Partner Perspectives Research Articles

(024) Sexual, Psychological, Interpersonal Well-being and (Unmet) Supportive Care Needs of Couples After a Gynaecological Cancer Treatment

Abstract Introduction Previous research has shown that gynecological cancer negatively affects the psychological and sexual well-being of patients. However, little is known on the impact of a gynecological cancer on the partner’s sexual, psychological and social function and on the supportive care needs of couples during and after the cancer treatment. Objectives To assess the sexual, psychological and relational functioning of women and their partners after a gynecological cancer treatment and to assess their (unmet) supportive care needs during and after treatment. Methods Patients treated for a gynecological cancer at the [blinded for review] between January 2012 and September 2019 and their partners completed self- reported questionnaires. Participants completed the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory II, the Female Sexual Function Inventory, the International Index of Erectile Function’s, the Sexual Distress Scale’s, the Couple Satisfaction Index’s, and the Dyadic Sexual Communication Scale. In addition, they completed a self-reported questionnaire on (unmet) supportive care needs during and after treatment. Results Sixteen couples participated in the study. Mean age was 59.5 (range 46-72) for women and 63 (range 50-76) for men. The mean duration since treatment was 3 years (range = 1-7).Thirty-eight percent of women and 23% of men reported moderate to high levels of anxiety whereas 18,75% of women and no men suffered from moderate to severe depression. Sixty percent of patients reported a sexual dysfunction and 40% reported significant sexual distress. Eighteen percent of men reported an erectile dysfunction and 33% reported a significant sexual distress. Whereas most couples were satisfied about their relationship, difficulties in sexual communication were expressed by most couples. Receiving psychological support, information and help with the changes in the sexual life were the most widely supported care needs of patients and partners during and after treatment. Although the highest domains of unmet needs during and after treatment for both partners were in the informational, relational and physical domain, more than 50% of couples reported unmet needs in the sexual domain. Conclusions Gynecological cancer and treatment negatively affects the psychological and sexual well-being of both the patient and her partner. Support during and after treatment should take aspects such as psychological and sexual distress and the partner perspective into account. Disclosure No.

Female genital modification: Untangling visual attractiveness of female genitalia from an Afrocentric perspective of male sexual partners

Female genital modification: Untangling visual attractiveness of female genitalia from an Afrocentric perspective of male sexual partners

Obstacles and facilitators of cancer-related dyadic efficacy experienced by couples coping with non-metastatic cancers

IntroductionCancer-related dyadic efficacy is an individual’s confidence to work together with a partner to conjointly manage the effects of cancer and its treatment. In other health contexts, higher levels of dyadic efficacy have been associated with fewer symptoms of psychological distress and higher ratings of relationship satisfaction. The aim of the current study was to explore patient and partner perspectives on what obstructs and facilitates cancer-related dyadic efficacy.MethodsThese aims were accomplished through a secondary analysis of data collected as a part of a collective qualitative case study. Participants (N = 17 participants) were patients undergoing treatment or recently completed treatment (within 6 months) for a non-metastatic cancer and their partners. To enable in-depth discussions among participants, data was collected through five focus groups. Participants described obstacles and facilitators of dyadic efficacy as dimensions of a common influence. Consistent with these descriptions, reflexive thematic analysis was used to identify influences on cancer-related dyadic efficacy and their subsequent obstructive and facilitative dimensions.ResultsFour main categories of influence with the potential to obstruct or facilitate cancer-related dyadic efficacy were identified along with their subthemes: appraisals of the couple relationship (quality and togetherness), communication (pattern and interest in information), coping (strategy and evaluation), and responses to change (in tasks and roles and sex life). Eight obstructive and seven facilitative dimensions of these subthemes were described.Discussion: This first analysis of obstacles and facilitators of couples’ cancer-related dyadic efficacy capitalized on the experiential expertise of individuals with cancer and their partners. These thematic results are instructive for the design of dyadic efficacy-enhancing interventions for couples coping with cancer.

"My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada.

In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.

PCR216 Insights from Social Media Posts on the Lived Experience of Alzheimer's Disease

To gain insights into the lived experience of Alzheimer’s Disease (AD) for persons-living-with-AD (PwADs) from the perspective of PwADs and care partners using social media (SM) data.

