Non-clinical Interventions Research Articles

Maternal Reason for Choosing Caesarean Section at Won Request and Without Medical Indication : A Literature Review

New research from the World Health Organization (WHO) shows that the incidence of caesarean sections in childbirth continues to increase globally, accounting for more than 1 in 5 (21%) of all births. Although there is a considerable amount of literature on complications following caesarean section, the demand for caesarean section without medical indication and at maternal request is increasing. This study aimed to identify the reasons why mothers choose to have a caesarean section without a medical indication. Mothers may choose to have a caesarean section due to fear of vaginal delivery, concerns about perceived health risks, previous traumatic childbirth experiences, worries about future sexual life, positive attitudes towards the caesarean section, and the decision-making process. It can be concluded that many expectant mothers are not adequately prepared for this process. Tackling this problem requires collaboration between different stakeholders. WHO has recommended guidelines for non-clinical interventions to reduce unnecessary caesarean sections, targeting women, health professionals and health organizations, facilities, or systems.

“Recovery is about change, so you have to change everything”: Exploring the evolution of recovery capital among women in substance use disorder treatment

Recovery capital is a framework in addiction research aiming to understand substance use disorder recovery holistically by considering individuals' access to resources across the four domains of human, physical, social, and community capital. Each domain is opposed by negative capital. The underrepresentation of women's experiences in substance use research and the limited understanding of substance use treatment's effect on recovery capital limits our understanding of how treatment programs can support women in developing and maintaining recovery capital. This secondary qualitative analysis of data collected from the RENEW study explores the experiences of n = 19 women enrolled in substance use disorder treatment in Connecticut at baseline. Interviews occurred at two time points three months apart between February 2020 and April 2021 and discussed participants' experiences with treatment and the resources they have access to early in recovery. Thematic analysis identified four main themes related to recovery capital development. First, the direct effects of treatment, defined as clinical pathways to recovery capital, promoted resource growth primarily in the domains of human and physical capital. Second, non-clinical pathways, including indirect effects of treatment, facilitated maintenance of treatment-related improvements in human, social, and community capital. Third, interactions between domains promoted recovery capital resource growth across domains. Finally, goals and expectations for treatment motivated resource development across study time points. This study's findings have important implications for operationalization of the recovery capital framework and highlight the importance of more robust integration of non-clinical interventions to improve the experiences of women in treatment for substance use disorders.

From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania

ObjectiveTo improve understanding of the drivers of the increased caesarean section (CS) rate in Romania and to identify interventions to reverse this trend, as well as barriers and facilitators.DesignA formative...

Nature Connectedness: An Investigation into Alleviating Emotional Disturbances among University Students

Emotional disturbances among undergraduate students have proven to affect students’ learning performance physically, emotionally and mentally. Among non-clinical treatments or techniques identified to address emotional disturbances is exposure to nature. This study investigates the impact of nature connectedness on emotional disturbances among 390 undergraduate students from various disciplines at one of Malaysia’s largest public universities. The research explores causal relationships and mediating effects among nature connectedness, restorativeness, spiritual values, and emotional disturbances, specifically stress, anxiety, and depression. The findings reveal significant associations between nature connectedness and restorativeness, as well as between nature connectedness and spiritual values. Notably, restorativeness emerges as a mediator between nature connectedness and stress, while spiritual values act as a mediator between nature connectedness and depression. The study underscores the potential of combining nature exposure and spirituality as a means of fostering psychological and emotional recovery. It is important to note that the generalizability of these findings is limited to the specific university sample in Malaysia. Nonetheless, the results contribute valuable insights into non-clinical interventions for addressing emotional challenges among undergraduate students.

Implementing the QUALI-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam: a process delineation and theory-driven process evaluation protocol

ABSTRACT The project ‘Quality Decision-making by women and providers’ (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women’s birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the planned process evaluation, which aims to assess how and for whom QUALI-DEC worked, the mechanisms of change and their interactions with context and setting; adaptations to intervention and implementation strategies, feasibility of scaling-up, and cost-effectiveness of the intervention. We developed a project theory of change illustrating how QUALI-DEC might lead to impact. The theory of change, together with on the ground observations of implementation processes, guided the process evaluation strategy including what research questions and perspectives to prioritise. Main data sources will include: 1) regular monitoring visits in healthcare facilities, 2) quantitative process and output indicators, 3) a before and after cross-sectional survey among post-partum women, 4) qualitative interviews with all opinion leaders, and 5) qualitative interviews with postpartum women and health workers in two healthcare facilities per country, as part of a case study approach. We foresee that the QUALI-DEC process evaluation will generate valuable information that will improve interpretation of the effectiveness evaluation. At the policy level, we anticipate that important lessons and methodological insights will be drawn, with application to other settings and stakeholders looking to implement complex interventions aiming to improve maternal and newborn health and wellbeing. Trial registration: ISRCTN67214403.

