Adult Health Care Research Articles

The Promotion of Non-Communicable Disease Screening in Gurage Zone, Ethiopia: A Mixed-Method Study

Background: Despite the high non-communicable disease (NCD) mortality in Ethiopia, NCD screening in the country remains suboptimal. This study assessed the health communication process and materials designed to promote NCD screening among adult primary healthcare facility attendants in the Gurage Zone, Ethiopia. Methods: A parallel mixed-methods approach was employed. Seven health communication materials were evaluated using the Modified Clear Communication Index Score by the Center for Disease Control and Prevention (CDC). Seven key informants who were involved in the production were interviewed to explore the process. Users’ satisfaction with the materials was assessed through a cross-sectional survey (N = 412). We used multivariable logistic regression with SPSS version 27 software to determine the factors associated with users’ satisfaction. Thematic analysis was applied for the qualitative data analysis using Opencode 4.03 software. Results: Qualitative interviews indicated that the production process relied on evidence, involved stakeholders, and included pretesting. The CDC index score revealed that five of the seven materials were considered clear and user-friendly, whereas two required improvement. Overall users’ satisfaction with the material was high with a mean score of 22.10 (SD ± 2.34; min: 14, max: 25). Age and educational status had significant positive association with users’ satisfaction. Conclusions: Developing health communication materials on promoting NCD screening based on evidence, stakeholders’ input, and pretesting can lead to good quality material and user satisfaction. We recommend future research works to measure changes in NCD screening service uptake as a result of using the health communication materials considered in this study.

Unmet Needs of Children and Young Adults With ADHD: Insights From Key Stakeholders on Priorities for Stigma Reduction.

Individuals with ADHD continue to face stigma, which can negatively impact their access to, adherence to, and quality of mental health services, as well as their overall wellbeing. Perspectives of various stakeholders regarding priorities for stigma reduction remain underexplored. This study explores young adult, parent, teacher, and mental health care professional perspectives on unmet needs of children and young adults with ADHD in the Netherlands, in the context of stigma reduction. A total of 24 respondents participated in seven small focus group discussions (FGDs). The FGDs facilitated in-depth discussions exploring stakeholder group perspectives on unmet needs of children and young adults with ADHD in educational, professional, and social settings. Data was analyzed using thematic content analysis. Three thematic categories of unmet needs were identified: (1) a lack of awareness, knowledge, and understanding of ADHD; (2) insufficient personalized approaches in education and health care; and (3) limited accessibility of information and support services. Within theme 1, respondents primarily highlighted the importance of improving education for primary school teachers and mental health care professionals. Theme 2 underscored the need for increased capacity for personalization and attention to the sociopsychological factors of ADHD, alongside recognizing strengths. Theme 3 emphasized the need for easy access to reliable information and mental health care, including peer networks, as well as proper follow-up and continuity of care. Findings highlight the need for improving our understanding of ADHD as a complex biopsychosocial condition, which requires specific adjustments in education and mental health care. Interventions to improve support and disrupt stigmatization should meet diverse needs, incorporate multi-level strategies, and involve key stakeholders.

Mastectomy Surgical Recommendations for Female-to-Male Transgender Patients, and a Discussion of Gender-Affirming Care for Gender-Dysphoric Adolescents

Introduction: Subcutaneous mastectomy (top surgery) in female-to-male patients is one of the most common procedures gender-dysphoric patients will undergo in order to live as their desired gender. Procedure: By consistently using the technique described in this article, surgeons can achieve consistent and aesthetically pleasing results. Complications are rare, but it is important to inform the patient that there may be issues related to bleeding, infection, wound healing, nipple necrosis (if using a graft), or dog ears. Discussion: Multiple states in the United States are seeking to ban this type of care and are even attempting to restrict health care for adults. These bans are being enacted despite carefully researched and written guidelines from major international organizations. By following these guidelines, physicians can provide safe and evidence-based care to adolescents. Conclusion: The evidence conclusively demonstrates that providing gender-affirming care to patients of all ages improves their mental health, reduces rates of depression, and decreases the risk of suicide.

Standing balance test for fall prediction in older adults: a 6-month longitudinal study.

A core component of older adult health care assessment includes identifying fall risk, which also includes identifying those with subtle balance deficits. To compare body displacement of the Center of Pressure (CoP) and time held during the balance test. Also, to examine whether balance tests at baseline can predict falls after 6months. A longitudinal study with 153 community-dwelling older adults, between 60-89years old. Anteroposterior (AP) and mediolateral (ML) amplitude and velocity CoP displacements were assessed in four upright positions using a force platform: double-leg, semi-tandem, tandem, and single-leg stances, with a maximum duration of 30s each. Adjusted repeated measures ANOVA were used to compare the differences among the balance positions. Comparisons between males and females were also conducted. Logistic regression adjusted for confounders was performed to verify whether upright balance tests can predict future falls. As the base of support narrows, body sway increases. A decrease in stance time was observed across the balance stages, i.e., double-leg/semi-tandem versus tandem versus single-leg stances. The mean duration held in the single-leg stance was 14.8s and for tandem was 22.2s. Similar stance durations were observed for double-leg and semi-tandem stances. Males were able to maintain balance positions longer than females even with greater CoP displacement. ML amplitude of CoP displacement and the time held during tandem and single-leg positions were able to predict falls after 6months (p < 0.05). In clinical practice in which only stance time is recorded, it is possible to interchangeably use the double-leg or semi-tandem stance. To identify early signs of imbalance, we suggest setting a time limit for the balance test equal to or greater than 23s, as 10s appear to be insufficient to detect subtle balance deficits. The time maintenance on tandem and single-leg positions was able to predict future falls.

Virtual Healthcare for Older Adults With Preventable Chronic Conditions: A Meta-synthesis of Quality Aspects.

Our study employed a six-step meta-synthesis approach to understand quality aspects of virtual healthcare trajectories and identify effective strategies for older adults with preventable chronic conditions across the world. Review of twenty-one articles revealed four key themes: functionality of virtual healthcare, equity in service delivery, satisfaction with care, and cost-effectiveness. Despite the challenges posed by technological and clinical complexities, virtual healthcare initiatives have significantly improved accessibility and availability of health services, thereby reducing disparities. Notably, telehealth saved an average of 166-minutes of travel time, demonstrating a clear benefit of virtual healthcare. While all parties expressed satisfaction with virtual healthcare, several challenges were reported, including a digital divide, limited access to digital devices, absence of a multidisciplinary approach, and lack of rural-specific programs.

“It’s a Circus”: Family Caregivers’ Perceptions on Accessing Mental Health Care for Individuals with Intellectual and Developmental Disabilities

ABSTRACT Background Previous research has demonstrated that individuals with intellectual and developmental disabilities (IDD) experience a variety of barriers in accessing mental health care and that family caregivers often play an integral role in helping individuals with IDD navigate these systems. However, little research has focused on family caregivers’ perceptions of accessing mental health services. Methods To better understand their perspectives, we analyzed responses to an open-ended question about challenges to accessing mental health resources for adults with IDD from 208 family caregivers. Responses were analyzed using a team-based approach to qualitative data analysis. Results We identified five themes that capture both systematic issues and personal or interpersonal challenges that reduce access to high quality mental health care among adults with IDD. In addition to the barriers, we also identified some accounts of families succeeding in accessing adequate mental health care. Conclusions We offer practical implications for research, policy, and practice that can help reduce barriers to mental health care for adults with IDD.

Transitioning Together: Collaborative Work in Adolescent Chronic Illness Management

Adolescents with chronic illnesses need to learn self-management skills in preparation for the transition from pediatric to adult healthcare, which is associated with negative health outcomes for youth. However, few studies have explored how adolescents in a pre-transition stage practice self-management and collaborative management with their parents. Through interviews with 15 adolescents (aged 15-17), we found that adolescents managed mundane self-care tasks and experimented with lifestyle changes to be more independent, which sometimes conflicted with their parents' efforts to ensure their safety. Adolescents and their parents also performed shared activities that provided adolescents with the opportunity to learn and practice self-management skills. Based on our findings, we discuss considerations for technology design to facilitate transition and promote parent-adolescent collaboration in light of these tensions.

Effectiveness of transitional care in Inflammatory Bowel Disease; Development, Validation, and Initial outcomes of a Transition Success Score.