Experience of a stem cell transplant in multiple myeloma: The patient and care partner perspective.

e18790 Background: Understanding patient experiences of their multiple myeloma (MM) disease journey, particularly related to the burden of autologous stem cell transplant (ASCT) and treatment recovery process, helps characterize unmet needs and quality of life of patients and their caregivers. A qualitative study of the experience of patients with MM who received ASCT and perspectives of caregivers was conducted. Methods: Recruited participants with MM were ≥18 years of age and received ASCT within the past 5 years or caregivers of patients who met these criteria. Two virtual focus group interviews were conducted, in which patients and caregivers were asked separately to narrate their disease journey starting with first symptoms and diagnosis, then focusing on the ASCT and recovery period. Results: A total of 16 participants, including 12 MM patients and 4 caregivers, were included. Nine participants (56.25%) were less than 60 years old, and eleven (68.75%) participants were female. Study participants were diverse in race/ethnicity; one-third of participants were Black and one-third comprised other minorities (Hispanic, Native Hawaiian, Asian, and Multiracial). Pain, weakness, and fractured bones (femur, hip, or spinal fractures) were common first symptoms. Other common patient-reported symptoms included high blood pressure, blurred vision, more frequent illnesses, unsteady gait, and anemia. The patients in the study were first diagnosed with MM in a variety of ways, mostly by a primary care physician and some in urgent care settings. The diagnosis process could take up to six months for some patients and commonly a community oncologist referred patients to a bone marrow transplant specialist, who was the primary driver in making ASCT decisions. Eight patients received their ASCT in an inpatient setting and four patients in an outpatient setting, with three eventually being hospitalized due to complications. Only one patient stayed in an outpatient setting the entire time. Initial recovery time after ASCT ranged from 2 weeks to 4 months; complete recovery took from 30 days to “never.” The most patient-reported difficulties during recovery time included nausea, loss of appetite, weakness, fatigue, and pain. Caregivers played an important role in the recovery process and often with negative financial impact related to missing work and travel expenses. Conclusions: Patients with MM who received ASCT and their caregivers perceived various unmet needs throughout their transplant journey. Post–stem cell transplant symptoms had a substantial impact on patients’ quality of life, especially with lengthy and challenging recovery. Innovative therapies are needed for newly diagnosed MM to reduce the burden of disease and enhance the quality of life for both patients and their caregivers.

Factors associated with a positive experience at US fertility clinics: the male partner perspective.

To determine factors associated with a positive male patient experience (PMPE) at fertility clinics among male patients. Cross-sectional study Setting: Not applicable Patients: Male respondents to the FertilityIQ questionnaire ( www.fertilityiq.com ) reviewing the first or only US clinic visited between June 2015 and August 2020. None Main outcome measures: PMPE was defined as a score of 9 or 10 out of 10 to the question, "Would you recommend this fertility clinic to a best friend?". Examined predictors included demographics, payment details, infertility diagnoses, treatment, and outcomes, physician traits, and clinic operations and resources. Multiple imputation was used for missing variables and logistic regression was used to calculate adjusted odds ratios (aORs) for factors associated with PMPE. Of the 657 men included, 60.9% reported a PMPE. Men who felt their doctor was trustworthy (aOR 5.01, 95% CI 0.97-25.93), set realistic expectations (aOR 2.73, 95% CI 1.10-6.80), and was responsive to setbacks (aOR 2.43, 95% CI 1.14-5.18) were more likely to report PMPE. Those who achieved pregnancy after treatment were more likely to report PMPE; however, this was no longer significant on multivariate analysis (aOR 1.30, 95% CI 0.68-2.47). Clinic-related factors, including ease of scheduling appointments (aOR 4.03, 95% CI 1.63-9.97) and availability of same-day appointments (aOR 4.93, 95% CI 1.75-13.86), were associated with PMPE on both univariate and multivariate analysis. LGBTQ respondents were more likely to report PMPE, whereas men with a college degree or higher were less likely to report PMPE; however, sexual orientation (aOR 3.09, 95% CI 0.86-11.06) and higher educational level (aOR 0.54, 95% CI 0.30-1.10) were not associated with PMPE on multivariate analysis. Physician characteristics and clinic characteristics indicative of well-run administration were the most highly predictive of PMPE. By identifying factors that are associated with a PMPE, clinics may be able to optimize the patient experience and improve the quality of infertility care that they provide for both men and women.