Engaging National Professional Society to Combat Postpartum Hemorrhage Using Bundle Approach - A FIGO-SAFOG-OGSB-MGH Project: Experience of Implementation in Bangladesh

Objective: To reduce the incidence and death due to post-partum Hemorrhage (PPH) and capacity building of health service providers by using PPH Emergency response using Bundle Approach. Method: Planning and implementation of WHO formulated PPH Bundles [Active Management of Third Stage of Labour (AMTSL), First response Bundle and Refractory PPH Bundle] by Obstetrical and Gynaecological Society of Bangladesh (OGSB) in 14 different levels of public and private hospitals in Bangladesh. After discussion with International Federation of Gynaecology and Obstetrics (FIGO) and South Asian Federation of Obstetrics and Gynaecology (SAFOG) team, a Memorandum of understanding (MOU) was signed; permission from Ministry of Health and Family welfare (MOHFW) was obtained through Directorate General of Health Services (DGHS) and also from all the institutions. The project period was from November 2019 to September 2022 in a spoke-and-hub fashion. A group of master trainers and a technical advisory group were developed comprising of senior obstetricians and gynecologist of Bangladesh. Data were obtained through record keeping of the respective hospitals and Management Information System (MIS) of DGHS, monitoring was done by OGSB and Massachusetts General Hospital (MGH)-FIGO team. Results: Consultative and planning meetings were organized among OGSB, FIGO, SAFOG and MGH: 16 master trainers, 74 trainers were produced and 740 health service providers (Doctor, Nurses, midwives) and 450 non clinical staffs were trained. All clinical and nonclinical bundles were implemented in 14 facilities in spoke-and-hub fashion. Occurrence of PPH, detection rate of PPH, filling up PPH checklist and debrief forms were improved. Data collection system, understanding about data improved a lot. Facility readiness, team work, data monitoring & supervision, network integration and leadership skills were instituted and shown excellent positive changes. Regular simulations were continued which helped old & new service providers to learn and continue proper use of the clinical and non-clinical interventions. Scale up was planned and continued. Conclusion: PPH emergency response using bundle approach was found to be an important practical way to reduce occurrence, death and disability related to PPH. Needs for surgery has reduced also. Quality of services improved in terms of providing standard care, record keeping and reporting. Regular supervision and monitoring; data management and personal motivation are the challenges. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 98-108

Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis

BackgroundCaesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use.MethodsWe re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success.ResultsWe found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components.ConclusionWe identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.

Prospects and Aspirations for Workforce Training and Education in Social Prescribing.

A social prescribing (SP) link worker (LW) is responsible for enabling and supporting individuals, by assessing their personal goals and co-producing solutions to make use of appropriate local non-clinical resources or interventions. As an emerging new role, LWs are not regulated by professional bodies associated with SP. Therefore, currently there is no standardised training for LWs who are from varied backgrounds. As such, LWs have varying knowledge about how to deal with individuals with complex needs, which can impact on their decision-making capabilities to seek solutions and navigate complex systems. The purpose of the research was to explore LWs' level of education, past and current training requirements as well as elicit how much LWs were willing to pay (WTP) to access and undertake training to improve their skill set. A rigorous mixed method research design was employed which included semi-structured interviews with key stakeholders and quantitative questionnaires including contingent valuation (CV) questions to a population of LWs across Wales from March to June 2020. Qualitative interviews with key stakeholders who commission and deliver social prescribing interventions employing LWs identified perceived link worker qualities and requirements for LW roles. Purposive sampling was used to identify and select individuals that have experience in managing LWs. Due to the COVID-19 pandemic, interviews were carried out exclusively online. LWs self-selected to complete the online questionnaires. Questionnaires gathered data on LW qualifications and demographic information with the CV questions gathering data on the value LW placed on accessing training in SP. Thematic narrative analysis was applied to interpret the data from the semi-structured interviews. Descriptive frequency analysis was conducted on the quantitative data generated from the online questionnaire. SP coordinators (n = 6) reported that 'personal skills' are the most essential skills required by LWs in SP intervention. Training is available for LWs; however, the training undertaken varies depending on the type of intervention delivered, with 70% of LWs previously undertaking training to facilitate their development as an LW. The results from the contingent valuation questionnaire (n = 54) indicated that 100% of the respondents would avail of training. LWs were asked how much they were willing to pay as a single payment for professional training; on average, LWs were WTP GBP 58 from their personal funds to access training and the associated benefits to enhance their skills and knowledge. The semi-structured interviews conducted with the key SP stakeholders yielded rich information and novel insight into LW training. External funding for the salary of the LW is an obstacle for LW development through training. In addition, the questionnaire results regarding stated preference techniques demonstrate that LWs place value on their professional development and would be willing to spend their own money on training to improve their knowledge and skills.

Effectiveness of Community-Based Outreach Interventions for Individuals Living with Mental Ill-Health in Australia: A Systematic Review

Objective. Mental ill-health is a common occurrence globally and represents a significant burden of disease. In Australia, the development and improvement of programs that connect individuals earlier in their mental ill-health journey is a national health priority. However, there are current informational gaps on community-based initiatives and their associated mental health outcomes. This review aimed to systematically identify, assess, and analyse studies reporting on community-based outreach interventions for individuals experiencing mental ill-health. Method. A systematic review of the literature was conducted across 6 electronic databases and Google Scholar on 01 November 2021 and 12 June 2022. The National Health and Medical Research Council Evidence Hierarchy was used to assess study quality, and the PAGER framework was used to synthesise and analyse the results of included studies. Results. Eighty-three studies met the inclusion criteria; 51% (n = 42 studies) incorporated digital technology, and 49% (n = 41 studies) involved nonclinical light-touch interventions. Individuals with severe mental ill-health were likely to benefit from targeted interventions, and individuals with mild to moderate symptoms of mental ill-health were likely to benefit from interventions involving high levels of engagement from participants. Conclusion. Results from this review provide an understanding of patterns related to the effectiveness of community-based outreach interventions. Knowledge from this review will inform the implementation of targeted strategies to enhance the proactive provision of mental health services in the community. Standardised outcome measures are needed to strengthen the evidence base for community-based outreach interventions, by enabling researchers and service providers to explore which type of intervention and with what intensity is best suited for participants with varying levels of mental ill-health.

Achievement of appropriate cesarean rates using Robson’s 10-Group classification system in Brazilian private practice

BackgroundIncreasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10–15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP).MethodsThis cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009–2019).ResultsThe PP overall CS rate was 15.1% (95%CI, 13.4–17.1%) versus the 19.8% (95%CI, 14.8–24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6–18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5.ConclusionsMultidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.

Global increased cesarean section rates and public health implications: A call to action.

Over the years; global caesarian section (CS) rates have significantly increased from around 7% in 1990 to 21% today surpassing the ideal acceptable CS rate which is around 10%-15% according to the WHO. However, currently, not all CS are done for medical reasons with rapidly increasing rate of nonmedically indicated CS and the so-called "caesarian on maternal request." These trends are projected to continue increasing over this current decade where both unmet needs and overuse are expected to coexist with the projected global rate of 29% by 2030. CS reduces both maternal and neonatal morbidity and mortality significantly when it is done under proper indications while at the same time, it can be of harm to the mother and the child when performed contrary. The later exposes both the mother and the baby to a number of unnecessary short and long-term complications and increase the chances of developing different noncommunicable diseases and immune-related conditions among babies later in life. The implications of lowering SC rate will ultimately lower healthcare expenditures. This challenge can be addressed by several ways including provision of intensive public health education regarding public health implications of increased CS rate. Assisted vaginal delivery approaches like the use of vacuum and forceps and other methods should be considered and encouraged during delivery as long as their indications for implementation are met. Conducting frequent external review and audits to the health facilities and providing feedback regarding the rates of CS deliveries can help to keep in check the rising CS trends as well as identifying the settings with unmet surgical needs. Moreover, the public especially expectant mothers during clinic visits and clinicians should be educated and be informed on the WHO recommendations on nonclinical interventions towards reduction of unnecessary CS procedures.

2023 ABM Annual Meeting Abstracts Supplement

Objective: Changing individuals’ beliefs about the consequences of experiencing stress, stress mindset, has emerged as a technique for promoting adaptive outcomes under stress. This technique may be particularly valuable given the potential malleability of stress mindset through brief non-clinical interventions. However, there is limited data on the effect of these interventions on the management of “real-world” ecological stressors. The current pre-registered study aimed to evaluate the effectiveness of a novel imagery-based intervention for changing stress mindset, and for improving key stress-related outcomes. Methods: University students visited a research lab twice over a two-week period (N = 150). The intervention was delivered following baseline measures in Session 1, and follow-up measures were taken in Session 2. Measures were perceived distress, psychological wellbeing, positive and negative affect, perceived physical health, proactive coping behavior, perceived somatic symptoms, and academic engagement. Objective academic performance data were also retrieved from university records. The intervention was pilot tested prior to the trial and was delivered using videos that provided information about stress, followed by guided imagery exercises. The control group received only a practice guided imagery exercise not related to stress. Data were analyzed using mixed design ANOVAs. Results: The intervention had a large effect on stress mindset immediately postintervention, and at the two-week follow-up, relative to the control group. There were no effects of the intervention on the stress-related outcomes for the preregistered analyses of the whole sample. Further theory-guided analyses revealed robust effects of the intervention on positive and negative affect, perceived distress, proactive coping behavior, and academic performance at the follow-up in participants who had high levels of perceived distress at the baseline. Conclusions: Findings reveal that the intervention is a promising approach for changing stress mindset, and that stress mindset can improve wellbeing and performance in those experiencing high levels of perceived distress. Future research should seek to replicate these findings and employ intensive longitudinal designs to examine momentary activation of stress mindset and its relationship with key stress-related outcomes following the intervention.

“Because it eases my Childbirth Plan”: a qualitative study on factors contributing to preferences for caesarean section in Thailand

BackgroundAlthough caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women’s and health professionals’ preferences for CS delivery in Thailand.MethodsWe conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes.ResultsThere were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers’ perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby’s safety, a protective shield for doctors); and (3) CS facilitates time management (baby’s destiny at an auspicious time, family’s management, manage my work/time).ConclusionsWomen mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women’s lives. From health professionals’ perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.

A Narrative Review on REM Sleep Deprivation: A Promising Non-Pharmaceutical Alternative for Treating Endogenous Depression.

Endogenous depression represents a severe mental health condition projected to become one of the worldwide leading causes of years lived with disability. The currently available clinical and non-clinical interventions designed to alleviate endogenous depression-associated symptoms encounter a series of inconveniences, from the lack of intervention effectiveness and medication adherence to unpleasant side effects. In addition, depressive individuals tend to be more frequent users of primary care units, which markedly affects the overall treatment costs. In parallel with the growing incidence of endogenous depression, researchers in sleep science have discovered multiple links between rapid eye movement (REM) sleep patterns and endogenous depression. Recent findings suggest that prolonged periods of REM sleep are associated with different psychiatric disorders, including endogenous depression. In addition, a growing body of experimental work confidently describes REM sleep deprivation (REM-D) as the underlying mechanism of most pharmaceutical antidepressants, proving its utility as either an independent or adjuvant approach to alleviating the symptoms of endogenous depression. In this regard, REM-D is currently being explored for its potential value as a sleep intervention-based method for improving the clinical management of endogenous depression. Therefore, this narrative review represents a comprehensive inventory of the currently available evidence supporting the potential use of REM-D as a reliable, non-pharmaceutical approach for treating endogenous depression, or as an adjuvant practice that could improve the effectiveness of currently used medication.

Barriers and Facilitators in the Implementation of Prevention Strategies for Chronic Disease Patients—Best Practice GuideLines and Policies’ Systematic Review

Visits of chronically ill patients account for 80% of primary care consultations. Approximately 15-38% of patients have three or more chronic diseases, and 30% of hospitalisations result from the deteriorating clinical condition of these patients. The burden of chronic disease and multimorbidity is increasing in combination with the growing population of elderly people. However, many interventions found to be effective in health service studies fail to translate into meaningful patient care outcomes across multiple contexts. With the growing burden of chronic diseases, healthcare providers, health policymakers, and other healthcare system stakeholders are re-examining their strategies and opportunities for more effective prevention and clinical interventions. The study aimed to find the best practice guidelines and policies influencing effective intervention and making it possible to personalize prevention strategies. Apart from clinical treatment, it is essential to increase the effectiveness of non-clinical interventions that could empower chronic patients to increase their involvement in therapy. The review focuses on the best practice guidelines and policies in non-medical interventions and the barriers to and facilitators of their implementation into everyday practice. A systematic review of practice guidelines and policies was conducted to answer the research question. The authors screened databases and included 47 full-text recent studies in the qualitative synthesis.

