Individual-level Behavior Change Research Articles

Equity-Centered Postdischarge Support for Medicaid-Insured People: Protocol for a Type 1 Hybrid Effectiveness-Implementation Stepped Wedge Cluster Randomized Controlled Trial.

Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE-an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. The study's objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability. We will perform a sequential randomized rollout of THRIVE to case managers at the study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record. This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025. The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes. DERR1-10.2196/54211. ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605.

Corporate Scandals as Punctuating Events That Change Human Resource Roles

Corporate scandals disrupt the landscape for organizational leaders and employees, providing a burning platform that creates new momentum for change. Here, we explore the implications for the human resources (HR) function as organization-level responses to scandals cannot occur without individual-level changes in employee behaviors—the domain of HR. We apply event systems theorizing to uncover the nature of the scandals through notions of strength, space, and time to better understand the range of possible outcomes for HR function roles. Empirical data are presented from in-depth qualitative case studies carried out in five large multinational corporations in the pharmaceutical, chemical, and financial services industries. Subsequently, we uncover how organization-level scandals punctuate the equilibrium of organizational operations, facilitating a recalibration of the balance between the potentially competing institutional logics of moral legitimacy and business priorities. We furthermore challenge universal HR role typology theorizing regarding the direct influence of external stakeholders on the role that HR can adopt inside organizations. Overall, we demonstrate that organizational responses to corporate scandals require individual-level and collective employee behavior change, placing the HR function at the intersection of managing risk, compliance, and legal requirements.

Barriers and facilitators to engagement in care and medication adherence for women living with HIV in the Southern United States

ABSTRACT Women living in the South have the second highest rate of HIV and the lowest rate of viral suppression among women in all regions in the United States (U.S.). Viral suppression is achieved by successfully linking women to HIV care and supporting adherence to antiretroviral therapy (ART). We aimed to qualitatively explore perceived barriers and facilitators to HIV care engagement and ART adherence among women living with HIV in the South. Participants (N = 40) were recruited across a broad geographic area of the South, assisted by a location-specific Community/Clinician Advisory Board (CCAB). Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care and adhering to ART. Intrapersonal qualities expressed through resilience and self-efficacy were amongst the most prominent themes for both engagement in care and adherence to medications. Structural barriers such as transportation and distance to care continued to be a barrier to engagement, while medication delivery facilitated adherence. Conclusion: Our findings highlight the complexity and interrelated nature of factors impacting care and adherence. Multilevel interventions that incorporate structural factors in addition to individual-level behavioral change are needed to facilitate engagement in care and adherence to ART.

Perceived national wealth increases support for structural climate policies

Climate change cannot be successfully mitigated solely through individual-level actions. Structural change is urgently needed. While wealthy countries have the greatest capacity to implement structural change, the question remains to what extent perceived country wealth is associated with support for structural climate policies over individual-level behaviour change policies. We found in Australian (Study 1) and UK (Study 2) samples (N = 967) that perceived national wealth positively predicts people's support for structural (vs. individual-level behaviour) change policies. In an experimental (Study 3, N = 401) and a quasi-experimental study (Study 4, N = 400; comparing South African and UK participants), we found that people in both wealthy and poor countries more strongly prefer wealthy (vs. poor) countries to implement structural (vs. individual-level behaviour) change policies. There was some evidence that these effects are mediated by perceiving wealthy countries to have a moral obligation to contribute to the solution of global issues. The findings suggest that there is considerable public support for wealthy countries to spearhead structural transformations to limit climate change. These insights can help environmental organisations and policymakers to gain public support for climate policies by emphasising their countries' moral obligation to implement change and by countering blame-deflecting narratives.

Perceived Inequality Increases Support for Structural Solutions to Climate Change

Economic inequality is fuelling climate change. The question, however, remains whether the degree to which people perceive their country as unequal influences their motivation to support climate policies. Across three studies (N = 1,459), we investigated whether perceived inequality influences people’s support for structural climate policies over policies aimed at individual-level behavior change. In an Australian (Study 1) and a United Kingdom (Study 2) sample, we found that perceived inequality positively predicts people’s support for structural (vs. individual-level behavior) change policies, even after controlling for political orientation. In an experimental study (Study 3), people who imagined living in an unequal (vs. equal) country more strongly wanted their country to implement structural (vs. individual-level behavior) change policies. These effects were mediated by a greater desire for drastic changes. This suggests that recognizing one’s country’s unequal wealth distribution may act as a catalyst for the structural change urgently needed to limit climate change.