Perspectives of patients, care partners, and primary care physicians on management of mild cognitive impairment and mild Alzheimer’s disease dementia

ABSTRACT Objectives Early diagnosis of mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD) dementia is crucial for effective disease management and optimizing patient outcomes. We sought to better understand the MCI and mild AD dementia medical journey from the perspective of patients, care partners, and physicians. Methods We conducted online surveys in the United States among patients/care partners and physicians in 2021. Results 103 patients with all-cause MCI or mild AD dementia aged 46–90 years, 150 care partners for someone with all-cause MCI or mild AD dementia, and 301 physicians (101 of which were primary care physicians, [PCPs]) completed surveys. Most patient/care partners reported that experiencing forgetfulness (71%) and short-term memory loss (68%) occurred before talking to a healthcare professional. Most patients (73%) followed a common medical journey, in which the initial discussion with a PCP took place 15 months after symptom onset. However, only 33% and 39% were diagnosed and treated by a PCP, respectively. Most (74%) PCPs viewed themselves as coordinators of care for their patients with MCI and mild AD dementia. Over one-third (37%) of patients/care partners viewed PCPs as the care coordinator. Conclusions PCPs play a vital role in the timely diagnosis and treatment of MCI and mild AD dementia but often are not considered the care coordinator. For the majority of patients, the initial discussion with a PCP took place 15 months after symptom onset; therefore, it is important to educate patients/care partners and PCPs on MCI and AD risk factors, early symptom recognition, and the need for early diagnosis and treatment. PCPs could improve patient care and outcomes by building their understanding of the need for early AD diagnosis and treatment and improving the efficiency of the patient medical journey by serving as coordinators of care.

Exploring the importance of predisposing, enabling, and need factors for promoting Veteran engagement in mental health therapy for post-traumatic stress: a multiple methods study

PurposeThis study explored Veteran and family member perspectives on factors that drive post-traumatic stress disorder (PTSD) therapy engagement within constructs of the Andersen model of behavioral health service utilization. Despite efforts by the Department of Veterans Affairs (VA) to increase mental health care access, the proportion of Veterans with PTSD who engage in PTSD therapy remains low. Support for therapy from family members and friends could improve Veteran therapy use.MethodsWe applied a multiple methods approach using data from VA administrative data and semi-structured individual interviews with Veterans and their support partners who applied to the VA Caregiver Support Program. We integrated findings from a machine learning analysis of quantitative data with findings from a qualitative analysis of the semi-structured interviews.ResultsIn quantitative models, Veteran medical need for health care use most influenced treatment initiation and retention. However, qualitative data suggested mental health symptoms combined with positive Veteran and support partner treatment attitudes motivated treatment engagement. Veterans indicated their motivation to seek treatment increased when family members perceived treatment to be of high value. Veterans who experienced poor continuity of VA care, group, and virtual treatment modalities expressed less care satisfaction. Prior marital therapy use emerged as a potentially new facilitator of PTSD treatment engagement that warrants more exploration.ConclusionsOur multiple methods findings represent Veteran and support partner perspectives and show that amid Veteran and organizational barriers to care, attitudes and support of family members and friends still matter. Family-oriented services and intervention could be a gateway to increase Veteran PTSD therapy engagement.

The Influence of Ethical Responsiveness on Relationships Through Distress

This study examined the role of ethical responsiveness on relationship satisfaction from a partner's perspective after experiencing a distressing life event (DLE). We used data from the Panel Analysis of Intimate Relationships and Family Dynamics (pairfam), which is a multidisciplinary, longitudinal study in Germany. Our study used anchor data, the original respondents who were randomly selected and gave permission to interview their partners. This study included two waves of anchor responses, which were 2016 and 2018, respectively. We utilized longitudinal structural equation modeling to evaluate whether the partner's ethical responsiveness buffers the negative impact of DLEs on relationship satisfaction per anchor's perspective. The results of our study indicated that partner's ethical responsiveness can buffer the negative impact of DLEs on anchor's perception of relationship satisfaction. Additionally, according to the perception of the anchors, we found that the partners who showed high levels of ethical responsiveness not only maintained their relationship satisfaction but even improved upon it 2 years beyond the DLE. Conversely, relationship satisfaction decreased over time for anchors who reported their partner with an average or lower level of ethical responsiveness. Clinical implications and limitations are also discussed.

School partner perspectives on the implementation of the Your Voice Your View sexual assault prevention program for high school students.