Randomized Clinical Trials of Machine Learning Interventions in Health Care

Despite the potential of machine learning to improve multiple aspects of patient care, barriers to clinical adoption remain. Randomized clinical trials (RCTs) are often a prerequisite to large-scale clinical adoption of an intervention, and important questions remain regarding how machine learning interventions are being incorporated into clinical trials in health care. To systematically examine the design, reporting standards, risk of bias, and inclusivity of RCTs for medical machine learning interventions. In this systematic review, the Cochrane Library, Google Scholar, Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection online databases were searched and citation chasing was done to find relevant articles published from the inception of each database to October 15, 2021. Search terms for machine learning, clinical decision-making, and RCTs were used. Exclusion criteria included implementation of a non-RCT design, absence of original data, and evaluation of nonclinical interventions. Data were extracted from published articles. Trial characteristics, including primary intervention, demographics, adherence to the CONSORT-AI reporting guideline, and Cochrane risk of bias were analyzed. Literature search yielded 19 737 articles, of which 41 RCTs involved a median of 294 participants (range, 17-2488 participants). A total of 16 RCTS (39%) were published in 2021, 21 (51%) were conducted at single sites, and 15 (37%) involved endoscopy. No trials adhered to all CONSORT-AI standards. Common reasons for nonadherence were not assessing poor-quality or unavailable input data (38 trials [93%]), not analyzing performance errors (38 [93%]), and not including a statement regarding code or algorithm availability (37 [90%]). Overall risk of bias was high in 7 trials (17%). Of 11 trials (27%) that reported race and ethnicity data, the median proportion of participants from underrepresented minority groups was 21% (range, 0%-51%). This systematic review found that despite the large number of medical machine learning-based algorithms in development, few RCTs for these technologies have been conducted. Among published RCTs, there was high variability in adherence to reporting standards and risk of bias and a lack of participants from underrepresented minority groups. These findings merit attention and should be considered in future RCT design and reporting.

Providing Emotional Support and Physical Comfort During a Time of Social Distancing: A Thematic Analysis of Doulas' Experiences During the Coronavirus Pandemic.

Doulas are trained, non-clinical professionals that provide a continuum of support for mothers. An interpretive phenomenological approach was used to explore the professional experiences of doulas (n = 17) during the COVID-19 pandemic in the US. Data were collected using brief intake surveys, in-depth semi-structured interviews, and an online discussion group. After a list of significant statements was created and grouped during emergent themes analysis, the reflections were summarized into three themes, (1) Doula Resilience, (2) Experiencing Vulnerability, and (3) Concern for Client Vulnerability that encapsulate the experiences of doulas during the COVID-19 pandemic. We conclude that as part of the COVID-19 recovery process, policy makers should look to non-clinical interventions for improving maternal health, such as promoting and supporting synergy between doulas and other maternal health service providers.

Depression, Anxiety, Perceived Stress and Family Support in COVID-19 Patients.

Objective: Coronavirus disease 2019 (COVID-19) was first reported in Iran in February 2020 and then quickly spread to many cities. Different factors contribute to the numerous psychological problems of this pandemic in patients, healthcare workers and the community. This study investigated the prevalence of perceived stress, anxiety and depression in COVID-19 patients hospitalized between March and April 2020 and revealed associations of these factors with social support received from family. Method : In this cross-sectional study, patients with COVID-19 admitted between 21st of March and 22nd of April 2020 were evaluated by three questionnaires: Anxiety and depression were evaluated using the hospital anxiety and depression scale (HADS), stress levels were evaluated using the four-item perceived stress scale (PSS-4) and family support was evaluated using the perceived social support scale-family (PSS-Fa). In addition to obtaining prevalence of the noted psychological disorders and their relationship with demographic details, relationship of stress, anxiety and depression with family support was also investigated using the Pearson's correlation coefficient. Results: Participants comprised 100 COVID-19 patients (38 females and 62 males). Findings suggested high levels of perceived stress in 26% of the participants, anxiety symptoms existed in 29% and borderline conditions existed in 17%. Moreover, depressive and its borderline symptoms were respectively observed in 17% and 23%. Family support was found to negatively and significantly correlated with anxiety (Pearson correlation = -0.249, P < 0.05) and depression. (Pearson correlation = -0.221, P < 0.05). Conclusion: Given the high prevalence of anxiety and depression in hospitalized COVID-19 patients, it is recommended to further focus on non-clinical interventions, such as providing psychological first aids, boosting psychological resilience, and enabling greater family support, in efforts to prevent transformation of these psychological symptoms into long-term psychological disorders.