Effects of timed and targeted counselling by community health workers on maternal and household practices, and pregnancy and newborn outcomes in rural Uganda

IntroductionPregnancy and birth-related complications claim the lives of millions of women and newborns every year. Improving their survival chances remains an urgent global challenge, including in Uganda. Community health workers (CHWs) play a crucial role in bridging the gap between the community and the official health system in Uganda. Timed and targeted Counselling (ttC) is an individual-level behavioral change communication method used by CHWs, aimed at pregnant women and caregivers of children under the age of two. AimThis study examined whether the implementation of the ttC intervention by the CHWs was associated with improved household practices and outcomes during the pregnancy and newborn period. MethodsA multi-stage sampling technique was employed with a total of 749 participants in the intervention group (ttC intervention), and 744 participants in the control group (no ttC). Data on quality of maternal and household antenatal care (ANC) and essential newborn care (ENC) practices, as well as on pregnancy and newborn outcomes were collected through questionnaires from May 2018 to May 2020. McNemar’s Chi-square tests were used to compare outcomes before and after implementation, and between the intervention and control group. ResultsResults showed that, compared to baseline, ttC contributed significantly to the demand for quality of service during ANC, ENC and partner involvement in maternal and newborn health. In comparison to the control group, the ttC group showed significantly higher early ANC attendance rates and higher quality of ANC and ENC. ConclusionttC is a comprehensive, goal-driven approach that seems to contribute to the improvement of quality of maternal and household practices, and pregnancy and newborn outcomes in Uganda. Trial registrationPACTR, PACTR202002812123868, registered on 25 February 2020, http://www.pactr.org/PACTR202002812123868.

Tobacco Cessation and Prevention Interventions for Sexual and/or Gender Minority-Identified People and the Theories That Underpin Them: A Scoping Review.

This scoping review takes stock of the social and behavior change theories that have underpinned tobacco interventions tailored to sexual and/or gender minority (SGM) people and reflects on the need to target contextually based drivers of SGM tobacco use inequities. Data sources were Medline (Ovid), Scopus, PubMed, and Google Scholar (January 01, 1946 to October 27, 2022). Peer-reviewed publications in English from anywhere in the world describing SGM-tailored tobacco cessation and/or prevention interventions were independently identified by a librarian and screened by the first and third authors. Three hundred and sixty-seven articles were extracted; an additional two were found by hand searching. A total of 369 articles were assessed for eligibility. Exclusion criteria were: Not an intervention, review article, not SGM-tailored, or tobacco-focused. We documented the intervention name, intervention components, theoretical frameworks cited in reference to intervention design and/or implementation, and evaluation outcomes. All authors provided input on theoretical framework categorization. We identified 22 publications corresponding to 15 unique interventions. Individual-level behavior change theories (ie, those focusing on within-person behavior change processes) were the most prominent. Among these, the Transtheoretical Model was the most frequently utilized, while Social Inoculation Theory, Theory of Reasoned Action, and Theory of Psychological Reactance were also employed. A minority of interventions referenced frameworks that more explicitly engaged with SGM people's social contexts, namely, Theory of Diffusion of Innovations and Minority Stress Model. Future SGM-tailored tobacco interventions should leverage both the strengths of individual-level behavior change theories and those of frameworks that understand tobacco use inequities as indivisible from place, context, and policy. This scoping review describes the theoretical underpinnings of sexual and/or gender minority (SGM)-tailored tobacco interventions published in the peer-review literature in English. It reflects on the need for greater utilization of social and behavior change theoretical frameworks that can engage with unique drivers of SGM tobacco use and barriers to cessation.

A computational cognitive model of behaviors and decisions that modulate pandemic transmission: Expectancy-value, attitudes, self-efficacy, and motivational intensity.

We present a computational cognitive model that incorporates and formalizes aspects of theories of individual-level behavior change and present simulations of COVID-19 behavioral response that modulates transmission rates. This formalization includes addressing the psychological constructs of attitudes, self-efficacy, and motivational intensity. The model yields signature phenomena that appear in the oscillating dynamics of mask wearing and the effective reproduction number, as well as the overall increase of rates of mask-wearing in response to awareness of an ongoing pandemic.

