Program Retention Research Articles

Adaptation, acceptability and feasibility of Problem Management Plus (PM+) intervention to promote the mental health of young people living with HIV in Kenya: formative mixed-methods research.

Problem Management Plus (PM+) is a psychological intervention that seeks to address common mental disorders among individuals exposed to adversity. Thus far, the potential for delivering PM+ by mobile phones has not been evaluated. To adapt PM+ for telephone delivery (ten weekly sessions of about 45 min each) and preliminarily evaluate its acceptability and feasibility with young people living with HIV (YLWH) in coastal Kenya. This was a mixed-method formative research. Qualitative data collection included consultations with stakeholders, conducting key informant interviews with HIV care providers and focus group discussions with potential end-users, i.e. YLWH. Moreover, brief exit interviews with recipients of the adapted PM+ were conducted. Quantitative acceptability and feasibility indicators and outcome measures were tracked/assessed during PM+ preliminary implementation involving 70 YLWH. From the qualitative inquiries, the adapted PM+ emerged as contextually appropriate, acceptable and feasible for mobile phone delivery, despite some concerns around missing nonverbal cues and poor network connectivity. High recruitment (85%) and fair programme retention (69%) were observed. Intervention sessions over the telephone lasted 46 min on average (range 42-55 min). Preliminary feasibility data indicated that the adapted PM+ has the potential of reducing common mental disorders among YLWH from the Kenyan coast. PM+ is acceptable and can feasibly be delivered via mobile phone to YLWH in coastal Kenya. This study sets the stage for a future fully powered, randomised controlled trial assessing the efficacy of the adapted PM+ in this or a similar setting.

Prehabilitation in high-risk patients scheduled for major abdominal cancer surgery: a feasibility study

BackgroundPatients presenting for major surgery with low cardiorespiratory fitness (deconditioning) and other modifiable risk factors are at increased risk of postoperative complications. This study investigated the feasibility of delivering prehabilitation in high-risk patients scheduled for major abdominal cancer surgery.MethodsEligible patients in this single-center cohort study included patients with poor fitness (objectively assessed by cardiopulmonary exercise testing, CPET) scheduled for elective major abdominal cancer surgery. Patients were recruited to participate in a prehabilitation program that spanned up to 6 weeks pre-operatively and comprised aerobic and resistance exercise training, breathing exercise, and nutritional support. The primary outcome assessed pre-specified feasibility targets: recruitment >70%, retention >85%, and intervention adherence >70%. Secondary outcomes were assessed for improved pre-operative functional status and health-related quality of life and for postoperative complications.ResultsEighty-two (34%) out of 238 patients screened between April 2018 and December 2019 were eligible for recruitment. Fifty (61%) patients (52% males) with a median age of 71 (IQR, 63–77) years participated in the study. Baseline oxygen consumption the at anaerobic threshold and at peak exercise (mean±SD: 9.8±1.8 and 14.0±2.9 mL/kg/min, respectively) confirmed the deconditioned state of the study cohort. The retention rate within the prehabilitation program was 84%, with 42 participants returning for repeat CPET testing. While >60% of participants preferred to do home-based prehabilitation, adherence to the intervention was low—with only 12 (28%) and 15 (35%) of patients having self-reported compliance >70% with their exercise prescriptions.ConclusionOur prehabilitation program in high-risk cancer surgery patients did not achieve pre-specified targets for recruitment, retention, and self-reported program adherence. These findings underpin the importance of implementation research and strategies for the prehabilitation programs in major surgery.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620000073909) retrospectively registered.

The State of the Humanities circa 2022

The State of the Humanities circa 2022

Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo.

This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan–Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78–20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women’s inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.

Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

BackgroundPrehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications.MethodsHigh-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session’s frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test.ResultsThe participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program’s frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01).ConclusionsTele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications.Trial registrationISRCTN, ISRCTN64482109. Registered 09 November 2021 - Retrospectively registered.

What Keeps Kids Coming Back? Retention in a Sport-Based Positive Youth Development Program.