The effectiveness of transition programs from paediatric to adult healthcare in adolescents with inflammatory bowel disease is not clear, as prospective studies using validated outcome measures for transition are lacking. This study aimed to develop and validate a quantitative Transition Success Score, and to apply it in a multicenter setting to assess the effectiveness of transitional care. The Top 10 outcome items related to successful transition, identified through an international Delphi study with IBD stakeholders, were integrated into a generic questionnaire, the Transition Success Score. In a prospective, multicenter study, Transition Success Score was scored by adult healthcare providers, young adult patients and caregivers, 9-15 months after transfer of care. In seven Dutch hospitals, 160 patients completed the Transition Success Score. The mean score was 25 (range 17-27), 25.6% of patients achieving maximum score. Hypothesis testing for construct validity revealed significant associations with characteristics related to transitional care, such as knowledge, independence, and quality of life (p <0.005). Structural validation indicated the score was most effective at discerning lower levels of transition success. Internal consistency was acceptable (0.64). High disease burden, exacerbation during or after transfer, and certain personality profiles were associated with lower scores. The Transition Success Score serves as a quantitative tool to evaluate the effectiveness of transitional care interventions and to identify inflammatory bowel disease patients at risk of encountering challenges during the transition to adult healthcare.

Understanding young caring in the UK pre- and post-COVID-19: Prevalence, correlates, and insights from three UK longitudinal surveys

BackgroundDespite increasing awareness of young carers in recent years, there remains a significant gap in our understanding of both the prevalence and the characteristics of young carers. Our study aims to address this gap by examining the impact of the COVID-19 pandemic on the prevalence and characteristics of young carers. MethodsThis research utilised data from three UK longitudinal surveys: the UK Household Longitudinal Study (UKHLS), the COVID Social Mobility and Opportunities (COSMO) study, and the Millennium Cohort Study (MCS). We focused on adolescents aged 16–18, and examined two pre-COVID (UKHLS and MCS) and two post-COVID (UKHLS and COSMO) samples. ResultsThe prevalence of young carers increased from 8.0 % pre-COVID to 9.8–11.9 % since COVID. Young carers were more commonly found in single-parent and socioeconomically disadvantaged households, with a higher prevalence of young carers in homes where parents were out of paid employment or held lower educational qualifications. Young carers were also more likely to reside in deprived areas. Most young carers engaged in low-intensity caring (< 10 h/week), but post-COVID there was an increase in high-intensity caring (10 + hours/week), predominantly assumed by young female carers. The primary recipients of care were parents, followed by grandparents and siblings, with no change in the care recipient type since COVID. ConclusionThis study showed an increase in the prevalence of young carers, particularly those providing high-intensity care, since the onset of the COVID pandemic. Further, young carers were more likely to come from socioeconomically disadvantaged households and areas. Given the potential impacts that young caring can have on young peoples’ lives, it is imperative that support for young carers is increased, particularly for those facing multiple disadvantages. In tandem, services that support adult health and social care need to play a key role in identifying young carers.

Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania

Abstract Background During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic. Methods Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024. Results 22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p &amp;lt; 0.05). Conclusions Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society. Key messages • Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. • Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.

Development of the iManage SCD mobile health application for transition

ObjectiveThis paper outlines the design and implementation of iManage SCD, a self-management mobile health application for adolescents and young adults (AYA) with sickle cell disease (SCD) during transition from pediatric to adult health care. MethodsThe Integrate, Design, Assess, Share (IDEAS) framework, emphasizing user insights, iterative design, rigorous assessment, and knowledge sharing, guided the development process. The design team consisted of researchers, psychologists, physicians, social workers, AYA with SCD, and parents of AYA with SCD (n = 16) across three states. Qualitative focus groups and interviews were conducted and analyzed using thematic analysis across the integrate and design phases. Point of use feedback from AYA with SCD was used to assess feasibility and acceptability. ResultsThe development process was centered around tenants of the Social-ecological Model of Adolescent and Young Adult Readiness to Transition. Development integrated multidisciplinary perspectives, fostering a person-centered approach. The iterative design process involved collaboration with a digital health firm, Agency39A. Health equity and implementation considerations were addressed at individual, community, and healthcare system levels. Themes that emerged from focus groups with AYA, clinicians, and researchers in the integrate and design phases of development included recommendations for content and user experience features. ConclusionsiManage SCD emerges as a comprehensive, user-friendly mobile health application, incorporating theoretical principles and direct user input. The development process demonstrated feasibility and acceptability, and the paper discusses dissemination strategies for the Community Health Workers and Mobile Health Programs to Help Young Adults with SCD Transition to Using Adult Healthcare Services (COMETS) study.

Focused on the Family: Development of a Family-Based Intervention Promoting the Transition to Adult Health Care for Adolescents with Type 1 Diabetes

Background/Objectives: There is minimal evidence for current interventions promoting the transition to adult healthcare for youth with type 1 diabetes (T1D). Few interventions exclusively target modifiable individual and family-based factors that contribute to transition readiness. The purpose of this paper is to describe the development of Behavioral Family Systems Therapy for Diabetes Transition (BFST-DT), a virtual family-based transition readiness intervention for adolescents with T1D. Methods: The development of BFST-DT occurred in three phases. In phase 1, focus groups with adolescents and young adults with T1D, their caregivers, and pediatric and adult diabetes providers were conducted to assess perspectives on common family challenges surrounding diabetes management and the transition to adult healthcare. In phase 2, focus group data were used to create video vignettes to be used as part of the intervention. In phase 3, BFST-DT was created through the adaptation of a previous evidence-based family intervention for families of adolescents with T1D. Results: BFST-DT is a virtual, 6-month family-based intervention involving four multi-family group meetings and six individual family meetings. It targets the modifiable and reciprocal interactions among individual and family transition readiness factors. Conclusions: BFST-DT is the first family-focused intervention promoting transition readiness in adolescents with T1D and is currently being tested. Intervention development benefits from prioritization of engagement with patients, caregivers, and providers, as their perspectives are invaluable for creating interventions that are relevant and acceptable to communities.

The Attitude of Nursing Staff Towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) Questionnaire: Development and Validation.

This study aims to report on the development and validation of the Attitude of Nursing staff towards Oral healthcare for Care-dependent Older adults (ANOCO) questionnaire. The development of the ANOCO questionnaire was performed in three stages between 2008 and 2019. In a first stage, domains related to oral healthcare attitudes were identified. Next, relevant statements per domain were formulated by a Delphi panel in two rounds, resulting in a questionnaire with 32 statements. In a final phase, this questionnaire was subjected to psychometric analysis, including an evaluation of the construct validity, an internal consistency analysis (Cronbachs alpha) and a principal component analysis. The questionnaire could significantly distinguish between known groups (dentists, nurses' aides, nursing students and nurses). Regarding internal consistency, Cronbach's alpha was 0.863 in the first sample (n = 361) and 0.843 in the second sample (n = 1051). Based on principal component analysis, 22 statements were retained. Four components with an eigenvalue of more than 1 explained 45% of the total variance. The ANOCO-22 questionnaire consists of 22 statements and is a valid tool to assess the changes or differences in the attitude of nursing staff towards oral healthcare for care-dependent older adults.

Picture communication symbols and voice symbols: iconicity and preference among healthy older adults in Taiwan

Purpose: Unaided (e.g., speech and gestures) and aided (e.g., symbol corpuses) communication modes facilitate older adults’ expression and comprehension. Adults aged 65 years and above constituted 18.27% of Taiwan’s total population in 2023; hence, prioritizing high-quality healthcare for older adults becomes critical. Commercial symbol corpuses, such as Picture Communication Symbols (PCS) and Voice Symbols (VS), play a vital role in aiding older adults with expression and comprehension in Taiwan. Previous studies on iconicity and preference of symbol corpuses have primarily been conducted in Western and South Asian cultural communities. However, these findings may not apply to all Asian communities. Hence, studies investigating these aspects in specific communities are needed. Through quantitative nonexperimental observations, we explored the iconicity of and preference for PCS and VS among 30 healthy older adults in Taiwan. Materials and Methods: A total of 12 practice words and test words each, familiar to the participants and socially and culturally validated, were selected for the developed VS–PCS iconicity and preference measurement. Verbal choices were made to select one line drawing in both measurements. Results & Conclusions: The findings revealed that VS is significantly more transparent and preferred than PCS. Accounting for the iconicity of and preferences for symbol corpuses is pivotal for symbol selection.

Adult mental healthcare professionals' experiences of family centred conversations with patients who are parents: a qualitative study.