A Tale of Two Urgent Food System Challenges: Comparative Analysis of Approaches to Reduce High-Meat Diets and Wasted Food as Covered in U.S. Newspapers

To improve food system sustainability, it is critical to reduce food loss and waste (FLW) and shift away from high-meat diets. We conducted a qualitative content analysis of 238 newspaper articles (2018–2020) to compare media framing and stakeholder involvement. For both issues, newspaper coverage often called for individual-level behavior change. Coverage of how consumers can reduce FLW was more detailed compared to diet change and portrayed numerous organizations and government agencies working in partnerships to reduce FLW. Coverage of diet change efforts portrayed substantial disagreement, including legislative efforts to restrict labeling of alternative meat and dairy products. Journalists covering new evidence on the need to shift diets for sustainability often quoted both the lead researcher and an opponent with ties to the livestock industry. Inclusion of “both sides” was similar to previous media coverage that presented climate change as an open debate for years. Strong scientific evidence shows the need to address both FLW and diet shifts to improve interconnected environmental and human health outcomes, and our analysis of media coverage shows important differences regarding how these two issues are covered in the media and approached by stakeholders in the U.S. These results can inform communication with consumers, journalists, and policymakers to more effectively translate evidence into solutions, especially at the organizational and policy levels.

Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare.

Effective implementation of evidence-based practices often involves multi-level strategies targeting individual-, organizational-, and system-level determinants of change. Although these multi-level implementation approaches can successfully facilitate EBP uptake, they tend to be complex and resource intensive. Accordingly, there is a need for theory-driven, generalizable approaches that can enhance efficiency, cost-effectiveness, and scalability of existing implementation approaches. We propose the Single-Session Intervention approach as an unexplored path to developing low-cost and scalable implementation strategies, especially those targeting individual-level behavior change. We argue that single-session strategies (S3) for implementation, which can simultaneously target myriad barriers to individual behavior change, may promote clinicians' EBP uptake and sustainment in a manner that is low-resource and scalable. We first overview the evidence-base supporting the Single-Session Intervention approach for patient-level outcomes; situate this approach within the implementation science literature by outlining its intersections with a leading framework, the Theoretical Domains Framework (TDF), as an exemplar; and illustrate how the TDF might directly inform the design and evaluation of single-session strategies for EBP implementation. Overall, single-session strategies (S3) for implementation reflect a promising but yet-to-be-tested means of streamlining and scaling individual-level behavior change efforts in healthcare settings. Future partnered research is needed to gauge the potential of this approach across diverse clinical and community contexts.

A comprehensive evaluation of built-environment as a risk factor for sleep disruption

Background/ Aim Sleep disruption is a significant public health issue, given its high prevalence and links to both injury and chronic disease. Interventions for improving sleep often focus on individual-level behaviour change. Modifying aspects of the built environment may be a strategy for population-level improvements. Few studies have evaluated the impacts of built environment on sleep. We assessed relationships between the built environment and sleep disruption using a well-characterized, population-based cohort. Methods Analyses were conducted among participants of the British Columbia Generations Project (BCGP) with complete data on built environment factors and self-reported sleep duration and quality(n=23,556). Measures of air pollution (PM₂.₅, NO₂), greenness (density within 250-metres) and intensity of light-at-night (LAN) were obtained from the Canadian Urban Environmental Research Consortium (CANUE), and linked to participants residential postal codes. Logistic regression analysis, adjusted for age and sex, was used to estimate the association between each built environment factor and self-reported sleep duration (<7 hours, ≥7 hours) and difficulty in falling or staying asleep (sometimes/most of the time/ always vs. rarely/never). Results Increased PM₂.₅ was associated with lower odds of insufficient sleep duration (OR=0.85/5µg/m³; 0.74-0.97) and greater odds of difficulty falling/staying asleep (OR 1.54/5µg/m³; 1.37-1.74). Increased LAN intensity was associated with greater odds of insufficient sleep (OR=1.04/10-unit; 1.02-1.07) but not with difficulty falling/staying asleep. Greenness exposure in the top quartile was associated with reduced odds of insufficient sleep (OR=0.92; 0.86-0.99) and difficulty staying/falling asleep (OR=0.97; 0.95-0.99) compared to those in the bottom quartile. Greenness, LAN and PM₂.₅ were moderately correlated (-0.5 < r < 0.5). Conclusions BCGP’s rich data enabled a comprehensive evaluation of the built-environment as a modifiable determinant of sleep disruption. Further analyses will elucidate the mediating effects of sleep on the links between built-environment and chronic disease. Keywords Sleep; Built Environment; Air Pollution; Greenness; Light pollution

Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children.