Despite the high risk for sexual assault among adolescents, few sexual assault prevention programs designed for implementation in high schools have sustained rigorous evaluation. The present study sought to better understand the factors that influenced the implementation of Your Voice Your View (YVYV), a four-session sexual assault prevention program for 10th grade students, which includes a teacher "Lunch and Learn" training as well as a 4-week school-specific social norms poster campaign. Following program implementation, eight school partners (i.e., health teachers, guidance counselors, teachers, and principals) participated in an interview to provide feedback on the process of program implementation. The Consolidated Framework for Implementation Research was utilized to examine site-specific determinants of program implementation. Participants discussed the importance of the design quality and packaging of the program, as well as the relative advantage of offering students a violence prevention program led by an outside team, as opposed to teachers in the school. School partners highlighted the importance of intensive preplanning before implementation, clear communication between staff, the utility of engaging a specific champion to coordinate programming, and the utility of offering incentives for participation. Having resources to support implementation, a desire to address sexual violence in the school, and a positive classroom climate in which to administer the small-group sessions were seen as school-specific facilitators of program implementation. These findings can help to support the subsequent implementation of the YVYV program, as well as other sexual assault prevention programs in high schools.

A Scoping Review of Experiential Learning in Public Health Education From the Perspective of Students, Faculty, and Community Partners

Background: Experiential learning is increasingly important in public health education. Purpose: Based on 33 studies, this is the first scoping review that provides clarity on the types of experiential learning activities (ELAs) used in public health education and the evaluation results from the perspectives of three stakeholders involved: students, faculty, and communities/external agencies. Methodology/Approach: A total of 1,912 citations were sourced from six electronic databases (Education Resources Information Centre, ProQuest Central, PubMed, Scopus, STM Source, and Web of Science) and manual searches (reference lists of included studies) independently by two researchers. A random-effects meta-analysis using forest plots and a meta-synthesis using a thematic synthesis approach were conducted. Findings/Conclusions: There was a diverse range of community-, classroom-, and work-focused ELAs used. Meta-analysis revealed positive outcomes in student satisfaction, problem-solving, and communication skills. This was triangulated with the meta-synthesis results, which also indicated an overwhelmingly positive attitude toward experiential learning by all three stakeholders. Implications: Future educational programs should consider the factors that contributed to the positive experiences from all three stakeholders’ perspectives, address the various challenges highlighted in this review to refine the experience, and assess the negative experiences of faculty, and community/external agencies in greater detail.

Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis

BackgroundPostnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often...

Community partner perspectives on the implementation of a novel safer supply program in Canada: a qualitative study of the MySafe Project

BackgroundThe adulteration of the illicit drug supply with fentanyl and its analogues is driving the ongoing overdose crisis in North America. While various harm reduction interventions address overdose-related risks, there is growing interest in safer supply programs, including the MySafe Project which utilizes a biometric dispensing machine that provides pharmaceutical opioid alternatives to the toxic drug supply. However, the experiences and perspectives of professional community partners on program implementation remain unexplored. This study aims to examine professional community partner perspectives on the feasibility, as well as barriers and facilitators to the implementation of the MySafe program.MethodsSemi-structured qualitative interviews were conducted with 17 professional community partners involved in program implementation across four pilot locations in Canada. Thematic analysis of interviews focused on perspectives on safer supply, barriers and facilitators faced during program implementation, and recommendations to inform future scale-up of low-barrier safer supply models across Canada.ResultsParticipants identified a variety of barriers, including the dependence on clinician buy-in, coupled with regulatory and logistical constraints. In addition, some participants perceived hydromorphone to be an inadequate substitute to the increasingly toxic street opioid supply. Lastly, technical difficulties were described as barriers to service uptake and delivery. Conversely, having political and community buy-in, availability of wrap-around services, and collaborative communication from the MySafe team served as facilitators to program implementation. Though community partners preferred establishing MySafe machines into existing community organizations, they also discussed benefits of housing-based MySafe programs. The potential role of this program in mid-sized to rural cities was also emphasized.ConclusionsTo address the overdose crisis, there is an urgent need to implement and evaluate novel solutions that address supply drivers of crisis. Community partner-informed research plays an integral role in ensuring program acceptability and proper implementation. Our findings identify current gaps and facilitators underlying the efficacy of one such model, together with future directions for improvement. Participant recommendations included a diversification of medications offered and types of locations for MySafe programs, a streamlined national approach to prescribing guidelines coupled with more robust training for healthcare professionals, and an emphasis on service delivery within an integrated services model. Our findings underscore a potential gap between the goals of healthcare providers in ensuring comprehensive care and the necessity for low-barrier models such as MySafe that can function both within and outside of integrated service models.

