An Exploratory Model of Shared Decision-Making in Women\u27s Reproductive Health in Indiana: A Cross-Sectional Study

Ecological approaches to shared decision-making (SDM) are underexplored in women’s reproductive health. The purpose was to identify ecological factors important to women in contraceptive and prenatal care SDM. In this cross-sectional study, women (18-45 years) living in Indiana who had sought reproductive healthcare completed an online survey (N=432). Multiple linear regression was utilized to identify predictors of SDM. Furthermore, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were conducted to explore ecological factors associated with SDM in contraception and prenatal care. Healthcare professional type was associated with decreased contraceptive SDM scores, but not prenatal care SDM scores. Access, social support, and patient-healthcare professional relationship demonstrated good global fit in confirmatory factor analysis. Path coefficients suggested significant relationships between these ecological factors and contraceptive and prenatal care SDM scores. Additionally, the ecological factors demonstrated good global fit for contraceptive and prenatal care SDM. Social support had a significant, strong, and inverse relationship with both contraceptive and prenatal care SDM in the models. Findings further SDM work by moving beyond option discussion and toward increased attention to women’s contexts and relationships. Taking a holistic approach to SDM and the patient experience ensures that women’s multi-faceted needs, influences, and preferences are met across healthcare settings

A Qualitative Investigation of Individual, Interpersonal, and Institutional Contributions to Postpartum Work-Family Balance

Managing personal and professional responsibilities may be challenging during the postpartum period, as employees navigate new roles, responsibilities, and family dynamics. The purpose of this paper was to understand the work/life balance experiences of diverse stakeholders and identify opportunities to improve the work environment. We conducted a series of in-depth focus groups with faculty, staff, and graduate students (n = 22), and in-depth interviews with administrators (n = 10) at a research-intensive university in the United States. A six-phase thematic analysis approach was used to examine the experiences and perspectives of individuals with different roles. Three themes with subsequent subthemes emerged: 1) employee role shapes perspectives on campus policies and practices; 2) confusion about policies exacerbates return-to-work issues; and 3) coworkers and supervisors are the primary sources of postpartum support in this workplace. Employees in our study expressed strong desires for clear, consistent institutional policies to ensure employees’ postpartum return-to-work experiences were not dependent on informal arrangements with coworkers and supervisors. Faculty, staff, and graduate student postpartum needs are shaped by individual, interpersonal, and community factors. Clear communication between individuals who make policy decisions and those who are subject to the policies may reduce employee issues during the postpartum period

“They Aren’t Going to Do Jack Shit”: Text-Based Crisis Service Users’ Perceptions of Seeking Child Maltreatment-Related Support From Formal Systems

Many of the children reported to child protective services (CPS) exhibit signs and symptoms that allow others to recognize their abuse or neglect and intervene; others, especially adolescents, must disclose their experiences to be identified. Relatively little is known about young people’s disclosure experiences, but individual, interpersonal, and cultural factors appear to influence when and how young people disclose. Technology-facilitated approaches, such as text- or chat-based hotlines or crisis services, may be one way to help young people share their maltreatment experiences and seek help. The current study contributes to the small body of literature that includes nonsexual maltreatment disclosures and sheds some light on how to support young people during their disclosures. We conducted a qualitative content analysis of all conversations from a text-based crisis service that resulted in a report to CPS (n = 244). Many of the texters had previously sought support from their peers or parents, and some had engaged with more formal systems. Many young people were hesitant to reach out to formal systems in the future, in part because of negative experiences during past disclosure experiences. Young people may be more likely to seek support through their preferred communication medium, so providing text- and chat-based communication may be one way to encourage and facilitate disclosure. As these resources become increasingly available, determining best practices for receiving disclosures through technology-facilitated platforms will be critical

Dataset identifying the posts and comments used in our

Dataset identifies the number of posts per day during our data collection efforts and the posts/comments included in our analysis</p

Factors Contributing to Filicide-Suicide: Differences Between Male and Female Perpetrators