Research finds engagement in sport-based positive youth development (PYD) programs contribute to key outcomes related to physical, social, emotional, cognitive, and mental health. Consistent, long-term participation ensures youth, especially those who are socially vulnerable, reap the most benefits. Even when common barriers are removed, retention remains a challenge. Using mixed methods, this study explored factors related to long-term retention among youth from socially vulnerable circumstances attending one sport-based PYD program. Factors related to youth participation in the previous year's program, as well as general youth demographics, were examined using difference tests and binomial logistic regression to explore retention among 124 of the 384 youth who returned to the program the following year. Results of the regression analyses showed the full model (with all predictors included), vs. an intercept-only model, was statistically significant, χ2 (11, N = 235) = 23.38, p = 0.02. The model correctly classified 88.2% of the non-returners and 28.0% of the returners for an overall correct classification rate of 67.2%. Better fitness levels, higher perceived social responsibility (an outcome targeted in the program), and some demographic variables (such as lower poverty rates and younger age) were associated with a greater probability of returning, although effect sizes were small. Additionally, interviews were conducted with 18 parent/caregivers of returning youth and 18 match comparison parent/caregivers of non-returning youth. Qualitative analyses revealed few differences in previous year's program experiences between returners and non-returners, as well as similarities in reported benefits from involvement. Both sets of parent/caregivers cited positive experiences overall, and particular benefits related to meeting new people and learning new sports. Parents/caregivers of non-returners, however, noted the value of physical literacy components of the program more so than their counterparts. Social interactions, both positive and negative, seem to have particular relevance for retention. Findings overall, however, demonstrate challenges with predicting retention and fostering long-term engagement among youth from socially vulnerable circumstances in programming.

Evaluating the cascade of care for anal cancer screening within a Ryan White HIV/AIDS Program clinic.

Care cascades can inform providers about differences in engagement and retention in care between patient populations thereby improving participation by targeting interventions more effectively. The objective of this study was to assess the uptake and retention of participants along the anal cancer screening algorithm within a single HIV clinic. Retrospective procedural and demographic data were collected within a Ryan White HIV/AIDS Program clinic from 18 December 2017 to 29 May 2021. A care cascade was constructed among eligible participants who engaged and were retained in the anal cancer screening algorithm. Engagement was defined as having at least one anal Pap smear. Retention was defined as having a follow-up anal Pap smear, and/or high resolution anoscopy, as indicated. Risk ratios (RR) were calculated to reveal factors associated with initiation and retention in screening. Of 821 eligible participants, 312 (38%) engaged in screening and 205 (66%) were retained in care. Anoreceptive intercourse was positively associated with engagement (RR 2.81, 95% confidence interval [CI] 2.05-3.90, p<0.001), whereas male gender was negatively associated (RR 0.26, 95% CI 0.20-0.33, p<0.001). Abnormal cytology results on Pap smear were associated with retention (RR 1.39, 95% CI 1.03-1.86, p=0.03). Overall engagement in anal cancer screening is low within our clinic, particularly among men, but retention in the screening program is notably better, especially among those with abnormal cytology. Target populations have been identified to increase awareness, and qualitative studies are underway to understand perceptions and barriers to engagement in anal cancer screening.

ManGuard an eHealth intervention to reduce cardiovascular risk in male taxi drivers: a pilot randomised controlled trial protocol

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy, Northern Ireland Background Men are at higher risk then women of developing cardiovascular disease (CVD) and male taxi drivers are a particularly high risk group because of their typically unhealthy behaviours, such as poor eating habits, smoking and a sedentary lifestyle. However, only two studies of behavioural interventions targeting taxi drivers have been identified, one of which had a high attrition rate. Therefore, an eHealth intervention co-designed by taxi drivers may prove more user-friendly and effective. Purpose The aim of this study is to assess the feasibility of a randomised controlled trial (RCT) of an eHealth intervention – ManGuard – to reduce CVD risk in male taxi drivers. Methods A wait-list controlled trial of 30 male taxi drivers in Belfast, Northern Ireland, will be assigned randomly to an intervention or usual care group. The ManGuard Application comprises seven modules: i) introduction and goal setting, ii) being active iii) eating well, iv) managing stress, v) smoking, vi) alcohol and vii) keep accelerating, the latter to be used as a re-cap module. This trial will establish feasibility, including recruitment, engagement and retention rates, program usability and participant satisfaction, as well as preliminary efficacy of ManGuard in improving key outcomes. Primary outcome is to determine the feasibility of an eHealth intervention for reducing CVD risk in male taxi drivers by assessing the following outcome measures: o Acceptability, recruitment, retention and engagement rates o Usability and participant satisfaction, process evaluation and survey The secondary outcome is to evaluate the preliminary efficacy of ManGuard compared to usual care in improving the following outcomes: o Clinical indices: CVD biomarkers (cholesterol, glucose), blood pressure, anthropometry (BMI, waist circumference, body fat percentage) o Physical activity o Psychosocial status: health related quality of life, self-efficacy, social support An in-depth qualitative process evaluation to explore acceptability of the intervention will also be conducted. Trial registration: This trial has been registered prospectively on the ISRCTN registry on 5 January 2022 Conclusion eHealth interventions have been shown to promote behaviour change and reduce CVD risk in men, but there is a lack of robust evidence for this in male taxi drivers, a high-risk group. This study aims to assess the feasibility of a future RCT assessing the impact of ManGuard on CVD risk in male taxi drivers. This study will inform a fully-powered trial that will provide robust evidence for eHealth interventions for this underserved population.