Many parents with a mental illness report a desire for both recognition of their parental role and support for themselves and their children. However, parents are often fearful of negative judgements from professionals about their ability to be a parent, which inhibits raising concerns about their children with clinical teams. Consequently, an essential first step to supporting families is for professionals to proactively identify which patients are parents, although evidence indicates this is not consistently part of services. Professionals could play a pivotal role in guiding parents about how to talk to their children about their mental illness; this in turn can facilitate family functioning and enable children to access evidence-based interventions. This approach is crucial for mitigating the well-documented intergenerational risk of poorer outcomes and mental illness in children of affected parents. This study aimed to explore adult mental healthcare professionals' beliefs and experiences of talking with patients about: i) their role as parents ii) communication with their children about mental illness. Semi-structured qualitative interviews were conducted with 19 adult mental healthcare professionals with 4-30 years' experience of working with adult patients under the care of NHS adult mental healthcare services in England. Audio recordings were transcribed verbatim and analysed using an inductive coding approach following the principles of thematic analysis. All participants recognised their responsibility to identify patients' children through routine safeguarding protocols, but supporting patients around telling their children the diagnosis was less common. Many participants expressed concerns that raising the topic of children with patients could conflict with other parts of their professional role or would not be welcomed. Obstacles to these conversations were identified, across individual, environmental and organisational factors. Potential facilitators included specific staff training and resources for clinical teams and families around how to tell children about mental illness. Adult mental healthcare professionals would benefit from enhanced training on the importance and methods of guiding parents to communicate with their children about mental illness. This should include routine identification of which patients are parents and recognition of the impact of an adult's mental illness on the wider family system.

Utilizing laser therapy to manage oral potentially malignant disorders in older adults at the primary care level.

Oral lesions are a significant concern among older adults because they can progress to oral cancer if not diagnosed and treated promptly and effectively. Transportation to the hospital is a major barrier to oral healthcare for many older adults. The purpose of this editorial is to address the challenges of managing oral potentially malignant disorders in the older population, highlighting the barriers they face in accessing healthcare services, the potential use of laser therapy for management, and the direction of research in this area. Due to the limited access of the older to healthcare services, primary healthcare facilities within communities serve as their primary providers. Laser therapy is recommended for the management of oral potentially malignant disorders due to its favorable outcomes. This approach has been tested in several primary healthcare centers in Thailand. In our project, laser therapy was used to treat oral potentially malignant disorders in primary and secondary healthcare services. This includes photodynamic therapy for older patients with extensive lesions, as well as individuals with oral leukoplakia and erythroplakia who have declined curative surgery. It has also been used in cases of recalcitrant lichen planus to steroid or photobiomodulation therapy. This approach has been well accepted by both oral healthcare providers and patients. To expand access to these treatment options in such settings, it is critical to empower healthcare professionals, particularly dentists and dental nurses, to integrate laser techniques into geriatric care and oral cancer screening. Establishing a network foundation for orofacial laserology would also enhance the potential of such settings.

Bridging gaps at key intersections: Strategies to improve early intervention and treatment access for eating disorders

ABSTRACTMental health is at the forefront of discussions in healthcare, education, and social settings, yet eating disorders remain poorly understood and inadequately treated. This paper presents evidence on risk factors for insufficient recognition and intervention for eating disorders across clinical and community healthcare settings and proposes actionable strategies to improve awareness and early intervention for eating disorders. Specifically, gaps in eating disorder awareness and treatment access are exacerbated at two key intersections within health and social systems. First, eating disorders manifest themselves at the intersection of mental and physical categories of health, which places them at risk of being misunderstood, poorly diagnosed, and insufficiently intervened upon. Second, the peak onset of eating disorders falls at the intersection of adolescence and young adulthood, which is a period of rapid developmental, social change, and transitions in care. This analysis highlights how systemic issues within existing social and health systems underlie these intersections and contribute to the continued stigmatization and inadequate treatment access for eating disorders. Given their increased incidence and severity, there is an urgent need to address both the individual and societal burden of these disorders. Healthcare systems must prioritize coordination between physical and mental health practices and improve transitions in care from pediatric and adult healthcare services. Identifying gaps at intersections provides the opportunity to make concrete progress toward improving awareness and treatment.

Understanding what it is like to experience pain as you grow up: a poetic meta-ethnography.