Background: One-quarter of homicide-suicide deaths in the U.S. are children. Filicide-suicide, a subset of homicide-suicide involving parent or caregiver perpetrators, is the most common form of homicide-suicide involving children. While these incidents have significant impacts, relatively few studies examine modifiable factors that contribute to these incidents. Objectives: The purpose of this study was to identify patterns of circumstances and contributing factors for filicide-suicide deaths, focusing on the individual and interpersonal differences between male and female perpetrators. Participants: This study utilized data from the National Violent Deaths Reporting System (NVDRS), which included 76 filicide-suicide incidents reported to NVDRS in 32 U.S. states between 2013-2015. Methods: We conducted a qualitative content analysis, which was grounded in the Marzuk et al. (1992) framework. We reviewed the filicide-suicide narratives and engaged in conversations about codes or themes that emerged for the filicide-suicide narratives. Additional codes were added as needed, and narratives were retroactively coded to ensure codes were consistently applied. Results: Relationship conflict and mental health issues were common among male and female perpetrators, but the manifestation of these factors differed greatly. For female perpetrators, relationship conflict, mental health issues, and children’s chronic health issues commonly co-occurred. In contrast, relationship conflict, history of violence, and consequences of violence (e.g., legal issues, job problems) more commonly co-occurred among male perpetrators. Conclusion: Filicide-suicides are preventable acts of violence with numerous contributing factors. Our findings highlight the need for prevention efforts to be grounded in these interpersonal experiences, particularly the differences between male and female perpetrators differences

Interactions of adolescent social experiences and dopamine genes to predict physical intimate partner violence perpetration.

OBJECTIVES:We examined the interactions between three dopamine gene alleles (DAT1, DRD2, DRD4) previously associated with violent behavior and two components of the adolescent environment (exposure to violence, school social environment) to predict adulthood physical intimate partner violence (IPV) perpetration among white men and women. METHODS:We used data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health, a cohort study following individuals from adolescence to adulthood. Based on the prior literature, we categorized participants as at risk for each of the three dopamine genes using this coding scheme: two 10-R alleles for DAT1; at least one A-1 allele for DRD2; at least one 7-R or 8-R allele for DRD4. Adolescent exposure to violence and school social environment was measured in 1994 and 1995 when participants were in high school or middle school. Intimate partner violence perpetration was measured in 2008 when participants were 24 to 32 years old. We used simple and multivariable logistic regression models, including interactions of genes and the adolescent environments for the analysis. RESULTS:Presence of risk alleles was not independently associated with IPV perpetration but increasing exposure to violence and disconnection from the school social environment was associated with physical IPV perpetration. The effects of these adolescent experiences on physical IPV perpetration varied by dopamine risk allele status. Among individuals with non-risk dopamine alleles, increased exposure to violence during adolescence and perception of disconnection from the school environment were significantly associated with increased odds of physical IPV perpetration, but individuals with high risk alleles, overall, did not experience the same increase. CONCLUSION:Our results suggested the effects of adolescent environment on adulthood physical IPV perpetration varied by genetic factors. This analysis did not find a direct link between risk alleles and violence, but contributes to growing research indicating that if genetic factors contribute to perpetration, this relationship is likely complicated and the result of interactions with other factors

Characteristics and Circumstances Associated with Work-Related Suicides from the National Violent Death Reporting System, 2013–2017

Workplaces are critical in suicide prevention because work-related factors can be associated with suicide, and because workplaces can be effective suicide prevention sites. Understanding the circumstances associated with work-related suicides can advance worksite prevention efforts. Data from the United States Centers for Disease Control and Prevention, National Violent Death Reporting System from 2013 to 2017 were used to examine characteristics and circumstances associated with work compared with non-work suicides. Work-related suicides included those indicated as work-related on the death certificate or in which the death investigation mentioned a work problem or work crisis. Of the 84,389 suicides, 12.1% had some relation to the decedent’s work. Males, those aged 21–54, and with at least a college education, were most likely to have work-related suicides. The circumstances most strongly associated with work-related suicide were financial problems (Odds Ratio (OR) = 4.7; 95% Confidence Interval (CI) = 4.5–5.0), prior depressed mood (OR = 2.4; 95% CI = 2.3–2.5), and eviction/loss of home (OR = 1.6; 95% CI = 1.4–1.7). Suicides among healthcare practitioners and management occupations had the highest odds of being work-related. Workplace wellness programs can consider incorporating services, such as financial planning and mental health services, as potentially up-stream approaches to prevent work-related suicide

Estimated percent and 95% confidence intervals of adolescent exposure to violence, perceived school social environment, dopamine genes, and associations with physical IPV perpetration.

<p>Estimated percent and 95% confidence intervals of adolescent exposure to violence, perceived school social environment, dopamine genes, and associations with physical IPV perpetration.</p

Probability of perpetrating physical IPV, by polymorphism and perception of school social environment.

<p>Probability of perpetrating physical IPV, by polymorphism and perception of school social environment.</p

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

Abstract Background Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals’ perspectives with the patients’ to determine how sexual violence conversations should occur in these environments. Methods Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18–45 (n = 22) living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization. Results There were three resulting themes: (1) healthcare professionals’ approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize. Conclusions Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women’s reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes