Health Experiences Research Articles

Police peer supporters in a domestic abuse-specific peer support initiative: Motivations, experiences and challenges

Police peer support programmes traditionally focus on mental health issues and experiences of trauma in work. Increased awareness of domestic abuse (DA), its impacts in the workplace, and calls to adopt trauma-informed approaches in the emergency and public services in the UK have culminated in a southern English police force instituting a novel peer support programme for personnel who are experiencing DA. This qualitative study interviewed 16 self-selected DA peer supporters to explore their motivations and experiences in providing support for their colleagues and the application of trauma-informed practice. Findings support previous research on the ongoing prevalence of stigma around help-seeking in the police generally, and this is perhaps even more pronounced for DA. However, the presence of this form of peer support has symbolic value to challenge prevailing culture and foster increased confidence to make disclosures. Findings also indicate value in adopting DA-specific peer support from an organizational justice perspective because this may enable a greater sense of staff well-being. The approaches employed in the DA peer support programme exhibited implicit trauma-informed practice, which could be made more explicit and aligned to wider initiatives of creating a more trauma-informed police service.

Adapting to the Digital Age: An Evaluation of Online Learning Strategies in Public Health and Social Care Education

Introduction. The global shift towards digital education in the wake of the COVID-19 pandemic has reshaped the landscape of higher education. Public health and social care programmes have adapted to this transformation, embracing online learning strategies to engage students. This study focuses on the assessment of online learning experiences in public health and social care education, particularly during the post-COVID-19 period. Materials and Methods. This qualitative study employed semi-structured interviews and focus groups with 49 university students in England. These phases, conducted both in person and via video, were audio and video recorded and transcribed verbatim. A purposive sampling technique was employed to gather data, and framework analysis facilitated data management and interpretation. Results. The presentation highlights three main themes and 12 accompanying sub-themes that capture the clear preferences of students for both in-person and online learning methods. The findings elucidate the merits and demerits of online learning strategies in contrast to traditional face-to-face classes. Online classes offer distinct advantages in terms of flexibility, cost-effectiveness, time efficiency, and technological proficiency. However, they also bring to the fore concerns related to social isolation, mental health challenges, technical challenges, and distractions within the home environment. Conclusion. Considering the global transition to digital education, this study contributes to the dynamic discourse surrounding online learning in the post-COVID-19 era. The diverse preferences expressed by students highlight the importance of personalised and flexible teaching methods in online education, underlining the need for adaptability and inclusivity to meet the diverse needs of today’s learners.

Health insurance coverage and experiences of intimate partner violence and postpartum abuse screening among rural US residents who gave birth 2016-2020.

Intimate partner violence (IPV) is elevated among rural residents and contributes to maternal morbidity and mortality. Postpartum health insurance expansion efforts could address multiple causes of maternal morbidity and mortality, including IPV. The objective of this study was to describe the relationship between perinatal health insurance, IPV, and postpartum abuse screening among rural US residents. Using 2016-2020 data on rural residents from the Pregnancy Risk Assessment Monitoring System, we assessed self-report of experiencing physical violence by an intimate partner and rates of abuse screening at postpartum visits. Health insurance at childbirth and postpartum was categorized as private, Medicaid, or uninsured. We also measured insurance transitions from childbirth to postpartum (continuous private, continuous Medicaid, Medicaid to private, and Medicaid to uninsured). IPV rates varied by health insurance status at childbirth, with the highest rates among Medicaid beneficiaries (7.7%), compared to those who were uninsured (1.6%) or privately insured (1.6%). When measured by insurance transitions, the highest IPV rates were reported by those with continuous Medicaid coverage (8.6%), followed by those who transitioned from Medicaid at childbirth to private insurance (5.3%) or no insurance (5.9%) postpartum. Nearly half (48.1%) of rural residents lacked postpartum abuse screening, with the highest proportion among rural residents who were uninsured at childbirth (66.1%) or postpartum (52.1%). Rural residents who are insured by Medicaid before or after childbirth are at elevated risk for IPV. Medicaid policy efforts to improve maternal health should focus on improving detection and screening for IPV among rural residents.