A recent Lancet Commission raised concerns about the management of child and adolescent pain. We aimed to undertake a comprehensive review of qualitative research to understand children and adolescent pain experiences across contexts. We used the 7 stages of meta-ethnography to synthesise findings. We combined the strengths of arts-based methods, translating themes into poems in a range of languages. We screened 7471 titles, 464 abstracts, and 302 full texts, including 189 reports (177 unique samples) incorporating 5875 young people. Age range across studies was 2 to 38 years, with 93% including those between the age of 11 and 20 years old. Studies spanned 30 years (1993-2023) with 121 (64%) published in the last 10 years. Almost all (93%) were set-in high-income countries. We report 6 themes focusing on transition to adulthood: (1) I want to stay within the safety of home; (2) don't exclude me from my own care; (3) it might hurt but it's for my own good; (4) I rely on others but I want some independence; (5) I am no longer a child but I am not an adult yet; and (6) I wasn't prepared for the transfer to adult health care. Our findings focus on the complex transition into adulthood and the importance of creating a genuine healthcare partnership with young people by acknowledging their perspectives, creating a safe and supportive environment, and preparing them for the transition to adult pain care. Arts-based methods have the potential to make findings from qualitative evidence syntheses accessible and impactful for compassionate health care.

Barriers and facilitators of transition of adolescents living with HIV into adult care in under-resourced settings of Southern Ethiopia: a qualitative study

BackgroundAdolescence is commonly perceived as a distinct and typically healthy stage of life. However, in regions with a high prevalence of HIV, like Ethiopia, numerous adolescents are contracting the virus. Upon testing and diagnosis, they encounter care-related issues, particularly barriers and facilitators of the healthcare transition from adolescent to adult clinics. Hence, the study aimed to investigate the barriers and facilitators influencing the transition of adolescents living with HIV (ALWHs) in the resource-limited settings of Southern Ethiopia.MethodsThe research employed a phenomenological study design with a qualitative methodology. Purposive sampling was used to gather data through in-depth interviews (IDIs) and focus group discussions (FDGs) involving ALWHs and their parents. The data analysis followed Van Manen’s principles.ResultsFollowing Van Manen’s guidelines, the data analysis revealed a conceptual framework with two major themes: “Barriers” and “Facilitators”. The theme barrier was derived from three sub-themes including behavioral barriers, social barriers, and system barriers in the transition. The theme facilitator was derived from four sub-themes including self-acceptance as an adult, a desire to experience new things, a supportive family, and friendly healthcare services. The study identified three levels of factors influencing the transition into adult clinics: individual, family/peer, and healthcare-related factors. The barriers to transition included lack of knowledge, being in a romantic relationship, psychosocial struggles, perceiving us as immature, stigma, negative peer pressure, lack of timely disclosure, absence of transition guidelines, disrespectful treatment, and absence of separate clinics. On the other hand, facilitators such as self-acceptance as an adult, desire for new experiences, family support, informed support and promising outcomes, flexible appointment scheduling, and psycho-social support groups were found to improve the transition process and enhance the overall well-being of adolescents living with HIV.ConclusionThe study highlights the complex transition process for ALWHs into adult healthcare. Barriers such as lack of knowledge, stigma, and disrespectful treatment pose challenges during this critical period. Conversely, facilitators like self-acceptance, family support, and youth-friendly healthcare services can enhance the transition experience and well-being of ALWHs. Collaborative efforts among ALWHs, families, and healthcare providers are crucial for successful transitions and improved health outcomes. Separated clinics catering to the unique needs of ALWHs are recommended to address privacy concerns.

DiaBetter Together: Clinical trial protocol for a strengths-based Peer Mentor intervention for young adults with type 1 diabetes transitioning to adult care

BackgroundType 1 diabetes (T1D) management is challenging for young adults, who are expected to transfer from the pediatric to adult T1D healthcare system while also managing typical developmental demands (e.g., social, financial, work/school, residential). Many young adults have extended gaps in care before following up in adult care, increasing risk for poor health outcomes. There are few evidence-based programs to support young adults with T1D to promote a timelier transition during this period. This paper reports on the design of DiaBetter Together, a randomized controlled trial to evaluate a 12-month Peer Mentor-delivered intervention compared to usual care among young adults with T1D during the transfer from pediatric to adult care. MethodsOne-hundred young adults (age 17–25) with T1D and 29 Peer Mentors enrolled in this randomized clinical trial. Peer Mentors are experienced, older young adults with T1D, trained by the study team to share transition experiences and strategies to successfully navigate the adult healthcare system, help young adults prepare for the first adult care visit, and use strengths-based support strategies to teach and model skills for managing T1D-related challenges. ResultsThe primary outcome of the trial is HbA1c, and secondary outcomes include time to adult care, engagement in diabetes self-management behaviors, and psychosocial well-being. ConclusionThe goal of this research is to evaluate a developmentally appropriate, supportive intervention that can improve T1D self-management and successful transfer of care during the difficult young adult years and promote optimal T1D health outcomes.