Health Visitors Research Articles

Women's experiences of the transition to motherhood and self-compassion

Health visitors have a pivotal role in supporting women in their transition to motherhood, equipping them with the necessary skills and knowledge to help them cope and thrive. This review was conducted to appraise the current literature around the role of self-compassion in the transition to motherhood and women's experiences of this, as well as the effectiveness of self-compassion on women's psychological wellbeing in this transition. Databases were searched against an inclusion criterion and 11 studies were selected for review. Review findings give insights into how self-compassion practices can aid the transition to motherhood by mitigating psychological challenges and promoting maternal wellbeing and mother–infant bonding. Self-compassion training opportunities should be provided to health visitors and other health professionals working with women from pregnancy, to competently deliver and facilitate such interventions.

Language ability and virtual mental healthcare utilisation among immigrant and refugee youth: a population-based cohort study

Background and objectivesThe widespread adoption of virtual care during the pandemic may not have been uniform across populations, including among paediatric immigrants and refugees. We sought to examine the association...

Human milk feeding for moderate and late preterm infants at age 2 months: Insights from a cluster randomized controlled trial 2-month follow-up

ObjectiveHuman milk (HM) is the optimal nutrition for infants; preterm infants demonstrate shorter HM feeding duration. Care interventions may increase HM feeding among preterm infants after NICU discharge. We compared Alberta Family Integrated Care (FICare) versus Standard Care on HM feeding in preterm infants at age 2 months. MethodsWe conducted a follow-up of a cluster randomized controlled trial of 455 infants and their mothers with data linked to the infant's 2-month public health visit. We used partial proportional odds to model group differences and factors associated with feeding type: exclusive HM (EHM), Non-EHM, or no HM (NHM). ResultsCompared to Standard Care, mothers in Alberta FICare were less likely to provide EHM versus NHM. There was no group difference between EHM and Non-EHM. Mothers with higher education who were on maternity leave or employed were more likely to provide EHM. Infants who received EHM at discharge were more likely to continue at age 2 months. Higher maternal breastfeeding self-efficacy at discharge was associated with a greater likelihood of EHM. ConclusionAlberta FICare was not associated with EHM feeding at age 2 months. InnovationDifferent factors predicted the three HM feeding categories, suggesting the need to individualize feeding supports.Trial Registration.ClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.

The characteristics of general practitioners and geriatricians who take overall responsibility for the care of older patients with multimorbidity

AbstractBackgroundOlder patients with multimorbidity often seek care from multiple health care providers and visit several medical institutions. Having a primary care provider who takes overall responsibility for their care may be beneficial. We conducted a survey to identify the characteristics of general practitioners and geriatricians who frequently assume such responsibility for older patients with multimorbidity.MethodsIn June 2022, we distributed by mail an anonymous questionnaire to 3300 family medicine specialists, primary care‐certified physicians, and geriatric specialists in Japan. We used a four‐point Likert‐type scale to score items related to conditions and patient backgrounds that pose challenges in treatment, key clinical factors, and important clinical strategies. Modified Poisson regression was used to identify factors associated with frequently assuming overall responsibility for medical care.ResultsData from 746 physicians were included in the analysis. Factors associated with frequently assuming overall responsibility for medical care of older patients with multimorbidity included providing inpatient ward care (prevalence ratio [PR] 1.237, 95% CI 1.124–1.362), providing home medical care (PR 1.357, 95% CI 1.225–1.504), frequently treating patients over 90 years old (PR 2.043, 95% CI 1.258–3.318), and the overall score for clinical strategies (PR 1.021, 95% CI 1.010–1.033).ConclusionsGeneral practitioners and geriatricians who frequently assume overall responsibility for the care of older patients with multimorbidity tend to engage significantly in ward and home medical care, often treat patients above 90 years, and employ numerous clinical strategies.