Disparities in behaviors and experiences among transgender and cisgender high school students — 18 U.S. states, 2021

PurposeTransgender youth (those whose gender identity differs from their sex assigned at birth) experience stigma and discrimination that can place them at increased risk for poor health outcomes compared with cisgender youth (those whose gender identity aligns with their sex assigned at birth). Limited population-based data exist on disparities among transgender and cisgender youth. MethodsWe examined differences in experiences of violence, substance use, mental health, suicide, sexual behavior, unstable housing, parental monitoring, and school connectedness among 98,174 transgender and cisgender high school students using data from 18 states that included an item to assess transgender identity on their 2021 Youth Risk Behavior Survey. ResultsOverall, 2.9% of students identified as transgender and 2.6% questioned whether they were transgender. Among transgender students, 71.5% reported that their mental health was not good, 32.3% had attempted suicide, and 29.0% experienced sexual violence. Transgender students were more likely than cisgender students to report experiences of violence, substance use, poor mental health, suicide risk, some sexual risk behaviors, and unstable housing, and were less likely to report feeling connected to others at school. ConclusionsInterventions that can address the causes of these adverse outcomes and promote the health and wellbeing of transgender youths are warranted.

Training the Next Generation of Local Public Health Leaders: A Case Study of Community Health Organizers in Pennsylvania.

Few short-term training programs exist for persons with limited experience or training in public health to support public health initiatives. We describe a public health training designed by the Pennsylvania (PA) Training Center for Health Equity for the PA Community Health Organizer (CHO) program. The CHO program was created to address the immediate needs of underserved communities and promote lasting health equity during the pandemic. CHOs are professionals who promote community action and align efforts with local organizations to build sustainable public health infrastructure and apply evidence-based practices to program policy, planning, and development. The training content, delivered by Project Extension for Community Healthcare Outcomes (ECHO) in 12 monthly sessions, focused upon foundational public health concepts in a novel community case study approach. The ECHO All Teach, All Learn training model was successful in providing relevant public health information to this new workforce, and the pre-/post-training evaluation demonstrated a positive increase in knowledge across all domains.

Clinical effectiveness of drop-in mental health services at paediatric hospitals: A non-randomised multi-site study for children and young people and their families - study protocol.

Despite the high prevalence of mental health difficulties in children and young people with long-term health conditions (LTCs), these difficulties and experiences are often overlooked and untreated. Previous research demonstrated the effectiveness of psychological support provided via a drop-in mental health centre located in a paediatric hospital. The aim of this prospective non-randomised single-arm multi-centre interventional study is to determine the clinical effectiveness of drop-in mental health services when implemented at paediatric hospitals in England. It is hypothesised that families who receive psychological interventions through the drop-in services will show improved emotional and behavioural symptoms. Outcomes will be measured at baseline and at 6-month follow-up. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or child at 6 months. Secondary outcomes include self and parent reported Paediatric Quality of Life Inventory (PedsQL), self-reported depression (PHQ-9) and anxiety measures (GAD-7) and family satisfaction (CSQ-8). This trial aims to determine the clinical effectiveness of providing psychological support in the context of LTCs through drop-in mental health services at paediatric hospitals in England. These findings will contribute to policies and practice addressing mental health needs in children and young people with other long-term health conditions. ISRCTN15063954, Registered on 9 December 2022.

Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis.

Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users' perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528.

Healing experiences at resort hotels (HERH): Conceptualization and scale development

Anchored in healing experiences literature and therapeutic landscapes theory, this study aims to develop a Healing Experiences at Resort Hotels (HERH) scale. Study 1 comprises an extensive review and culminates in the initial identification of five dimensions. Subsequent intensive interviews with ten interviewees yield 170 statements, which are refined into 26 items spanning five dimensions. In Study 2, through exploratory structural equation modeling using 280 survey responses, results are refined to 22 items across four dimensions: sensory healing, social healing, wellness and cultural healing, and natural healing. With another 574 survey responses, Study 3 then confirms the scale’s reliability, construct and discriminant validity, and criterion-related validity. This four-dimensional 22-item HERH scale constitutes a groundbreaking effort to create a comprehensive scale for healing experiences at resort hotels. As a practical tool, the HERH can be applied by hoteliers to evaluate the quality of healing experiences at resort hotels.

