still Here, Trying To Find My Way : Understanding The Experiences Of Hiv Disruption And Reorganization Among Older African Americans In Detroit

Adults aged fifty and older are the fastest growing age group with HIV/AIDS. Research on older adults with HIV has focused primarily on health status and physiological changes that occur as people age with HIV. However, little is known about the socio-cultural consequences that occur when older adults are diagnosed with HIV and as they age with HIV. Drawing from an anthropological approach to the life course and Becker\u27s (1997) framework of life disruption, this dissertation research explored to what extent people experienced disruption from living with HIV and reorganized their lives after experiencing disruption. The specific aims included identifying and describing (1) how experiences of living with HIV map onto Becker\u27s (1997) framework of life disruption and (2) the major disruptions and socio-cultural consequences of aging with HIV. This dissertation study took place from January to September 2009. The dataset consisted of data previously collected from a larger parent study (2002-2006) and in-depth interviews with older African Americans living with HIV (N=14) and health care professionals (N=3) collected in 2009. Findings from the qualitative analysis of interviews reveal patterns of living with HIV that support and conflict with Becker\u27s framework of life course disruption and reorganization. Participants described experiencing major disruptions to sexuality and intimacy since living with HIV. This dissertation research provides insight into understanding how HIV impacts the expectations and experiences of older adults living with HIV and the ongoing importance of sexuality and intimacy throughout the life course

Perceived and functional disability in adults with chronic pain: what accounts for discrepancies?

Disability among patients with chronic pain can be assessed functionally (behaviorally) or subjectively (self-report). However, discrepancies--including low or zero correlations--between these methods are commonly reported. Research suggests that subjective disability may be more influenced by psychosocial factors than disability measured during functional tasks, leading to under/over reporting, but further investigation is needed. This study sought to identify correlates of discrepancies between subjective and functional disability in two samples of patients with chronic pain. Retrospective data was compiled from clinical records of 389 patients evaluated at a university multidisciplinary chronic spinal pain treatment program (52.7% men; 88.9% White, 9.8% Black; spinal pain duration M = 53.54 months; 74.2% reported low back pain; 18.1% did not complete high school, 30.9% completed high school, 36.6% attended some college or vocational training, and 14.1% had a college degree or higher). A sample of 174 adults with rheumatoid arthritis (RA) was recruited from rheumatology clinics (84% women; 55% White, 44% Black, 1% Hispanic; age M = 54.6 years; education M = 13.5 yrs; RA duration M = 11.2 yrs). In each sample markers of psychosocial adjustment (e.g., depression, pain, coping, disability status), subjective disability, and functional disability were assessed. Subjective and functional disability measures were standardized, and a discrepancy score calculated (functional - subjective). Results identified a salubrious pattern of disability discrepancy (subjective \u3c functional), which was associated with less pain, better social functioning, more adaptive coping, and less dysfunctional coping in the chronic spinal pain sample (small to medium effect size, p \u3c .05). The salubrious discrepancy pattern was inversely associated with disability compensation, depression, negative affect, pain, and dysfunctional coping in the RA sample (small effect size, p \u3c .05). Kinesiophobia, religion, and positive affect were not associated with the discrepancy score. The discrepancy pattern where subjective \u3e functional was not associated with any markers of healthy adjustment. Overall, markers of better psychosocial adjustment were modestly associated with the salubrious pattern of functional \u3e subjective disability, whereas poor adjustment was associated with the reverse discrepancy pattern. Theoretical and clinical implications of these findings are discussed

Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial

Background and purpose: Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. Methods: Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. Results: On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. Conclusions: Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from an emotional expression or emotional reduction approach to chronic pain

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Background: One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual Shark Tank competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. Methods: Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. Results: Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. Conclusions: Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA\u27s DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability

Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration

IntroductionThe Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA.MethodsOrganized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators.ResultsIn the first eight Shark Tanks (2016–2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank.ConclusionDoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations