Interpersonal Level Research Articles

Experiences of family caregivers of children living with thalassaemia-major in Karachi: a phenomenological study

IntroductionThalassaemiamajor, a global health burden, presents a growing challenge in Pakistan’s strained healthcare system. This study explores how caregivers of children with beta-thalassaemia major navigate healthcare services, aiming to identify facilitators and barriers to accessing optimal care.MethodsA qualitative interpretative phenomenological approach was employed. In-depth interviews with 18 purposively sampled caregivers from Karachi thalassaemia centres were conducted. Thematic analysis using a combined inductive-deductive approach identified themes within the interview data.ResultThe study revealed significant challenges for caregivers at individual, interpersonal and organisational levels. Lack of awareness about carrier states, limited disease knowledge, financial constraints and concerns about the child’s future emerged as primary hurdles. Parents felt helpless due to the absence of emotional and social support for their children’s treatment. Obstacles such as complicated registration processes at thalassaemia-care centres, high costs of chelating agents and blood unavailability were major barriers to seeking care and caregiving. Additionally, the study highlighted the absence of guidelines for thalassaemia-carrier detection among mothers during antenatal care.ConclusionThe study emphasised the importance of implementing premarital screening programmes due to the lack of knowledge about the disease and carrier state. To prevent the disease, it is crucial to include thalassaemia-carrier detection for mothers in antenatal guidelines and provide counselling at the primary level. Additionally, caregivers encountered treatment accessibility issues, prompting the establishment of a satellite thalassaemia centre linked to a top-tier tertiary care hospital in the public sector. This initiative addressed treatment challenges and improved overall care for patients with thalassaemia and their caregivers.

Expansion and evaluation of level II and III recovery residences for people taking medications for an opioid use disorder: project HOMES (Housing for MAR Expanded Services) study protocol

IntroductionAs the US continues to battle the opioid epidemic, recovery residences remain valuable services for people in recovery. While there is a growing body of literature describing positive outcomes experienced...

Provider perspectives on maternal care challenges for Black and Latine Women in Indiana: a qualitative interview study

Indiana consistently ranks among the states with the highest maternal and infant mortality in the United States, particularly affecting Black and Latine communities, endangering their right to safe and respectful maternal care. Providers working with these communities are crucial in identifying challenges faced by their clients, and to inform programmes and policies. We interviewed 32 clinical and community-based providers to understand their perspectives on the challenges faced by their Black and Latine clients from February to April 2021. Participants were identified through online sources and referrals. Interviews, conducted over online video, were recorded, transcribed, and analysed following a six-step thematic approach. Six areas of challenges emerged: non-medical infrastructure and policy problems, effects of systemic racism and bias, insecurity of the Latine community, dissatisfaction with maternal care delivery, issues in navigating maternal healthcare, and limitations to holistic models of care. The results demonstrate the interconnected structural, organisational, and interpersonal nature of the challenges. Though challenges were described at structural and organisational levels, the focus of state maternal care programs is largely at personal and interpersonal levels. Obstetric racism, citizenship restrictions, shortage of Black and Latine providers, and transportation issues are complex problems, requiring multilevel interventions and policies to ensure Black and Latine women can exercise their right to safe and respectful maternal care. A rights-based approach centring the needs of Black, Latine and other minoritised communities should be implemented to make effective changes with an equity focus.

11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments

Abstract Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health. Key messages • Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals. • Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.

5.A. Scientific session: From theory to action - Applying the Medical Research Council framework on complex interventions

Abstract The reasons for the workshop: Globally, public health problems such as obesity, poor mental health, and social inequality in health are on the rise. Tackling these significant challenges requires well-designed complex interventions. Interventions rarely follow linear sequences from intervention design toward large-scale implementation. Rather, they take non-linear trajectories by constantly adapting the intervention design according to the context. This thinking is outlined in the British Medical Research Council’s (MRC) 2021 framework for developing and evaluating complex interventions. This workshop encompasses four case projects, each corresponding to one of the four phases in the framework: i) development, ii) feasibility, iii) implementation, and iv) evaluation. However, recognising the deliberately generic nature of this framework, our workshop also encompasses co-creation, process evaluation, and implementation theories and methodology. Combining these methodologies presents challenges that necessitate clear argumentation and critical reflection. In this workshop, we will share the challenges encountered when applying the MRC 2021 framework and hopefully inspire future innovative opportunities in intervention research. Specifically, this workshop aims to: i) exchange challenges from intervention research methods and theories drawing on presenters’ experiences across four public health case projects. Presenters will critically reflect on the key concepts from the MRC framework including context, programme theory, engagement of stakeholders, uncertainties, and refinement of interventions. ii) discuss opportunities for future complex intervention research and outline best practices for using the MRC 2021 framework for complex interventions. The added value of organising the workshop: The audience attending this workshop will reflect on multiple on-the-ground experiences of applying methodology and principles from the MRC 2021 framework as well as methods and theories relevant to intervention research: co-creation, qualitative (e.g., ethnography, interviews) and quantitative (e.g. experimental, observational) methods applied to all core phases of complex interventions. At the end of the workshop, the audience will be invited to participate in an open, plenary discussion facilitated by the workshop’s chairs: two international experts on complex interventions, Reader Rhiannon Evans and Prof. Helle Terkildsen Maindal. The experts will encourage the presenters and audience to reflect critically on the case projects and ways forward for complex intervention research. Coherence between the presentations in relation to the workshop topic: The four case projects are guided by the MRC 2021 framework for complex interventions and involve public health interventions at the individual, interpersonal, and structural levels in Denmark and Canada. Key messages • Tackling public health challenges demands innovative and well-designed complex interventions combining research traditions, principles from health promotion, and cutting-edge best-practice frameworks. • The symposium will create a platform for cross-disciplinary knowledge exchange through case projects and expert-led joint discussions on how to apply the MRC 2021 framework for complex interventions.

Polish midwives’ experiences of providing maternity care to Ukrainian women in Poland

Abstract Background Migrants’ health has attracted the attention of researchers for many years, particularly from the perspective of barriers in access to healthcare systems. Providing high quality care to migrants and refugees, especially in contexts of significant and sudden arrivals, may be particularly challenging. Aim The aim of our research was to learn about the experiences and strategies of midwives providing maternity care for Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine. Methods Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed. Results Healthcare personnel experiences a number of barriers to the provision of high-quality care to the migrant population. Polish midwives expressed mainly experience of two groups of barriers on: (1) individual and interpersonal, (2) management and organization levels. Firstly, at the individual and interpersonal level midwives experienced: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for woman fleeing the war. Secondly, at the management and organizational level midwives experienced: lack of organizational support, interpreting services and documentation in any other language than Polish. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units. Conclusions The Polish health care services need systemic solutions prepared jointly by state and local authorities and considering the voices of midwives to support the provision of high-quality care to migrant population. Key messages • Midwives were left to their own devices. • Midwives need better preparation for providing high-quality care to migrant population.

A Workplace Intervention to Strengthen Supervisor Support for Employees With Common Mental Health Problems: A Mixed-Methods Realist Evaluation

The purpose of this study is to obtain insight into whether, how and under which circumstances a novel workplace intervention works. This intervention aims to strengthen the supportive behaviour of Dutch supervisors in promoting the work participation of employees with common mental health problems (CMHPs), provided by occupational health professionals (OHPs). In a mixed-methods realist design, we evaluated changes over time, reasoning that supportive behaviour would be changed through motivation and skills and we explored how mechanisms of change may be triggered by personal, environmental and intervention factors. Compared to baseline (n = 92), self-reported supportive behaviour of supervisors increased post-intervention (n = 65, 3 months) and increased significantly post-follow-up (n = 56, 6 months). A statistically significant regression model (R2 = 0.29) indicated that factors such as increased self-efficacy and skills, being assessed as supervisor on sick leave numbers, previous collaboration between OHP and supervisor, and having dealt with CMHP before were positively related to the changes in supervisors’ supportive behaviour. According to supervisors, working mechanisms on the interpersonal level were the OHPs’ expertise and trust and the co-supervisors collective efficacy. On the individual level, mechanisms were self-efficacy, willing to improve and skills to act. Enabling circumstances to trigger those mechanisms were being given time and structural, low-key access to OHP expertise, in a safe learning climate. This preventive, multifaceted, action-oriented workplace intervention had a positive impact on supervisor support in promoting work participation among employees with CMHP. These findings may encourage employers to invest in supervisors’ capacity, thereby enabling employees with CMHP to keep working and perform well in their jobs.

Social Stigma and Vulnerabilities of Women Living With HIV/AIDS in Kyrgyzstan: Service Providers’ Perspectives

In Kyrgyzstan, registered HIV cases doubled from 2013 to 2019, with women constituting 39% of cases in 2021. Women living with HIV (WLHIV) encounter heightened intimate partner violence, stigma, and discrimination. This study explores the experiences and vulnerabilities of WLHIV in Kyrgyzstan from the perspective of professionals engaged in HIV care and advocacy. Data from in-depth, semi-structured interviews with 10 professionals engaged in HIV prevention were analyzed using grounded theory methods. The analysis revealed two primary categories related to the experiences of WLHIV as observed by professionals in the field: (a) Challenges faced by WLHIV at the personal, interpersonal, community, and institutional levels, and (b) The way forward—providers’ ideas about addressing stigma and vulnerability. Urgent action is needed to address the needs of WLHIV, emphasizing confidentiality and support, recognizing discrimination as violence, and fostering financial independence.

Using the Candidacy Framework to understand individual, interpersonal, and system level factors driving inequities in women with breast cancer: a cross-sectional study

BackgroundPersistent inequities in breast cancer outcomes exist. Understanding women’s experiences along the care pathway is the first step to finding solutions to tackle these inequities.MethodsSecondary data analysis of the 2017/2018 English National Cancer Patient Experience Survey (n = 25,408) using logistic regression to explore inequities in care experience by sociodemographic factors (age, ethnicity, socioeconomic position, sexual orientation) across 59 survey questions. We used the Candidacy Framework to interpret and organise our findings.ResultsCompared to older (65–74) and White British women, young (35-44, OR = 0.55 [0.44, 0.69]), Asian (OR = 0.52 [0.41, 0.67]), Black (OR = 0.67 [0.46, 0.97]) and White Other (OR = 0.63 [0.49, 0.81]) women were more likely to rate their overall care experience less positively, respectively. Similar findings were observed along all domains of the cancer pathway. Through a candidacy lens, we identified multilevel factors related to this variation including prolonged help-seeking behaviours (individual), poor patient-provider communication (interpersonal), and variation in access to healthcare professionals and resources (system level).ConclusionMultilevel factors influence inequities in the experience of care along the breast cancer pathway for young women and women from minoritised groups. Interventions are necessary to ensure cancer care systems are responsive to women’s health needs and provide equity of care to all patients.

Context-Specific Resilience Through a Cultural Lens: Social-Ecological Factors Among Chinese Families of Children with Neurodevelopmental Disabilities.

With the rise in attention towards Neurodevelopmental Disorders in Hong Kong and worldwide, understanding the role of social ecological resilience in reducing parenting stress and enhancing child outcomes is crucial, particularly within the unique cultural context of Chinese families. This study utilized a social ecological model to examine resilience factors at individual and interpersonal levels among Hong Kong parents of children with Neurodevelopmental Disorders. It also compared the stress and resilience conditions and differential functions of social ecological resilience between parents with and without children diagnosed with Neurodevelopmental Disorders. A sample of 447 parents of children with and without Neurodevelopmental Disorders were assessed by a newly developed Social Ecological Resilience Scale, along with measures of parenting stress and the internalizing and externalizing behaviors of their children. Independent sample t-tests showed that Chinese parents of children with Neurodevelopmental Disorders report significantly higher parenting stress and more internalizing and externalizing difficulties in their children compared to those without Neurodevelopmental Disorders. Multiple linear regression analyses indicated that enhanced social ecological resilience among parents predicted improved parenting stress and better outcomes in children's behaviors. Notably, social ecological resilience factors showed varying effects between parents with and without children diagnosed with Neurodevelopmental Disorders. These findings highlight that both individual and interpersonal resilience factors among parents predicted improved parenting stress and better outcomes in children's behaviors and certain resilience factors may be contextually motivated. Policy makers and practitioners should consider developing context-specific strategies and programmes to help the focal target group.

The effect of interprofessional education on the surgical team members' self-efficacy perception of interprofessional communication in the healthcare system.