The effect of forest-based health and wellness on the stress-relieve of middle-aged people

In order to explore the impact of experience in forest-based health and wellness (FHW) on the stress of middle-aged people, 12 participants aged 35–39 were selected to conduct a 3-day/2-night study on FHW experience in Wencheng, Wenzhou. Huawei bracelets were used to monitor participants’ movement, pulse and blood pressure and their mood state was measured before and after the health care experience using the Profile of Mood States (POMS) scale. After the FHW experience, the lowest value of bracelet stress appeared on the second day of the experience for men and women. The total mood disturbance (TMD) decreased by 38.8 points on average, which significantly improved the positive mood and relieved the stress. The decompression effect of the FHW experience showed some variability among individuals. Furthermore, there were gender differences in alleviation of fatigue and puzzlement, which was greater for females than males.

The impact and user experience of a student-led clinic providing preventative services.

Preventative services are required to address the risk factors for chronic conditions such as cardiovascular disease. The National Health Service Health Checks in England were introduced to provide such services. One School of Pharmacy established a student-led clinic to provide this service to the local community. The clinic was provided by undergraduate pharmacy students and delivered free of charge within a central city locality. The aim was to explore the impact of the clinic on user thoughts and motivations around healthy living and investigate user experience. A sequential explanatory mixed methods approach was used consisting of a survey that measured users' thoughts about their health and well-being and experience of the clinic. Qualitative interviews explored the user experience and barriers and facilitators to making healthier lifestyle choices. One hundred and fifty-four members of the public accessed the clinic over the evaluative period. Ninety-six (60%) completed the pre-post survey and 12 participated in follow-up interviews. Users reported statistically significant improvements in how informed, competent and motivated they felt towards making healthier lifestyle choices after the clinic consultation. Interview findings highlighted the positive user experience, reported appreciation for clinic accessibility, availability of healthy lifestyle education, and a desire for more preventative services being as readily available. The student-led clinic has demonstrated positive impacts on user experience, knowledge, competence, and motivation to make healthier lifestyle choices. The clinic provides proof-of-concept for pharmacy students to deliver preventative community services that aim to improve population health at a time when primary care is experiencing unprecedented challenges.

Caregiver and Child Mental Health During 3 Years of the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) lockdowns (stay-at-home orders) had significant mental health consequences in 2020 to 2021 for caregivers and children. Little is known about "postlockdown" periods in 2022 to 2023. We investigated the mental health experiences of Australian families throughout the 3 years of the COVID-19 pandemic (2020-2023), by demographic characteristics and lockdown length. A total N = 12 408 caregivers (N = 20 339 children, aged 0-17 years) completed Australia's only representative, repeated, cross-sectional, National Child Health Poll across 6 waves (June 2020-April 2023). Caregivers reported mental health for themselves (Kessler-6, poor versus not) and each child (self-rated mental health, poor/fair versus good/very good/excellent), and perceived impacts of the pandemic on own/child mental health (negative versus none/positive). Binary logistic models were fitted to predict marginal probabilities of each mental health measure by state/territory group (proxy for lockdown length), over time, adjusted for potential demographic confounders. Poor caregiver Kessler-6 was similar between genders but more common for sole caregivers, and those with a home language other than English and lower education. Poor/fair child self-rated mental health was similar between genders and increased with child age. Perceived negative impacts were more common for females and socially advantaged caregivers. Overall, negative mental health experiences increased with lockdown length, peaking with the height of lockdown in July 2021, before declining. Negative mental health experiences of Australian caregivers and children decreased during postlockdown periods of 2022-2023; however, social gradients persisted. These data can inform more precise mental health policies that enable better use of limited mental health infrastructure.

