot randomized controlled trial Protocol: Life context-informed pre-visit planning to improve care plans for primary care patients with multiple chronic conditions including diabetes.

BackgroundMultimorbidity is common, and care is impacted by patient life context. Effective, efficient interventions to improve patient-centered outcomes such as perceived treatment burden are limited. There is a need for interventions that integrate patient contextual information into primary care encounters to improve such outcomes. Patient life context is a multitude of factors that influence a patient's life and healthcare, including social determinants of health and broader elements such as family and work demands.MethodsThis pilot randomized controlled trial (RCT) protocol will compare standard pre-visit planning to context-informed pre-visit planning that incorporates the patient's life context, for patients with diabetes plus other chronic comorbid conditions. Primary outcomes include measures of trial protocol and intervention feasibility and acceptability: physician study and visit perceived burden, patient satisfaction, and patient, physician and staff experience with the trial. Additional measurements of intervention impact include: initial estimates of effect size on patient treatment burden and other patient-oriented outcomes, change in glycemic control, and other intermediate medical outcomes.DiscussionThis intervention is novel as it collects patient life context information using a direct person-to-person approach, allows physicians to review the information prior to patient arrival at the clinic and, where appropriate, incorporate it when negotiating treatment plans, and is longitudinal, summarizing evolving contextual information over time. This pilot RCT has the potential to demonstrate trial protocol and intervention feasibility and acceptability, and estimate effect size on patient and provider outcomes, to inform for a future, definitive RCT.Trial Registration: This trial was registered at ClinicalTrials.gov prior to patient enrollment: NCT04568382

Perceptions of patients with wounds due to chronic limb-threatening ischemia

Patients with chronic limb-threatening ischemia (CLTI) face numerous barriers to caring for lower extremity wounds. We explored the perceptions of CLTI patients to their wound/management and sought to determine attitudes towards their vascular provider as well as willingness for management through telemedicine. Patients admitted to hospital for treatment of Rutherford Grade 5 and 6 CLTI were asked complete a wound evaluation survey and took part in a semi-structured interview. Semi-structured interviews were recorded, transcribed, and analyzed using an inductive coding strategy. Codes were grouped for thematic analysis and aggregated into assertions. Eleven patients with a mean age of 60 years (35-79 years) were interviewed. All patients had peripheral artery disease (PAD) and eight patients had diabetes as well. Three overarching themes were identified. First, patients appear to have limited coping mechanisms and are overwhelmed by the care of their wounds. Second, in this cohort of patients, many had become passive observers of their care as demonstrated by a limited understanding of their disease processes and detachment from wound management. The third theme was how strong the desire to do everything to prevent limb loss was, but patients acknowledged this is hard to translate into real life with limited resources. Patients with CLTI have concerns that vascular providers must recognize and address to build strong patient-provider relationships and increase activation for management of their wounds and other medical conditions. Patients who have access to technology and with guidance may be able to understand getting care through remote medicine

Moving beyond referrals to strengthen late-life depression care: a qualitative examination of primary care clinic and community-based organization partnerships.

BackgroundNational guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults.MethodsWe conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants' experiences with the partnered initiative.ResultsWe found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations.ConclusionsThese findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities

Is sleep really for sissies? Understanding the role of work in insomnia in the US

This study explores the role of work in patient narratives about their experiences with insomnia. "Work" includes such facets as the nature of one's occupation, the associated volume or amount of work required, mental demands related to work, work schedules and work-related stress. Interviews conducted with 24 patients aged between 22 and 74 receiving treatment for insomnia at one of two sleep medicine clinics in Oregon and Texas, USA, suggest that work is a pivotal influence in shaping interpretations of the nature of insomnia, its causes, and the efficacy of medical treatment. Results suggest correlations between sleeplessness and modern working lifestyles in American culture, in which labor seems to transcend the physical workplace, manifesting itself in the form of cognitive labor or continued problems into retirement. Patients often cite work as the primary causal agent in the development of their insomnia, their primary reason for needing "good" sleep, their impetus for seeking medical attention, and behavioral compliance with a medically prescribed regimen. Insomnia as an illness experience thus serves as a mechanism through which respondents consciously or unconsciously comment on the nature of work in their lives. The medical and social implications of these results are discussed.USA Insomnia Work Sleep disorders Explanatory models Illness experience Cognitive labor