The potential of a rights-based approach to refugee-focused mental health policy in Aotearoa New Zealand

ABSTRACT In accordance with international human rights commitments, individuals with a refugee background have the right to mental health services that are available, accessible, acceptable, and of good quality. However, refugee-background individuals living in Aotearoa New Zealand experience a myriad of barriers at the individual, community, and policy level that impede access to appropriate mental health services. This commentary puts forward the argument that the incorporation of a human rights-based approach to mental healthcare service at a policy level is essential for reducing barriers to care and increasing the accessibility of mental health services. The article provides key recommendations for reforming the current New Zealand Refugee Resettlement Strategy (NZRRS) to include rights-based indicators for children and youth, to monitor accessibility relative to geographic location, to disaggregate data, to extend the 12-month monitoring period and to extend monitoring beyond one mental health visit. Further research is needed to understand how best to implement these recommendations and develop insight into how Aotearoa New Zealand can more effectively uphold the rights of refugee-background individuals with the ultimate goal of developing a mental health system that is more inclusive and responsive to their needs.

Core Mental Health Clinician Capacity and Use Rates in the US Military

Active duty service members have higher mental health stress and cannot choose where to live. It is imperative to understand how geographic access may be associated with their ability to obtain mental health treatment and how the COVID-19 pandemic was associated with these patterns. To identify changes in the prevalence and intensity of mental health care use when service members experienced changes in core mental health clinician (defined to include psychiatrists, psychiatric nurse practitioners, clinical psychologists and social workers, and marriage and family therapists) capacity in their communities and whether patterns changed from before to after the onset of the COVID-19 pandemic. This retrospective cohort study of the active duty population between January 1, 2016, and December 31, 2022, was conducted using individual fixed-effects models to estimate changes in the probability of mental health care visits and visit volume when a person moved across communities with adequate core mental health clinician capacity (≥1 clinician/6000 beneficiaries), shortage areas (<1 clinician/6000 beneficiaries), and areas with 0 clinicians within a 30-minute drive time. All US active duty service members stationed in the continental US, Hawaii, and Alaska were included. Data were analyzed from January through July 2024. The first set of outcomes captured the probability of making at least 1 mental health care visit in a given quarter; the second set of outcomes captured the intensity of visits (ie, the number of visits log transformed). This study included 33 039 840 quarterly observations representing 2 461 911 unique active duty service members from the Army, Navy, Marines, and Air Force (1 959 110 observations among Asian or Pacific Islander [5.9%], 5 309 276 observations among Black [16.1%], 5 287 168 observations among Hispanic [16.0%], and 18 739 827 observations among White [56.7%] individuals; 27 473 563 observations among males [83.2%]; mean [SD] age, 28.20 [7.78] years). When an active duty service member moved from a community with adequate capacity at military treatment facilities to one with 0 clinicians within a 30-minute drive, the probability of a mental health visit to any clinician decreased by 1.13 percentage points (95% CI, -1.21 to -1.05 percentage points; equivalent to a 11.6% relative decrease) and the intensity of total visits was reduced by 7.7% (95% CI, -9.0% to -6.5%). The gap increased from before to after the onset of the COVID-19 pandemic, from 8.5% (equivalent to -0.82 percentage points [95% CI, -0.92 to -0.73 percentage points]) to 16.2% (equivalent to -1.58 percentage points [95% CI, -1.70 to -1.46 percentage points]) in the probability of visiting any clinician type for mental health. In this study, active duty personnel assigned to locations without core military mental health clinicians within a 30-minute drive time were less likely to obtain mental health care and had fewer mental health care visits than those in communities with adequate military mental health capacity even if there was adequate coverage from the civilian sector. The care disparity increased after the onset of the COVID-19 pandemic.

Parents’ perceptions of the safe environment for every kid (SEEK) model in the Swedish child health services

BackgroundThe Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.ObjectiveThe aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.Participants and settingEighteen parents (13 women and five men) in two Swedish counties participated in the study.MethodsSemi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.ResultsThree themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.ConclusionsThe study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

Adaptation and Validation of the Psychological Consequences of Screening Questionnaire (PCQ) for Cognitive Screening in Primary Care.