Attachment and negative affect on mental health and pain experience patients with Multiple Sclerosis: mediated by coping strategies and loneliness

BackgroundMultiple sclerosis and its related stressors significantly affect the mental health of people with MS. Considering the progressive and relapsing-remitting nature of the disease and somatic complaint, the Pain experience for MS patients is challenging. We examined the direct effects of Attachment and the negative affect on mental health and pain experience and the indirect effects of Attachment, negative affect, loneliness, and coping strategies on the mental health and pain experience of people with multiple sclerosis. MethodsThree hundred forty-five patients with MS were selected through the Iranian MS Association. Measures included the negative affect (PANAS), Adult Attachment Inventory (AAI), General Health Questionnaire (GHQ28), short-form McGill pain questionnaire (SF-mpq-2), Social and emotional loneliness scale for adults (SELSA-S), Coping Inventory for Stressful Situations(CISS-21). The present study has employed the Structural Equation Model (SEM) to investigate the direct and indirect effects of coping strategies, attachment, loneliness, and negative affect on mental health and pain experienced by individuals with MS. The fit of the model to the data was examined using the Discrepancy Function Divided by Degrees of Freedom (CMIN/DF), Normed Fit Index (NFI), TuckerLewis Index (TLI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA). ResultsThe fit indices results showed that the model's fit was good. Furthermore, findings indicate that 13% (R2=13) of the pain experience Changes and 47% (R2=47) of the mental health Changes are explained via study predictors. Negative affect directly affects mental health and pain experience, and Attachment directly affects mental health. Negative affect indirectly affects coping strategies. Attachment and Negative affect indirectly affect loneliness. Loneliness and coping strategies indirectly affect mental health and pain experience. ConclusionStudy findings contribute to our understanding of the crucial structures that play a role in the mental health and pain experience of individuals with MS. Loneliness and coping strategies as mediating variables play essential roles in these people's mental health and pain experience. In the times ahead, it would be beneficial to prioritize addressing negative affect, attachment, coping strategies, and loneliness in the patients with MS' medical and psychological intervention.

Associations between childhood violence and mental health in refugee settings in Uganda

BackgroundChildhood violence and mental health remain concerning public health issues globally yet there is limited evidence on the associations between experiences of such violence and mental health in refugee settings. ObjectiveTo assess the association between experiences of childhood violence (sexual, physical, and emotional violence) and mental health (severe mental distress, self-harm, suicidal ideation and/or attempted suicide) in refugee settings in Uganda. Data and MethodsData are from the 2022 Uganda Humanitarian Violence against Children and Youth Survey (HVACS) conducted among 1,338 females and 927 males aged 13-24 years between March and April 2022. Cross-tabulation with chi-square tests and multivariate logistic regression analysis were used to assess the association between experiencing childhood violence and mental health. ResultsThe results show a high prevalence of experiencing childhood violence (females 40.8% vs males 55.2%) and mental distress (45% for both males and females). Females who experienced childhood sexual violence had significantly higher odds of reporting severe mental distress (aOR=1.989; CI=1.216-3.255), suicidal ideation and/or attempted suicide (aOR=4.119; CI=2.157-7.864) and self-harm (aOR=3.734; CI=1.619-8.609) compared to those who did not experience such violence. Experiencing childhood physical or emotional violence was also significantly associated with increased odds of reporting suicidal ideation and/or attempts and self-harm among females. Among males, childhood emotional violence was significantly associated with increased odds of reporting suicidal ideation and/or attempts (aOR=9.233; CI=2.293-37.177) or severe mental distress (aOR=2.823; CI=1.115-7.148). ConclusionChildhood exposure to violence was associated with poor mental health, with a higher risk observed among females. The findings of this paper provide critical insights to facilitate the development or strengthening of violence prevention and response interventions on violence against children in refugee settings.

