Embrace the good, refuse the bad: Haitian American children's selective engagement with the United States

This qualitative research study investigates the perceptions of children, parents, and staff members at a Boston multi-service nonprofit for Haitian immigrants. It is an exploration of how children cultivate their identity, and how a center for immigrants functions in the current sociopolitical climate. There is an evidentiary lacuna of qualitative explorations on children of immigrants’ perceptions and health. The COVID-19 pandemic makes this issue even more temporally relevant, as new data suggests structural factors make marginalized groups, such as people of color and immigrants, more vulnerable to infection and death. This study will contribute to the body of work on children of immigrants’ health by 1) analyzing the unique child perspective, as opposed to focusing entirely on adults or using quantitative child measures, 2) employing qualitative data to create more robust depictions of lived experiences, 3) and situating data in the particular Haiti/U.S. historical, political relationship. This study’s methodology includes ethnographic participant observation during regular visits to a nonprofit organization for immigrants (Fanmi Nou) over the course of several months, semi-structured video interviews with children, parents, and staff members of this organization, and content analysis of documents produced by Fanmi Nou. Through different waves of migration to the United States, children of Haitian immigrants have lived bicultural lives. In the last four years, however, biculturalism and transnationality have come under growing assault. As a reactionary response to overt hostility, parents, staff members at Fanmi Nou, and children themselves, actively promote a Haitian identity in children. Living under an administration characterized by its hostility to immigrants, Haitian American children pick and choose which aspects of American life to welcome and which to reject. Through a multi-service nonprofit organization, these children and their families selectively engage with the U.S. political, educational, and social systems. I argue that these children and this organization strategically support the healthy development of self under these new restrictions

A Mixed-Methods Comparison of Interventions to Increase Advance Care Planning.

PURPOSE: Although interventions can increase advance care planning (ACP) engagement, it remains unclear which interventions to choose in primary care settings. This study compares a passive intervention (mailed materials) to an interactive intervention (group visits) on participant ACP engagement and experiences. METHODS: We used mixed methods to examine ACP engagement at baseline and six months following two ACP interventions. Eligible patients were randomized to receive mailed materials or participate in two ACP group visits. We administered the 4-item ACP Engagement survey (n = 110) and conducted interviews (n = 23). We compared mean scores and percent change in ACP engagement, analyzed interviews with directed content analysis to understand participants ACP experiences, and integrated the findings based on mailed materials or group visits intervention. RESULTS: All participants demonstrated increased ACP engagement scores. At six months, group visit participants reported higher percent change in mean overall score compared with mailed materials participants (+8% vs +3%, P < .0001). Group visits participants reported that being prompted to think about end-of-life preferences, gaining knowledge about ACP, and understanding the value of completing ACP documentation influenced their ACP readiness. While both interventions encouraged patients to start considering and refining their end-of-life preferences, group visits made patients feel more knowledgeable about ACP, highlighted the importance of completing ACP documentation early, and sparked further ACP discussions with others. CONCLUSIONS: While primary care patients may benefit from mailed ACP materials, patients reported increased readiness after ACP group visits. Group visits emphasized the value of upstream preparation, ongoing conversations, and increased knowledge about ACP

Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Objective New paediatric sepsis criteria are being developed by an international task force. However, it remains unknown what type of clinical decision support (CDS) tools will be most useful for dissemination of those criteria in resource-poor settings. We sought to design effective CDS tools by identifying the paediatric sepsis-related decisional needs of multidisciplinary clinicians and health system administrators in resource-poor settings.Design Semistructured qualitative focus groups and interviews with 35 clinicians (8 nurses, 27 physicians) and 5 administrators at health systems that regularly provide care for children with sepsis, April–May 2022.Setting Health systems in Africa, Asia and Latin America, where sepsis has a large impact on child health and healthcare resources may be limited.Participants Participants had a mean age of 45 years, a mean of 15 years of experience, and were 45% female.Results Emergent themes were related to the decisional needs of clinicians caring for children with sepsis and to the needs of health system administrators as they make decisions about which CDS tools to implement. Themes included variation across regions and institutions in infectious aetiologies of sepsis and available clinical resources, the need for CDS tools to be flexible and customisable in order for implementation to be successful, and proposed features and format of an ideal paediatric sepsis CDS tool.Conclusion Findings from this study will directly contribute to the design and implementation of CDS tools to increase the uptake and impact of the new paediatric sepsis criteria in resource-poor settings