Yakima Basin Integrated Plan—A collaborative partner's perspective

AbstractResilience to climate change is not a process that can be done single‐handedly. Centring the focus around building both a climate‐resilient system and well‐rounded partnerships, the Kittitas Reclamation District (KRD), Washington State, USA, as part of the Yakima River Basin Integrated Water Resource Management Plan (YBIP), has been successful in mitigating water scarcity in the Kittitas Valley and benefitting the larger Yakima River Basin. By using collaborative governance, a decision‐making process that breaks down barriers and engages people across the boundaries of public agencies, different levels of government and the public, the KRD has modified its long‐term operational goals. The priority is now to establish if a proposed project can provide benefits to other interests and their water needs throughout the Yakima River Basin. We must work together to look at the big picture of a large geographical area in an effort to solve multiple water issues through a single project. As part of YBIP, the goals come to fruition through comprehensive planning for water conservation and the established relationships the partners have with each other. We work together using trust, respect and civility to move towards action and acknowledging that achieving our goals is made possible through collaboration. Opportunities to work together are sought out and taken so that water conservation and other water resiliency projects can be funded and implemented as quickly as possible in an effort to plan for future water scarcity. Protecting the certainty of the water supply for the future of the farms and the ecosystem is of utmost importance.

Financial Toxicity and Its Association With Health-Related Quality of Life Among Partners of Colorectal Cancer Survivors

Partners of colorectal cancer (CRC) survivors play a critical role in diagnosis, treatment, and survivorship. While financial toxicity (FT) is well documented among patients with CRC, little is known about long-term FT and its association with health-related quality of life (HRQoL) among their partners. To understand long-term FT and its association with HRQoL among partners of CRC survivors. This survey study incorporating a mixed-methods design consisted of a mailed dyadic survey with closed- and open-ended responses. In 2019 and 2020, we surveyed survivors who were 1 to 5 years from a stage III CRC diagnosis and included a separate survey for their partners. Patients were recruited from a rural community oncology practice in Montana, an academic cancer center in Michigan, and the Georgia Cancer Registry. Data analysis was performed from February 2022 to January 2023. Three components of FT, including financial burden, debt, and financial worry. Financial burden was assessed with the Personal Financial Burden scale, whereas debt and financial worry were each assessed with a single survey item. We measured HRQoL using the PROMIS-29+2 Profile, version 2.1. We used multivariable regression analysis to assess associations of FT with individual domains of HRQoL. We used thematic analysis to explore partner perspectives on FT, and we merged quantitative and qualitative findings to explain the association between FT and HRQoL. Of the 986 patients eligible for this study, 501 (50.8%) returned surveys. A total of 428 patients (85.4%) reported having a partner, and 311 partners (72.6%) returned surveys. Four partner surveys were returned without a corresponding patient survey, resulting in a total of 307 patient-partner dyads for this analysis. Among the 307 partners, 166 (56.1%) were aged younger than 65 years (mean [SD] age, 63.7 [11.1] years), 189 (62.6%) were women, and 263 (85.7%) were White. Most partners (209 [68.1%]) reported adverse financial outcomes. High financial burden was associated with worse HRQoL in the pain interference domain (mean [SE] score, -0.08 [0.04]; P = .03). Debt was associated with worse HRQoL in the sleep disturbance domain (-0.32 [0.15]; P = .03). High financial worry was associated with worse HRQoL in the social functioning (mean [SE] score, -0.37 [0.13]; P = .005), fatigue (-0.33 [0.15]; P = .03), and pain interference (-0.33 [0.14]; P = .02) domains. Qualitative findings revealed that in addition to systems-level factors, individual-level behavioral factors were associated with partner financial outcomes and HRQoL. This survey study found that partners of CRC survivors experienced long-term FT that was associated with worse HRQoL. Multilevel interventions for both patients and partners are needed to address factors at individual and systemic levels and incorporate behavioral approaches.