Positioning virtual reality as means of clinical experience in mental health nursing education: A quasi-experimental study

PurposeVirtual reality technology has been used to establish a risk-free environment in which students can practice psychiatric nursing. A quasi-experimental study was conducted to examine the effects of a virtual reality (VR) based mental health nursing simulation on practice performance of undergraduate nursing students. MethodsA quasi-experimental, pre- and post-test design was used. A total of 68 students were randomly assigned to an experimental group (n = 32) and a control group (n = 36). The control group received conventional simulation using text scenario-based role play. The intervention group received VR software consisting of 360° video clips and related quiz questions. ResultsThe self-reported perceived competency in nursing performance showed no statistically significant improvement in the experimental group, whereas the control group showed a statistically significant improvement in symptom management (t = 2.84, p = 0.007) and nurse-patient interaction (t = 2.10, p = 0.043). Scores from the assessor showed better performance scores in the experimental group in symptom management (t = −2.62, p = 0.011), violence risk management (t = −3.42, p = 0.001), and nurse-patient interaction (t = −3.12, p = 0.003). ConclusionsThe findings of this study indicate the potential of using VR for optimized mental health nursing simulation. VR technology allowed realistic experiences which may ensure students have a more comprehensive understanding of mentally ill patients and in doing so, overcome barriers of traditional simulation, resulting in better learning outcomes.

Six aspects of female genital mutilation education (SAFE) model: findings from a qualitative study

ObjectivesRecent figures show that over 200 million women and girls, globally, live with the consequences of female genital mutilation (FGM). Complex debilitating physical, psychological and social problems result from the...

First semester college experiences: Associations with substance use and mental health

IntroductionSubstance use (SU) and mental health (MH) concerns often occur as students transition from high school to college and may be associated with first semester experiences. MethodsIncoming first-year college students at a U.S., predominantly white, midwestern university were recruited for an intervention study. Participants reported on substance use, mental health, and college experiences at the end of their first semester of college (n = 781; 62.9 % female, mean age = 18.06 [SD = 0.24]; 77.2 % non-Hispanic white; 84.6 % heterosexual). Data for these current analyses were cross-sectional. ResultsIdentifying as Black, Indigenous, or another Person of Color, as a sexual minority, or as female was associated with more challenging first semester experiences. Social experiences that represent more social engagement were associated with greater substance use. College experiences reflecting an easier transition were associated with fewer mental health concerns. Alcohol use moderated the relation between academic challenges and mental health with stronger associations found at greater levels of alcohol use. ConclusionsFirst semester experiences were related to student mental health and substance use, suggesting the importance of early, targeted support for students to adjust to campus life.

A randomized comparative-effectiveness study of two enhanced prenatal care models for low-income pregnant people: Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE)

BackgroundImproving perinatal mental health and care experiences and preventing adverse maternal and infant outcomes are essential prenatal care components, yet existing services often miss the mark, particularly for low-income populations. Recently, an enhanced group prenatal care program, “Glow! Group Prenatal Care and Support,” was developed in California's Central Valley in response to poor perinatal mental health, disrespectful care experiences, and high rates of adverse birth outcomes among families with low incomes. MethodsEngaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE) is a pragmatic, two-arm, randomized, comparative-effectiveness study designed to assess depression (primary outcome), the experience of care (secondary outcome), and preterm birth (exploratory outcome) among Medicaid-eligible pregnant and birthing people, comparing those assigned to Glow! Group Prenatal Care and Support (Glow/GC) with those assigned to enhanced, individual prenatal care through the California Department of Public Health's Comprehensive Perinatal Services Program (CPSP/IC). Participating clinical practices offer the two comparators, alternating between comparators every 6 weeks, with the starting comparator randomized at the practice level. Participant-reported outcomes are assessed through interviewer-administered surveys at study entry, during the participant's third trimester, and at 3 months postpartum; preterm birth and other clinical outcomes are abstracted from labor and delivery records. Patient care experiences are further assessed in qualitative interviews. The protocol complies with the Standard Protocol Items for Randomized Trials. ConclusionsThis comparative-effectiveness study will be used to determine which of two forms of enhanced prenatal care is more effective, informing future decisions regarding their use.Trial Registration: ClinicalTrials.gov: NCT04154423.