Context-specific measures with adequate external validity are needed to appropriately determine psychosocial effects related to screening for cognitive impairment. Two-hundred adults aged ≥65 y recently completing routine, standardized cognitive screening as part of their Medicare annual wellness visit were administered an adapted version of the Psychological Consequences of Screening Questionnaire (PCQ), composed of negative (PCQ-Neg) and positive (PCQ-Pos) scales. Measure distribution, acceptability, internal consistency, factor structure, and external validity (construct, discriminative, criterion) were analyzed. Participants had a mean age of 73.3 y and were primarily female and socioeconomically advantaged. Most had a normal cognitive screening result (99.5%, n = 199). Overall PCQ scores were low (PCQ-Neg: = 1.27, possible range 0-36; PCQ-Pos: = 7.63, possible range 0-30). Both scales demonstrated floor effects. Acceptability was satisfactory, although the PCQ-Pos had slightly more item missingness. Both scales had Cronbach alphas >0.80 and a single-factor structure. Spearman correlations between the PCQ-Neg with general measures of psychological distress (Impacts of Events Scale-Revised, Perceived Stress Scale, Kessler Distress Scale) ranged from 0.26 to 0.37 (P's < 0.001); the correlation with the World Health Organization-Five Well-Being Index was -0.19 (P < 0.01). The PCQ-Neg discriminated between those with and without a self-reported subjective cognitive complaint ( = 2.73 v. 0.89, P < 0.001) and was associated with medical visit satisfaction (r = -0.24, P < 0.001) on the Patient Satisfaction Questionnaire. The PCQ-Pos predicted self-reported willingness to engage in future screening ( = 8.00 v. 3.00, P = 0.03). The adapted PCQ-Neg is an overall valid measure of negative psychological consequences of cognitive screening; findings for the PCQ-Pos were more variable. Future studies should address measure performance among diverse samples and those with abnormal screening results. The PCQ scale is an overall valid measure of psychological dysfunction related to cognitive screening in older adults receiving normal screen results.PCQ scale performance should be further validated in diverse populations and those with abnormal cognitive screening results.The adapted PCQ may be useful to both health research and policy stakeholders seeking improved assessment of psychological impacts of cognitive screening.

High Out-of-Pocket Cost Burden of Mental Health Care for Adult Outpatients in the United States.

This report describes characteristics of patients who had high out-of-pocket (OOP) spending on mental health care relative to income. A sample of 8,923 U.S. adults with outpatient mental health visits was drawn from the 2018-2021 Medical Expenditure Panel Survey. Respondents who spent ≥10% of their disposable family incomes on OOP mental health visits were defined as having a high OOP cost burden. Using weighted percentages, the authors found that 2.4% of psychiatric outpatients had a high OOP burden; among those below the federal poverty level, 12.8% had a high OOP burden. Patients with a high (vs. low) OOP burden were statistically significantly more likely to be uninsured (7.5% vs. 2.4%) or diagnosed as having a substance use disorder (8.7% vs. 2.8%) or bipolar disorder (14.5% vs. 8.0%). Despite federal policies extending the availability of insurance for mental health care, many low-income psychiatric outpatients experience high OOP cost burden.

Differences in health visiting contacts for children of mothers with and without a history of adversity-related hospital admissions in England (2018/19 to 2019/20): an analysis of novel linked community health and hospital data.

ObjectiveExplore differences in children’s contact with health visiting (HV) services by pre-birth exposure to maternal adversity. ApproachFor the first time, we linked the Community Services Dataset (CSDS), which records HV contacts for children in England from 1 April 2018 to 31 March 2020, to Hospital Episode Statistics (HES) which contains births and mothers’ hospital admissions in the preceding 3 years. We used admissions that included ICD-10 codes related to mental health, substance use and violence to identify children born to mothers with a history of adversity. We compared characteristics of children’s HV contacts (i.e. number, mode, location, duration) stratified by maternal adversity. ResultsOverall, 85.2% of 626,478 children in CSDS linked to a birth record in HES. Among children receiving HV contacts, 11.7% were exposed to maternal adversity: 11.1% mental health, 1.3% substance use, 0.4% violence. Children with maternal adversity had more HV contacts than other children (mean = 3.8 vs 2.7, p&lt;0.001). There were no differences in contact mode (i.e. face-to-face or phone) for children with maternal adversity compared to others, but their contacts were longer (44.5% lasting &gt;30 minutes vs 35.1%, p&lt;0.001) and more likely to be at home (56.3% vs 47.8%, p&lt;0.001). ConclusionsHV services respond in different ways to children with and without pre-birth exposure to serious maternal adversity, reflecting the “proportionate universalism” that underpins HV services in England. ImplicationsThe differential service response for vulnerable children may require additional resources (e.g. staff, training) which should be considered when designing and funding HV services.