Student Retention and Success in an RN-BSN Program: Determining Variables and Methods

Background The Online Registered Nurse to Baccalaureate Science in Nursing (RN- BSN) Program has a retention rate of close to 97.5% (UTEP, 2020). Attrition rates in nursing programs are high. The National League for Nursing (NLN) last reported a 25 % attrition rate which may double for minority students in four-year nursing programs (NLN, 2014; Elkin, 2019). As online courses in colleges and universities are growing and are predicted to become mainstream by 2025, it is essential to identify factors contributing to our retention rates. American Association of Colleges of Nursing (AACN) has made it part of its 2021-2022 policy priorities to increase access to nursing programs (AACN, 2021). Objective The purpose of this study was to ascertain the factors affecting nursing student retention. The information was used to make changes to the existing online programs in our school and better support our students. The research question was “What factors do students identify that influenced their RN to BSN program retention?” Methodology The participants were chosen using a convenience sampling technique. The university was a public institution located in a border town. Three types of questions were asked: (1) general demographic information, (2) nursing career, and (3) program requirements for the RNBSN. Results A total of 33 participants completed the RN-BSN retention program study. The findings indicated that several general factors contribute to retention and student success, including student support services, mandatory orientation programs for students and faculty, credit student success courses, remedial academic ability programs (which discuss support services, particularly computer tech support), and recognizing the importance of diversity in the classroom and at work. Conclusion Examining the characteristics of distance education students, as well as their distinct abilities and needs, may assist schools in improving student retention. Reconsidering the characteristics and unique features of distance learning students may help schools retain students with a variety of needs, such as access to scholarships, loans, and financial incentives to continue their education.

The Ph.D. Panic: Examining the Relationships Among Teaching Anxiety, Teaching Self-Efficacy, And Coping in Biology Graduate Teaching Assistants (GTAs)

Anxiety among graduate students in the United States has increased over the last several decades, affecting not only their overall mental health but also reducing retention in graduate programs. High teaching anxiety can negatively impact teacher well-being and student learning, yet teaching anxiety in graduate teaching assistants (GTAs) is not well studied. Biology GTAs teach most introductory Biology labs and discussions nationally, thus broadly influencing the quality of undergraduate education. We investigated Biology GTA teaching anxiety at a large research-intensive university by (1) measuring teaching anxiety of Biology GTAs, and (2) exploring the relationships between teaching anxiety, self-efficacy, and coping. Using correlation plots and multiple linear regressions, we found that greater teaching self-efficacy was related to lower teaching anxiety in Biology GTAs (R&lt;sup&gt;2&lt;/sup&gt;adj=0.65, p&amp;lt;0.001), and coping was positively correlated to self-efficacy. These results suggest that teaching self-efficacy is important to reducing teaching anxiety, and coping frequency may help to build self-efficacy. Thus, effective coping may be linked to reduced anxiety via increases in self-efficacy, although these specific relationships need to be further explored. Although anxiety did not differ significantly among graduate students in our population, reduced anxiety was linked to direct increases in self-efficacy and indirect increases in coping. With a rising mental health crisis in academia, particularly among graduate students, these results can inform teaching professional development for GTAs, by incorporating dialogue about teaching anxiety, self-efficacy, and coping. Encouraging greater awareness and discussion about mental health issues in academia, we can further reduce its stigma and mitigate its impacts.