The current study aimed to assess the effect of interprofessional education on participants' self-efficacy perception of interprofessional communication at different levels of a healthcare system (relationships in the interpersonal, interprofessional, and administration levels). This is a sequential explanatory mixed-method study. Learners include surgical residents, surgical technology nurses, and anesthesia nurses (n = 130) who participated in the intervention and control groups. The quasi-experimental study was conducted in the first step. The educational strategy was interprofessional education and the main teaching method was case-based learning. The self-efficacy perception of the participants was assessed by a 26-item questionnaire before and 1 month after the intervention. The descriptive tests (mean, SD, percentage), student t-tests, and ANOVA were analyzed. The participants' experiences were explored through semi-structured interviews. Qualitative content was analyzed by Lundman and Graneheim's approach. The results showed that the scores of the learners in the intervention group (4.05 ± 0.31) improved significantly compared to the control group (3.35 ± 0.37) (p = 0.0001). In the present study, the experiences of the participants were categorized into a theme "explicit and implicit confrontations with perceived distrust in the system" which includes two categories "failure to internalize professionalism among team members" and "dominance of a paternalistic culture within the health care system". The results showed the positive impact of interprofessional education interventions on participants' self-efficacy perception of interprofessional communication. The results showed that interprofessional education, with the participation of different professionals and managers at different levels of a healthcare system, improved the participants' perception of self-efficacy regarding interprofessional communication. The results showed the improvement in the participants' communication with team members and managers required to solve the perceived explicit and implicit confrontations in the surgical departments. The implementation of an interprofessional education strategy focused on interprofessional professionalism and collaboration principles in clinical activities, formal and informal education in the surgical department is recommended.

Communication, Climate Mitigation, and Behavior Change Interventions: Understanding Message Design and Digital Media Technologies

Using the socio-ecological model of social and behavior change communication, our review highlights current trends in understanding message design factors and media technologies promoting proenvironment and climate mitigative behaviors. We explain that much of this research has focused on the individual level, and relatively few studies have been conducted at the interpersonal and community levels. With respect to changing communication ecology, we note the potential for research on the use of social media platforms to influence positive behavior changes and, conversely, the challenges of misinformation and its impact on behavior shifts. This area requires further investigation as these communication platforms transform and become increasingly relevant. Additionally, we need to explicate the long-term shifts and impacts of behavior change interventions as well as track behaviors over time. Overall, our review underscores the continued need for research across different geographical, sociopolitical, and technological contexts.

A qualitative dyad analysis of barriers and facilitators of antiretroviral therapy (ART) adherence among people who inject drugs (PWID) with HIV in Kazakhstan.

People with HIV (PWH) who inject drugs (PWID) face many barriers to ART adherence. Kazakhstan has one of the fastest growing HIV epidemics in the world, primarily fueled by injection drug use, yet ART adherence among PWID is low. Social support can help address these barriers, but ART adherence among PWID is rarely examined within the relationship context. We conducted interviews with 20 PWID with HIV and 18 of their intimate partners and performed a qualitative dyad analysis to examine ART adherence factors. The results indicated many barriers and facilitators of ART adherence at the individual level (e.g., substance use), interpersonal level (e.g., social support) and structural level (e.g., stigma, transportation). Reported adherence barriers and facilitators had high congruence between dyad members; however, some notable differences were found between dyads. Compared to PWH, partners without HIV had a lack of awareness about the role of stigma in impeding ART adherence. Different manifestations of social support to facilitate ART adherence were noted between seroconcordant dyads (e.g., taking pills together, attending appointments together) and serodiscordant dyads (e.g., reminders to take pills, providing babysitting to enable attendance at doctor appointments). Future research and programs may benefit from integrating dyad approaches into ART adherence interventions.

The role of fear as a barrier and facilitator to antiretroviral therapy initiation in Indonesia: insights from patients and providers

ABSTRACT Initiating antiretroviral therapy (ART) in Indonesia poses major challenges, with limited studies on specific ART initiation barriers and facilitators. Using a socioecological approach, we explored, through semi-structured interviews, the perspectives of 67 participants: 17 people with HIV not (yet) on ART, 30 people with HIV on treatment, and 20 HIV service providers (HSPs). Fears emerged as pervasive barriers to initiation encompassing, at the intrapersonal level, (irrational) fears of negative medical and non-medical consequences. At the health system level, fears were linked to concerns about bureaucracy and insufficient universal coverage. On a societal level, fears stemmed from prevalent myths, misinformation on social media, and the impact of COVID-19. Interestingly, fear also served as a facilitator to initiation. At the intrapersonal level, initiation was driven by a fear of deteriorating health or death due to AIDS-related conditions. At the interpersonal level, buddies and HSPs leveraged to motivate initiation. At the societal level, accurate yet fear-inducing information on social media stimulated initiation. Perspectives differed between people with HIV and HSP, with people with HIV emphasizing barriers on intrapersonal to health system levels, while HSP focused mostly on intrapersonal and interpersonal barriers, albeit recognizing the crucial role of health systems.