Building responsive and resilient supply chains: Lessons from the COVID‐19 disruption

Building responsive and resilient supply chains: Lessons from the <scp>COVID</scp>‐19 disruption

218 Researcher and Stakeholder Partner Perspectives on Engaged Research During the COVID-19 Pandemic

OBJECTIVES/GOALS: We sought to explore how the COVID-19 pandemic impacted community and stakeholder engagement in research from both researcher and stakeholder partner perspectives and to identify challenges, strategies, and other facilitators affecting their experience, including those related to virtual engagement. METHODS/STUDY POPULATION: We conducted semi-structured interviews with ten researchers and eight stakeholder partners who conducted or collaborated on stakeholder-engaged health research during the COVID-19 pandemic (March 2020 onwards). Potential participants were identified purposively and through snowball sampling. Interviews were conducted via Zoom, recorded, and transcribed for analysis. The transcribed data were qualitatively analyzed through an iterative process involving memoing and consensus coding using inductive and deductive codes. We reviewed memos and code reports to identify and describe key categories and themes. RESULTS/ANTICIPATED RESULTS: The challenges and facilitators identified varied based on factors such as geographic scope of the partnership (local vs national) and previous engagement type (virtual vs in-person). Many challenges were related to virtual engagement, such as dealing with distractions, limited access to Internet, or difficulty forming relationships online, or to wellbeing and personal circumstances, such as feeling burnt out, managing increased caregiving responsibilities, or concern about risk of illness if conducting in-person activities. Facilitators identified included having strong existing partnerships, utilizing strategies to enhance virtual engagement, adapting activities to manage risk of in-person interactions, and showing support to stakeholder partners. DISCUSSION/SIGNIFICANCE: By better understanding challenges and facilitators affecting experiences of both researchers and stakeholder partners engaging in research during the COVID-19 pandemic, we can develop strategies and resources to better support research partnerships during future health emergencies.

"At least we finally found out what it was": Dementia diagnosis in minoritized populations.

Disparities in diagnosis persist among persons living with dementia (PLWD); most research on delayed diagnosis relies on medical records or administrative claims. This study aimed to identify factors that delay or facilitate dementia diagnoses in racial or ethnic minoritized PLWD and elicit care partner perspectives on timing and effects of diagnosis. Maryland-based participants cared for a PLWD age 60 or older, self-identified as Black/African/African-American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in-depth, semi-structured interviews were conducted and analyzed using conventional qualitative content analysis methods. Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding dementia influenced recognition and discussion of dementia among families and communities. Diagnoses were family-initiated and started in primary care. Care partners were divided in their perceptions of diagnosis timeliness and whether earlier diagnosis would have changed outcomes. Family reactions to dementia diagnoses varied; most participants expressed a strong sentiment of service and duty to care for older family members. Participants overwhelmingly felt the benefits of obtaining a dementia diagnosis outweighed harms. Numerous factors affect dementia diagnosis in racial and ethnic minoritized PLWD. Normalization of brain health discussions and systematic, proactive discussion and detection of dementia in primary care may address multilevel barriers and facilitators to diagnosis. Systems-level and community-led public health interventions may also help address disparities in brain health education and dementia diagnosis.

Communicative participation with public authorities: Experiences of people with aphasia, people who stutter, and employees of public authorities.

Several studies have examined the communicative participation of people with communication disorders (PWCD). Hindering and facilitating factors were analyzed in different population groups considering various private and public communication contexts. However, knowledge about (a) the experiences of persons with different communication disorders, (b) communication with public authorities, and (c) the perspective of communication partners in this area remains limited. Therefore, this study aimed to explore the communicative participation of PWCD with public authorities. We analyzed communicative experiences (hindering and facilitating factors) and suggestions for improving communicative access described by persons with aphasia (PWA) and persons who stutter (PWS) as well as by employees of public authorities (EPA). In semi-structured interviews, PWA (n=8), PWS (n=9), and EPA (n=11) reported specific communicative encounters with public authorities. The interviews were analyzed using qualitative content analysis, focusing on hindering/facilitating experiences and suggestions for improvement. The personal experiences of the participants during authority encounters were represented by the interwoven themes of familiarity and awareness, attitudes and behavior, and support and autonomy. The perspectives of the three groups overlap in several areas; however, the results also indicate specific differences between PWA and PWS as well as between PWCD and EPA. The results indicate a need to improve awareness/knowledge about communication disorders and communicative behavior in EPA. Moreover, PWCD should actively engage in encounters with authorities. In both groups, awareness must be raised about how each communication partner can contribute to successful communication, and avenues to achieve this goal must be demonstrated.