This longitudinal study compared children’s health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO) Program contributed data. Children aged 4–12 years and their caregivers were recruited in California, Colorado, North Dakota, and New Hampshire. Dietary intake, physical activity, screen time, and sleep duration were assessed with questionnaires pre-pandemic and during the pandemic. The final sample included 347 children: 47% female and 62% non-Hispanic White. Compared with pre-pandemic, weekday screen time duration was higher during the pandemic (3.0 vs. 4.5 h, p < 0.001). Unadjusted increases in screen time duration differed by race and ethnicity: 1.3 h/day for non-Hispanic White children, 2.3 h/day for Hispanic children, and 5.3 h/day for non-Hispanic Black children. Overall, no changes occurred in sugar-sweetened beverage (SSB) intake (p = 0.26), discretionary food intake (p = 0.93), and physical activity (p = 0.15). Sleep duration increased by 30 min among children who did not meet sleep recommendations pre-pandemic. Child sex and maternal education level were not associated with health behavior change. The pandemic may have exacerbated disparities in some health behaviors. Families may need support to re-establish healthy routines.

Improving Maternal Cardiovascular Health in Underserved Populations: a Narrative Review of Behavioral Intervention Trials Targeting Postpartum Weight Retention.

Racial/ethnic minority and socioeconomically disadvantaged individuals experience greater postpartum weight retention, which has been linked to the development of cardiovascular disease. This article reviews recent literature on behavioral interventions targeting postpartum weight retention in these populations. Seven randomized controlled trials published since 2010 were selected for this review. Four were successful in reducing or preventing postpartum weight retention. Recruitment primarily occurred in low-income urban areas. All interventions reported using the Social Cognitive Theory and targeted mostly individual-level behavior change focused on diet and physical activity. Four were technology-based, and most implemented strategies to increase cultural relevance of the intervention. Opportunities for future interventions include expand target population to enroll individuals starting in pregnancy and address rural populations; incorporate empirically tested retention strategies; increase focus on psychosocial factors, particularly chronic stress; utilize multilevel approaches; continue to leverage technology; and maximize efforts to increase cultural relevancy.

“Languishing” in critical perspective: Roots and routes of a traveling concept in COVID-19 times

As the COVID-19 pandemic entered its second year, the New York Times published a column offering readers a name for its negative impact on mental health and well-being: “languishing.” Originally developed by positive psychologists, the term was designed to capture a sense of distress involving feelings of emptiness, stagnation, and lack of motivation that fall short of clinical significance. The column struck so strong a chord with readers that it was designated the most-read NY Times story of 2021. In this article, I examine how the concept of “languishing” traveled into U.S. popular discourse and consider the term’s emerging cultural valences and interpretive dynamics. I also examine key gaps and discrepancies between operationalized and vernacular usages of the term. Analysis focuses on a set of weekly journals created as part of the Pandemic Journaling Project, an online journaling platform and research study launched in May 2020. The journals show how a “psy” concept, once unmoored from its origins as a research construct, can become (re)invented as a cultural resource available to help people narrativize distress and, in some cases, name and confront injustice. Yet the popular appeal of “languishing” also raises urgent questions—in particular, about the growing role of positive psychology in both public and policy discussions about health and well-being. The field’s emphasis on individual-level behavior change tends to neglect the structural factors, ideological contexts, and relations of power that predispose some people to languish, and others to flourish, in the first place. While the language of “languishing” may prove helpful to some, its individual-level focus risks distracting us from another urgent need: to confront the root causes of today's profound and wide-reaching mental health burden—a burden that may not have been precipitated, but certainly has been exacerbated, by the ongoing pandemic.