Abstract 6141: Understanding the role of gp78 in breast cancer health disparities

Abstract Background: Breast cancer is a devastating disease where death rates for women of African ancestry (AA) are 40% higher than that of European ancestry (EA), demonstrating racial disparity in mortality. gp78 protein is an independent predictor of poor outcomes in women of AA that is over-expressed in aggressive breast cancers. The purpose of this research was to understand how gp78 is associated with poor survival rates by studying tumor biology and gene expression. We hypothesize a positive correlation between the overexpression of gp78 protein in higher amounts for AA women than that of European ancestry women which may correlate with specific functional pathways. Methods: Medical data was collected from a health disparities cohort in Eastern North Carolina. The patient’s race, ethnicity/ancestry were self-reported at the initial visit; the study cohort was reported as 50% AA. Immunohistochemistry to measure protein expression, DNA mutation &amp; gene expression used with Gene Set Enrichment Analysis(GSEA) of 147 patients to identify functional pathway differences in tumor biology between high versus low gp78 expression versus gp78 expression based on patient race. Hierarchical clustered heatmaps were used to compare overlapping genes that were differentially expressed. Results: 49 common genes were identified as the overlap between the genes in the differential gene expression list for gp78 and the two different gene set enrichment analyses compared: GSEA based on patients expressing high versus low gp78 protein by IHC versus GSEA based on white vs black patients (race). The hierarchical cluster analysis of the gene expression patterns identified two prominent clusters: association by extracellular factors in the tumor microenvironment and association by mitochondrial regulation and proliferation. Conclusions: This study suggests that gp78 differences based on race may be linked to tumor microenvironment, mitochondrial function, &amp; proliferation linking gp78 as a biomarker that is differentially expressed based on race and more highly correlated with breast cancer aggressiveness to functional properties of mitochondrial metabolism &amp; tumor microenvironment. We will explore this gene signature/biomarker that may predict survival based on race. This discovery provides new areas of research to explore the relationship of extracellular factors in the tumor microenvironment, mitochondria regulation, &amp; proliferation. Clinical &amp; nonclinical interventions addressing racial health disparity in mortality should target breast cancer-specific health determinants (both environmental and biological) among those of AA with efforts to decrease racial disparities in mortality rates. These new observations indicate gp78 may be a biomarker that can predict survival based on race using tumor biology, which can contribute to new strategies for reducing the rate at which women of AA disproportionately suffer from breast cancer mortality. Citation Format: Sediqua Sherese Bufford. Understanding the role of gp78 in breast cancer health disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6141.

Identifying factors associated with adolescents' Intention for childbirth.

Around the world, caesarean section rates have steadily increased over the past few decades. The World Health Organization (WHO) guidelines on nonclinical interventions to reduce caesarean section rates emphasize educational interventions and support programs. In this study, we have determined factors associated with adolescents' intention regarding childbirth options using the Theory of Planned Behavior (TPB). The sample was comprised of 480 high school students in Greece who were invited to complete a questionnaire consisting of three sections: a section on sociodemographic data; a section featuring the Adolescents' Intentions towards Birth Options (AIBO) scale, a recently developed instrument that accesses attitudes and intentions regarding vaginal birth and caesarean section; and a section detailing participants' awareness regarding reproduction and birth. Multiple logistic regression found that participants' impressions of vaginal birth and the TPB constructs were significantly associated with intention towards caesarean section. In particular, participants with a negative impression of vaginal birth had a 2.20-fold higher probability of reporting their preference for caesarean section, compared to participants with neither a negative nor a positive impression. Furthermore, participants with higher scores on the "Attitudes towards vaginal birth," "Subjective norms," and "Perceived behavior control over vaginal birth" subscales had a significantly lower probability of reporting preference for caesarean section. Our study demonstrates the effectiveness of the TPB to identify factors that influence adolescents' preference for childbirth. We highlight the necessity to implement nonclinical interventions to reduce the preference for caesarean section, providing evidence for developing school-based educational programs for a timely and consistency implementation.