Social Risks and Health Care Use in Medically Complex Patients

Integrated health care systems have initiated major investments to identify and address social risks, particularly for patients with multiple medical conditions. To evaluate the association of social risks with health care use among patients with complex multimorbidity. This longitudinal cohort study assessed Kaiser Permanente Northern California (KPNC) patients with (1) moderate medical complexity (defined by high comorbidity score, high risk of hospitalization, and/or prior emergency department [ED] admissions) and (2) high medical complexity (eg, meeting additional criteria, such as ≥7 medications and laboratory evidence of poor disease control). Social risks (eg, requiring medical financial assistance and self-reported social barriers to care). Inpatient and outpatient health care use during 12 months of follow-up (January 15, 2023, to January 14, 2024). The sample included 97 252 KPNC patients (mean [SD] age, 69.5 [16] years; 52.1% female; 10.6% Asian, 11.1% Black, 18.3% Hispanic, 54.6% White, and 5.5% other race or ethnicity [eg, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, multiracial, or unknown race]; and 8.8% insured by Medicaid), including 27 827 with moderate medical complexity (5074 [18.2%] with social risks) and 69 425 with high medical complexity (17 343 [25.0%] with social risks). In fully adjusted models, for moderate medical complexity, social risks were associated with higher odds of inpatient admissions (odds ratio [OR], 1.2; 95% CI, 1.1-1.4), ED visits (OR, 1.2; 95% CI, 1.1-1.3), and mental health visits (OR, 1.2; 95% CI, 1.1-1.3) vs individuals without social risks. Among individuals with high medical complexity, social risks were associated with higher odds of inpatient admissions (OR, 1.2; 95% CI, 1.1-1.2), ED visits (OR, 1.2; 95% CI, 1.1-1.2), and 30-day readmissions (OR, 1.2; 95% CI, 1.1-1.3) and higher odds of mental health visits (OR, 1.3; 95% CI, 1.2-1.3) vs individuals without social risks. In this cohort study of individuals with medical complexity, coexisting social risks were associated with substantial downstream health care use. Efforts to reduce use in individuals with complex medical comorbidity could include concurrent efforts to identify and reduce social risks.

Association of emergency department characteristics with presence of recommended pediatric-specific behavioral health policies.

In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies. We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021. Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC. Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.

Health visiting in the UK in light of the COVID-19 pandemic experience: (RReHOPE) findings from a realist review.

Child health programmes in the United Kingdom offer every child and their family an evidence-based programme to support child health and development. During the COVID-19 pandemic, health visiting services in many areas were reduced to a partial service, with significant variability between and within the four United Kingdom countries. This study investigated the impact of the pandemic on health visiting services and developed recommendations for policy and practice. Conduct a realist review of relevant literature. Engage with key stakeholders in policy, practice and research across the United Kingdom. Identify recommendations for improving the organisation and delivery of health visiting services, with a focus on services being equitable, effective and efficient. The realist review followed Pawson's five iterative steps and involved key stakeholder representatives at every step. We searched five electronic databases and references of included articles, as well as relevant organisational websites, to find quantitative, qualitative, mixed-methods and grey literature related to health visiting services in the United Kingdom during the COVID-19 pandemic. An assessment of their relevance to our initial programme theory determined inclusion in the review. Data were extracted, organised and presented as draft context, mechanism and outcome configurations. These were iteratively refined through meetings with 6 people with lived experience of caring for babies during the pandemic and 23 professional stakeholders. Context, mechanism and outcome configurations were then translated into findings and recommendations. One hundred and eighteen documents contributed to the review and collectively revealed the far-reaching, uneven and enduring impact of the COVID-19 pandemic on babies and families. Data uncovered significant concerns of families and practitioners amidst the pandemic, along with the service's corresponding actions. These concerns and responses underscored the critical importance of fostering and sustaining trusting relationships between health visitors and families, as well as conducting holistic assessments for early intervention. Although we found minimal evidence of decision-making within organisational/managerial levels, the data illustrated the diverse and complex nature of health visiting work and the need for flexibility and resourcefulness. The primary limitation of this review was a lack of specific evidence from the United Kingdom nations other than England. There was also a lack of data focusing on changes during the COVID-19 pandemic at a local management level. The needs of babies, children and families, and the delivery of services to support them, were not prioritised in the early phase of the pandemic response. Our data show that the health visiting service was concerned with maintaining visibility of all children, and especially supporting families with a new baby. Health visiting services adapted in numerous ways to respond to these concerns. Implications for policy and practice are presented, identified from our analysis and discussions with stakeholders. The RReHOPE study is part of a jigsaw of evidence, which will provide a much stronger evidence base for future policy and practice. This realist review presents several areas for future research, including how health visiting is organised at local management level; how to optimise limited resources; factors affecting differing uptake in different regions; and analysis of the effectiveness of health visiting using large cohort studies. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme under award number NIHR134986.