Advancing a tourist perspective in inclusive place branding: anticipated constraints of domestic tourists with foreign backgrounds

ABSTRACT Research on inclusive place branding has primarily focused on residents, while tourists are yet to be addressed, except in representation studies. Inclusion is, however, more than a matter of representation. It must also consider the needs of the tourists. This study explores people with foreign backgrounds’ anticipated constraints to domestic tourism. This article advances knowledge of inclusive place branding in multicultural societies by introducing the constraint-negotiation model to analyse the anticipated constraints. The data includes online focus groups with 30 participants living in Sweden. The findings identify constraints on individual, interpersonal, and system levels. These include language skills, knowledge of the domestic destination and personal habits, lack of domestic network, strong network in another country, and beliefs about place brand communication. The study creates new knowledge of inclusive place branding by enhancing an understanding of constraints to inclusive tourism from a tourist perspective, and the anticipations of people with a foreign background. The findings suggest that understanding and addressing people’s experiences and needs are significant, and inclusion in a multicultural society is a multifaceted and ongoing process. Furthermore, the findings suggest that it is crucial to incorporate non-included groups in the process of producing place brand communication.

‘What’s in it for us?’ How Inclusive Behavior Benefits Interpersonal Communication at Work

This article examines how inclusive behavior affects communication on an interpersonal level while presenting a perspective on how these effects are created and obtained. We present our findings through a multiple case study design of the positive communication benefits attributed to inclusive behaviors while generating a better understanding of how and when these benefits occur. This contribution could help organizations identify the value of practicing inclusion and guide them toward acquiring the benefits of inclusive behavior. The article also suggests that informal learning plays a substantial role in reaping interpersonal benefits due to the practice of inclusive behavior in work-related settings.

Risk Factors for Disease Aggravation in Older Patients With Non-communicable Diseases: Interpretive Structural and Hierarchical Holographic Modelling.

This study aimed to analyse and determine the risk factors of disease aggravation faced by older patients with non-communicable diseases (NCDs) and their interwoven correlations. We employed a descriptive and cross-sectional study, which followed the STROBE guidelines for reporting. We conducted a semi-structured in-depth interview with 26 older patients with NCDs from a hospital in Qingdao, China between July and August 2022 on the basis of the literature review. Then, we analysed data using the directed content analysis and determined risk factors through a focus group discussion and the Delphi consultation. Afterward, we combined interpretive structural modelling and hierarchical holographic modelling to construct a hierarchical structure model and drew relationship framework diagrams to exhibit diversified risk factors and complex interwoven correlations. We identified 30 risk factors from individual, interpersonal, organisational, community and policy levels. The hierarchical structure model constructed by interpretive structural modelling demonstrated a four-layer structure, and the individual and interpersonal levels were at the highest layer. The relationship framework diagrams demonstrated the identification process of risk factors and interwoven correlations at individual and organisational levels. Risk factors causing disease aggravation amongst older patients with NCDs are diverse. To delay the progression of NCDs, we should comprehensively explore risk factors, interpret the root causes and effects of risks from multiple perspectives and consider the interaction amongst multi-level risk factors to develop precise measures related to risk control. Controlling risk factors is an effective measure to postpone disease aggravation. Through this study, we provide a scientific and comprehensive basis for clinical risk screening so that healthcare providers can sense potential risk factors for disease aggravation in older patients' surroundings and formulate targeted nursing measures according to the risk factors faced by different patients. Patients participated in interviews to supplement risk factors included in our study. Experts provided opinions on the inclusion, exclusion and modification of risk factors.

The Body Advocacy Movement-Health: a pilot randomized trial of a novel intervention targeting weight stigma among health professional students