The role of culture in advancing sustainable energy policy and practice

This paper offers a culturally sensitive analysis of measures to improve the energy performance of households. Comparing and combining insights from two recent sustainable energy initiatives in Ireland, we show how integrated approaches that work with participants’ everyday practices and their links with people and place can yield substantial and sustained reductions in household energy use. Recognizing the centrality of culturally rooted meanings related to domestic energy use and the services it provides, our analysis challenges approaches to energy saving that overemphasize technology use and individual-level behavior change. Instead, it treats domestic energy use as an inherently social phenomenon that reflects place-specific cultural practices and material conditions. The paper also provides important lessons for upscaling and diffusion of good practice that recognize the centrality of formal and informal community networks and related aspects of trust in local social relations. Involving local advocates with strong social awareness and (inter-)cultural competences can increase engagement in community-based initiatives and deliver more sustainable results. Overall, the paper addresses a major energy policy challenge that has generated intense public debate, namely how to design and implement sustainable energy initiatives that meet the needs of participants and deliver lasting reductions in domestic energy use.

Identifying effective interventions to promote consumption of protein-rich foods from lower ecological footprint sources: A systematic literature review.

Addressing overconsumption of protein-rich foods from high ecological footprint sources can have positive impacts on health such as reduction of non-communicable disease risk and protecting the natural environment. With the increased attention towards development of ecologically sustainable diets, this systematic review aimed to critically review literature on effectiveness of those interventions aiming to promote protein-rich foods from lower ecological footprint sources. Five electronic databases (Medline, Web of Science, Scopus, Embase and Global Health) were searched for articles published up to January 2021. Quantitative studies were eligible for inclusion if they reported on actual or intended consumption of protein-rich animal-derived and/or plant-based foods; purchase, or selection of meat/plant-based diet in real or virtual environments. We assessed 140 full-text articles for eligibility of which 51 were included in this review. The results were narratively synthesised. Included studies were categorised into individual level behaviour change interventions (n = 33) which included education, counselling and self-monitoring, and micro-environmental/structural behaviour change interventions (n = 18) which included menu manipulation, choice architecture and multicomponent approaches. Half of individual level interventions (52%) aimed to reduce red/processed meat intake among people with current/past chronic conditions which reduced meat intake in the short term. The majority of micro-environmental studies focused on increasing plant-based diet in dining facilities, leading to positive dietary changes. These findings point to a clear gap in the current evidence base for interventions that promote plant-based diet in the general population.

A Relationship-Oriented Model of Research Participation: The Brain Health Community Registry

Historically excluded and minoritized populations are significantly under-included in health studies of Alzheimer’s disease and related dementias (ADRD) despite bearing a disproportionate burden of disease—evidenced by higher incidence, prevalence, and poorer health outcomes. Meaningful progress toward identifying and alleviating causes of health disparities in ADRD necessitate effective and scalable approaches for broadening inclusion in research. Rigorous studies evaluating research participation among minoritized populations are limited and have predominantly focused on individual-level factors and behavioral change (i.e. religiosity, willingness). These approaches frequently overlook the influence of unequally distributed structural and social determinants on participation despite the compounded financial, social, emotional, and logistical consequences that result from ADRD. Using an intersectional and social justice lens, we developed the Participant and Relationship-Oriented Research Engagement Model, which characterizes research as a form of relationship and extends social determinants frameworks to the context of research participation. We report core components of the model and its application in the design and preliminary evaluation of the Brain Health Community (BHC) Registry, which features proactive and systematic evaluation of potential unmet needs among prospective participants, and connections to relevant services (i.e. respite care, adaptive devices). Preliminary testing of the model and participant feedback on the BHC suggest it is a feasible approach to research engagement, and that associated assessment tools and resource protocols are acceptable and sufficiently adaptable to heterogeneous sets of unmet needs. Primary challenges include ongoing assessment of engagement and routine changes in service ability, which can be addressed through community-based resource networks.

Initiatives and partnerships in an Australian metropolitan obesity prevention system: a social network analysis