Parental and healthcare provider attitudes towards the Healthy Child Programme in England: a qualitative analysis

BackgroundThe Healthy Child Programme (HCP) in England, delivered by Health Visitors (HV) and Nursery Nurses (NN), aims to assess growth and development in pre-school age children. This qualitative analysis aimed to evaluate the perceptions and experiences of HCP providers and parents located in a London borough.MethodsThis qualitative analysis is part of a larger study piloting an automated growth screening algorithm in a London borough. We conducted three focus group discussions; two with parents of pre-school children participating in the pilot study, one in English (n = 6) and one in Sylheti (n = 5), and one with HVs and NNs (n = 11). Sampling was purposeful, and written informed consent was obtained. Groups were facilitated by the same bilingual researcher using semi-structured topic guides. Data were analysed using reflexive thematic analysis and assessed for intercoder reliability.ResultsThree broad themes were identified in the data: (1) lack of clarity around the role of the HV and NN; (2) a lack of resources; and (3) a desire for a preventative service. Underlying these themes was a sense of disempowerment shown by HVs/NNs and parents, as well as systemic issues in terms of the accessibility and practicality of the service. Nevertheless, parents and HVs/NNs all stressed the importance of the service in providing information, reassurance and advice.ConclusionsVarious challenges prevent the HCP from providing equitable and effective care to every child. However, the service was recognised as very valuable by users and providers despite systemic difficulties.

Documentation of hearing difficulty by providers amidst cognitive concerns: A study of the Medicare Annual Wellness Visit.

Documentation of hearing difficulty by providers amidst cognitive concerns: A study of the Medicare Annual Wellness Visit.

Return to Work After Release From Prison.

Work preservation is crucial for the reintegration of ex-prisoners and the prevention of recidivism. We describe the application of an interdisciplinary diagnostic protocol (occupational health visit, psychiatric interview, psychological counselling and testing) in the case of a dairy industry worker (female, 45-year-old), released on half-freedom after approximately a year of detention in prison for attempted murder. This crime can seriously hamper job resumption. The evaluation revealed a slightly depressed mood (consistent with recent life events), in the absence of major psychiatric disorders or other disturbances that could compromise working abilities or represent a danger for the coworkers. The patient was, therefore, judged able to resume her job. At six months follow-up, she had fully served her sentence and had returned to her previous job, with good relations with her colleagues. However, she encountered hostility from her employer, which induced her to find a new job as a secretary. Her mental health status was improved. The interdisciplinary approach described here may allow ex-prisoners to return to work by helping the company physician to formulate the judgement of job fitness, offering at the same time suggestions for a rational occupational reintegration.

Healthcare Professionals’ Perspectives on Perinatal Well-Being Across the Perinatal Period

OBJECTIVE:Perinatal well-being (PWB) is holistic, multifaceted, and more than the absence or low levels of adverse physical, emotional, and mental elements. Little is known about the understanding of perinatal well-being (WB) by perinatal healthcare professionals (HCPs). The objectives were twofold: (a) to explore what perinatal HCPs understand by PWB and (b) to explore what they perceive influences PWB.METHODS:Nine UK-based HCPs (n= 4 health visitors,n= 4 perinatal mental health clinicians,n= 1 midwife, andn= 1 General Practitioner) caring for women during the perinatal period completed an online qualitative survey relating to PWB. Participants also ranked factors which may potentially influence PWB.RESULTS:Four overarching themes were developed from the qualitative responses encompassing different aspects of PWB including the context of women’s WB, the dynamic nature of this period, and the role of HCPs. They also characterized the period as a uniquely stressful and risky time.CONCLUSIONS:HCPs predominantly described physical and mental elements when discussing PWB. Some did mention the importance of financial, spiritual, and relational elements. The predominant focus on physical and mental aspects of WB may reflect the biomedical model underpinning perinatal/maternity care provision. The pros, cons, and implications of a move toward a more WB-focused approach within policy and practice are an area for future research.