Evaluation of reports received on a digital platform for monitoring and self-care of individuals facing the COVID-19 pandemic in Brazil: Contributions to public health

ObjectivesTo evaluate the contribution of the digital platform “Meu Diário de Quarentena (MDQ)" or My Quarantine Diary concerning the monitoring and self-care of individuals with COVID-19 in Brazil. And to analyze the epidemiological and clinical characteristics related to the disease and the users who adhered to the support provided by MDQ. MethodsMDQ was developed by a multidisciplinary team and offered to the general population to provide self-care and health education during the COVID-19 pandemic, relying on users' self-reporting of information (such as signs and symptoms, pre-existing health conditions, and medications used during quarantine). The outcomes were measured, and the web app's support experience for public health was reported. ResultsMDQ had 2439 active users on the platform, with 485 (19.9 %) self-reporting a COVID-19 diagnosis, mostly from individuals in the southeastern region of Brazil (56.5 %). The most common pre-existing health condition reported was related to circulatory system diseases. The most frequent reported signs and symptoms included headache, cough, myalgia, nasal congestion and muscle weakness. Corticosteroids, multivitamins, and anti-inflammatories were the most used medications during the pandemic period. There were several reports related to how users were feeling during the pandemic, and among these reports, negative feelings toward isolation stood out, such as “feeling lonely”, “anxious”, and “feeling useless”. A significant association was found between sex (p < 0.001) and age (p < 0.001) in relation to self-reported cases of COVID-19. ConclusionsThe use of MDQ during extended quarantine was an easy and interesting way of interaction and support for people during COVID-19 pandemic.

Patient-reported outcome measures with chest wall perforator flap reconstruction: The northern health experience

Patient-reported outcome measures with chest wall perforator flap reconstruction: The northern health experience

The Prevalence of Sexual Harassment and Bullying Among Norwegian Afghanistan Veterans: Does Workplace Harassment Disproportionately Impact the Mental Health and Life Satisfaction of Female Soldiers?

Experiencing sexual harassment and bullying during military service can lead to negative consequences for a soldier's mental health and life satisfaction, including increased risk of depression, anxiety, and posttraumatic stress. No studies have to date investigated the prevalence and correlates of sexual harassment and bullying among Norwegian Afghanistan veterans, despite the increased global focus on these topics. In 2020, 6,205 Norwegian Afghanistan veterans (8.3% women) completed an online post-deployment survey, including questions about experiences of sexual harassment, bullying, mental health, and life satisfaction. Compared to their male counterparts, female veterans experienced significantly more sexual harassment and bullying during Afghanistan deployment (3.2% vs. 0.04% for experiencing sexual harassment, and 4.0% vs. 1.0% for bullying) and during other military services (14.3% vs. 0.4% for sexual harassment, and 15.9% vs. 3.7% for bullying). Sexual harassment was associated with younger age and experiencing childhood sexual harassment for both women and men, with men also having longer deployments. Bullying was associated with longer deployments and childhood sexual harassment for women, while men who reported bullying more often had longer deployments, held an officer rank, were less inclined to have a spouse/intimate partner, and reported childhood sexual harassment and bullying. Both sexual harassment and bullying were associated with increased risk of mental health problems and reduced life satisfaction for women, but this was only true for bullying among men. Despite lower reported rates of workplace harassment compared to studies from other cultures, this study demonstrates that sexual harassment and bullying in the military can negatively impact soldiers' mental health and life satisfaction. Notably, female veterans' mental health and life satisfaction appear to be particularly affected by sexual harassment during military service, an association not seen in males. This underscores the need for gender-specific, cultural, and context-sensitive prevention and support for workplace harassment experiences.