BackgroundLimited resources make prevention of complex population-level issues such as obesity increasingly challenging. Collaboration and partnerships between organisations operating in the same system can assist, however, there is a paucity of research into how relationships function at a local level. The aim of this study was to audit initiatives, explore networks, and identify potential opportunities for improving the obesity prevention system in a Health Service area of Western Australia (WA).MethodsA mixed-methods study was undertaken in a metropolitan Health Service in Perth, WA in 2019–20. Structured face-to-face interviews (n = 51) were conducted with organisations engaged in obesity prevention, to identify prevention initiatives and their characteristics using a Systems Inventory tool. The Research Team identified the 30 most active organisations during the Systems Inventory, and an online Organisational Network Survey was administered to explore: relationships across six domains; partnership duration; frequency of interaction with other organisations; barriers to implementation; and key contributions to obesity prevention. Descriptive statistics were used to summarise barriers, contributions and Systems Inventory data. Organisational Network Survey data were analysed using social network analysis through UCINET 6 for Windows and Netdraw software. Whole network and cohesion scores were calculated: average degree; density; diameter; and degree centralization. Core-periphery analysis was conducted to identify densely connected core and sparsely connected periphery organisations.ResultsThe Systems Inventory identified 189 unique prevention initiatives, mostly focusing on individual-level behaviour change. Fifty four percent (n = 15) of the Organisational Network Survey respondent organisations and most core organisations (67%, n = 8) were government. The information and knowledge sharing network had a density of 45% indicating a high level of information and knowledge exchange between organisations. The lowest densities were found within the receiving (3.3%), providing (5.5%) and sharing (5.6%) funding networks, suggesting that these formal relationships were the least established.ConclusionApplying a systems thinking lens to local obesity prevention revealed that initiatives conducted focused on individual-level behaviour change and that collaboration and communication between organisations focused on information sharing. Capturing the extent and nature of initiatives and the way partnerships operate to improve obesity prevention can help to identify opportunities to strengthen the networks.

Traversing the Aging Research and Health Equity Divide: Toward Intersectional Frameworks of Research Justice and Participation.

Meaningful reductions in racial and ethnic inequities in chronic diseases of aging remain unlikely without major advancements in the inclusion of minoritized populations in aging research. While sparse, studies investigating research participation disparities have predominantly focused on individual-level factors and behavioral change, overlooking the influence of study design, structural factors, and social determinants of health on participation. This is also reflected in conventional practices that consistently fail to address established participation barriers, such as study requirements that impose financial, transportation, linguistic, and/or logistical barriers that disproportionately burden participants belonging to minoritized populations. These shortcomings not only risk exacerbating distrust toward research and researchers, but also introduce significant selection biases, diminishing our ability to detect differential mechanisms of risk, resilience, and response to interventions across subpopulations. This forum article examines the intersecting factors that drive both health inequities in aging and disparate participation in aging research among minoritized populations. Using an intersectional, social justice, and emancipatory lens, we characterize the role of social determinants, historical contexts, and contemporaneous structures in shaping research accessibility and inclusion. We also introduce frameworks to accelerate transformative theoretical approaches to fostering equitable inclusion of minoritized populations in aging research.

MHealth to reduce HIV-related stigma among youth in the United States: a scoping review.

Multiple intersecting stigmas and discrimination related to sex, gender, HIV, and race/ethnicity may challenge HIV prevention and treatment service utilization, particularly among youth. This scoping review describes recent and ongoing innovative mobile health (mHealth) interventions among youth in the United States that aim to reduce stigma as an outcome or as part of the intervention model. To identify examples of stigma-mitigation via mHealth, we searched peer-reviewed published literature using keyword strategies related to mHealth, HIV, stigma, and youth (ages 10 to 29). We identified eleven articles that met our inclusion criteria, including three describing data from two randomized controlled trials (RCTs), five describing pilot studies, one describing the process evaluation of an ongoing intervention, one describing formative work for intervention development, and one published study protocol for an ongoing intervention. We review these articles, grouped by HIV prevention and care continuum stages, and describe the mHealth approach used, including telehealth, simulation video games, motion comics, smartphone applications (apps), social media forums, online video campaigns, video vignettes, and a computerized behavioral learning module. Four studies focused on preventing primary acquisition through individual-level behavior change (e.g., reducing condomless anal intercourse), three focused on increasing HIV testing, three focused on linking to prevention services [e.g., pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)] and one focused on promoting adherence to antiretroviral therapy (ART). Our review did not identify any published studies using mHealth with a primary aim to reduce stigma as a way to improve care engagement and increase viral suppression among youth in the United States. Additional RCTs and implementation studies examining the effectiveness of mHealth stigma-reduction interventions on HIV-related outcomes are needed to end the HIV epidemic among youth. mHealth offers unique advantages to address the complex intersecting stigma barriers along the HIV continuum to improve HIV-related outcomes for youth.