BackgroundWeight stigma among healthcare professionals is associated with negative health impacts on patients, yet there are few effective strategies to combat weight stigma among health professional learners. The Body Advocacy Movement-Health (BAM-Health) is a novel group-based, peer-led stigma reduction intervention for health professional students that targets weight stigma across intrapersonal, interpersonal, and structural levels. The present study (1) assesses short-term impacts of BAM-Health participation on intrapersonal and interpersonal weight bias compared to an informational brochure control condition and (2) explores the feasibility and acceptability of BAM-Health among a sample of health professional students.MethodsSixty-seven health professional students participated in BAM-Health (n = 34) or received an informational brochure about weight stigma (n = 33). Participants completed validated self-report surveys assessing internalized weight/ appearance concerns and interpersonal weight stigma prior to their assigned intervention (baseline), immediately following intervention (post-intervention), and four weeks after intervention (follow-up). Baseline to post-intervention and baseline to follow-up effect sizes on each measure were calculated. At post-intervention, participants completed feedback surveys for thematic assessment.ResultsBAM-Health participation had a large baseline to post-intervention effect on internalized weight/ appearance concerns that diminished slightly at follow-up (Cohen’s d = -0.88; d = -0.62). Receipt of the informational brochure had a small effect on internalized weight/ appearance concerns (d = -0.27); however, these changes were not sustained at follow-up (d = 0.04). BAM-Health participation resulted in reductions in interpersonal obesity stigma and anti-fatness with small effect sizes (d = -0.32; d = -0.31). The effect on obesity stigma was slightly amplified at follow-up (d = -0.43); however, decreases in anti-fatness were not sustained (d = -0.13). The brochure condition failed to demonstrate effects on anti-fatness (d = 0.13, d = 0.14) or obesity stigma (d = -0.12; d = -0.12) at either time point. Between-session attrition rates of 4.5%, favorable quantitative ratings on post-session acceptability surveys, and free responses demonstrating appreciation of the virtual group environment and session activities reflect feasibility and acceptability of BAM-Health.ConclusionsBAM-Health is a novel peer-led intervention that aims to reduce weight stigma among health professional students. BAM-Health met feasibility benchmarks and received positive feedback from participants, demonstrating acceptability and indicating interest among health professional students in analyzing and reducing weight stigma in their personal lives and careers. The intervention led to promising decreases in internalized and interpersonal weight stigma at post-intervention, some of which were sustained at follow-up. However, lack of effect on internalized weight/ appearance concerns measures may indicate that BAM-Health participants are more likely to reject weight stigma directed toward others following intervention, while maintaining thin ideals for themselves. Further investigation of BAM-Health with a larger sample and continued program development is warranted.

Barriers and Facilitators for Physical Activity Among Children and Youth With Autism-A Scoping Review.

The purpose of this scoping review was to systematically synthesize barriers and facilitators for physical activity (PA) among children and youth with autism spectrum disorders (ASD) across the socioecological model. Five electronic databases were searched in March 2022 for studies examining barriers and facilitators for PA among children and youth with ASD. An updated search was performed in April 2024. The framework synthesis method was utilized, and the socioecological model was the chosen framework. Fifty-four studies published from 2008 to 2024 were included. Among the included studies, 57% included the perspectives of children and youth with ASD alone or together with proxies (eg,parents, teachers, and coaches), while 43% included only the perspectives of proxies. Barriers and facilitators on the intrapersonal and interpersonal levels were most substantial. The analysis led to 2 main categories of barriers and facilitators, those unique to children and youth with ASD, and those similar to what had been identified through research on children and youth, both typically developing and with other disabilities. This comprehensive scoping review shows the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and highlights both the factors unique to this population and more general factors affecting PA participation. The findings from this synthesis might be used to guide the development of inclusive PA in physical education, organized sports, and other community PA arenas.

Protective Factors Associated With Lower Likelihood of Injection Drug Use and Experiencing Overdose Among Incarcerated Women

PurposePrior studies evaluated protective factors individually as they relate to fewer drug use risk behaviors and related consequences. This is the first study to examine protective factors as part of a multilevel framework along a risk continuum among women involved in the criminal legal system who use drugs. This study describes factors within the socio-ecological framework that are protective against engaging in injection drug use and experiencing nonfatal overdose. MethodData were collected from 900 women with a history of opioid use disorder who were incarcerated and enrolled in the National Institutes of Health/National Institute on Drug Abuse–funded Justice Community Opioid Innovation Network cooperative. Analysis focused on the relationship among individual, interpersonal, and community- or institutional-level protective factors associated with not injecting drugs and not experiencing an overdose in the 90 days before incarceration using multinomial logistic regression. FindingsFindings from this study suggest that, even among a sample of women who use drugs, there are a number of factors associated with being less likely to report higher-risk injection behavior and/or overdose experiences at the individual level (age, religiosity, and less polysubstance use), interpersonal level (not having a partner who injects drugs), and community or institutional level (fewer months incarcerated, less treatment utilization, and less enacted stigma by health care workers). ConclusionsFindings from this study underscore the importance of being able to target prevention interventions to women at different stages of substance use severity and to capitalize on protective factors for those at lower-risk levels to reduce the trajectory of risk to injection practices and overdose experiences.