Overview of TB Patient Compliance for Control during the Covid-19 Pandemic at the UGM RSA TB Clinic

Tuberculosis (TB) is a public health problem that is a global challenge and is the third leading cause of death in Indonesia and the first leading cause of death due to infectious diseases. Based on data from the Ministry of Health of the Republic of Indonesia, there has been a decrease in the number of TB cases found and treated. As one of the strategies to control risk factors for TB disease transmission, RSA UGM provides a special clinic for TB patients whose rooms meet national standards. However, several times researchers found that there were still TB patients who controlled outside the TB clinic schedule so that they mingled with non-TB patients, which resulted in increasing the risk of TB disease transmission to patients visiting the UGM Hospital. The World Health Organization (WHO) declared Covid-19 a pandemic on 9 March 2020. This has caused public fear to visit health facilities. This study aims to determine the level of compliance of TB patient visits during the Covid-19 pandemic at the UGM RSA TB Clinic. This descriptive observational study used secondary data, with a total sampling technique and analyses using univariate analysis. Of the 40 samples that met the inclusion and exclusion criteria, 92.5% of patients were in the productive age range (18-65 years), mostly male (70%). The proportion of patients with pulmonary TB was 62.5% and the remaining 37.5% were extra- pulmonary TB patients. There was an increase in adherence of TB patients to control at the TB clinic and on schedule from month 1 to the following months.

Informing creation of the FEEDS Toolkit to support parent-delivered interventions for eating, drinking and swallowing difficulties in young children with neurodisability: intervention use by neurodevelopmental diagnosis and healthcare professional role

BackgroundThe FEEDS (Focus on Early Eating, Drinking and Swallowing) study focused on interventions used to improve feeding for children with neurodisability and eating, drinking and swallowing difficulties (EDSD), and the...

Predictors of enrollment in a virtual diabetes prevention program among women veterans: a retrospective analysis

BackgroundThe Diabetes Prevention Program (DPP) is a nationally disseminated lifestyle intervention shown to prevent type 2 diabetes (diabetes). However, enrollment in the program remains variable. We sought to identify patient characteristics associated with enrollment in a virtual DPP program among women Veterans to inform ongoing diabetes prevention efforts.MethodsWe conducted a retrospective analysis of 2021–2024 Department of Veterans Affairs (VA) data collected through the VA Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 Program, an effectiveness-implementation trial to expand access to preventative health services for women Veterans. We included women meeting DPP eligibility criteria (BMI ≥ 25 kg/m2 [or ≥ 23 if Asian] with ≥ 1 risk factor for diabetes [e.g., prediabetes]) who received care at six VA sites implementing virtual DPP. We used logistic regression to examine the association between DPP enrollment and prior use of VA preventive services for weight management or diabetes prevention including the VA MOVE! clinic, Whole Health visits, nutrition visits, weight loss medications, and/or metformin. We adjusted for sociodemographic factors, comorbidities, number of DPP recruitment contacts, and site.ResultsA total of 1473 women Veterans received DPP outreach. On average, their age was 53 years (range 20–96), BMI 34 kg/m2, HbA1c 5.9%, 0.7% were Asian, 44% Black, 2% Hispanic, and 44% White. In our adjusted models, prior use of VA preventative services was not significantly associated with DPP enrollment. Younger women (OR:0.97, p = 0.002) and those who received more recruitment contacts (OR:2.63, p < 0.001), were significantly more likely to enroll in DPP. Women with housing instability were significantly less likely to enroll (OR:0.44, p = 0.029).ConclusionsWe found no difference in women Veterans’ enrollment in DPP based on prior use of VA weight management and prevention services. Frequency of outreach by VA sites may increase engagement in lifestyle interventions. Virtual DPP may support engagement in preventive lifestyle interventions for diverse groups of women Veterans, as a first program or as a complement to other VA services.Trial registrationClinicalTrials.gov, NCT05050266. Registered on 20 September 2021.