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

Improvement in nonvolatile memory operations for metal–ferroelectric–insulator–semiconductor capacitors using HfZrO2 and ZrO2 thin films as ferroelectric and insulator layers

Metal–ferroelectric–insulator–semiconductor (MFIS) capacitors were characterized to elucidate the optimum design schemes for the ferroelectric field-effect transistor applications. The Hf1−x Zr x O2 (HZO) thin films (18 nm) were prepared on the SiO2 and ZrO2 insulator layers (ILs) with different film thicknesses. The choice of 10 nm thick ZrO2 IL was found to be an optimum condition to properly balance between the values of electric fields applied to the HZO (E HZO) and ZrO2 (E IL) layers, leading to effective improvement in capacitance coupling ratio and to suppression of charge injection for the MFIS capacitors. Furthermore, the crystalline natures of the crystallized HZO films were also found to be strategically controlled on the ZrO2 ILs, which can additionally enhance the E HZO with reducing the E IL. As consequences, the MFIS capacitors using 10 nm thick ZrO2 IL exhibited the ferroelectric memory window as large as 2.5 V at an application of ±5 V, which corresponds to 2.7 times wider value, compared to that obtained from the device using 2 nm thick SiO2 IL. Long-time memory retention and robust program endurance were also verified for the fabricated MFIS capacitors.

Retention in Community Health Screening among Taiwanese Adults: A 9-Year Prospective Cohort Study.

Largely conducted in Western developed nations, research on community health screening has mainly been of limited duration. This study aims to ascertain the predictors of retention in a community health screening program, involving multiple admission cohorts over a 9-year period in Taiwan. Retention is defined as the participation in subsequent waves of health screening after being recruited for an initial screening. Data came from a prospective cohort study, named “Landseed Integrated Outreaching Neighborhood Screening (LIONS)”, in Taiwan. This research retrieved 5901 community-dwelling Taiwanese adults aged 30 and over from LIONS and examined their retention in three follow-ups during 2006–2014. Generalized estimating equations were employed to evaluate retention over time as a function of social determinants, health behaviors, and health conditions. Being middle-aged, higher education, and regular exercise were positively associated with retention. Conversely, smoking, betel-nut chewing, psychiatric disorder, hypertension, type 2 diabetes mellitus, stroke, and a longer time interval since enrollment were negatively associated with retention. Furthermore, retention rates varied substantially across admission cohorts with more recent cohorts having a lower rate of retention (aOR = 0.33–0.83). Greater attention needs to be directed to retention over time and variations across admission cohorts. Additionally, those who are in either younger or older age groups and have chronic diseases or unhealthy behaviors should be targeted with greater efforts.

59-LB: Outcomes of an Employer-Sponsored Virtual Type 2 Diabetes (T2D) Reversal Program in Working-Age Adults

Objective: To evaluate short-term outcomes of an employer-sponsored virtual T2D reversal program, conducted through medically supervised nutritional intervention and provider-led telehealth, in working-age adults. Methods: This pre-post study included 119 employees with T2D and high HbA1c and/or high spending on T2D prescriptions who enrolled in the T2D reversal program October 15, 2020-January 27, 2021. HbA1c, fasting glucose (FG) , body weight, body index mass (BMI) , and waist circumference pre- and post-enrollment were assessed from annual employer-sponsored wellness screening conducted 2019-2021, independently of the T2D reversal program. Program prescriptions (insulin, DPP4, GLP1, meglitinide, sulfonylurea, TZD, SGLT2) were compared pre vs. post (Table footnote 1) . Pharmacy spending for these prescriptions was estimated from a third-party claims database. Results: The program retention rate was 82% at 6 months and 67% at 1 year. Mean levels of all outcome measures declined significantly from pre to post (Table) . The number of prescriptions decreased for 47 (39.5%) of the 119 participants and increased for 3 (2.5%) . For 89 individuals participating for 6 months or more, average monthly prescription spending declined 18% (to $449 from $547) during the first 6 months after enrollment (vs. the prior 12 months) . Conclusions: A virtual T2D reversal program helped lower HbA1c, FG, body weight, BMI, and waist circumference in employees with diabetes while reducing prescriptions and pharmacy spending. Disclosure Z. Chen: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C. E. Birse: Employee; Quest Diagnostics. A. R. Arellano: Employee; Quest Diagnostics. M. S. Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. M. J. Mcphaul: Employee; Quest Diagnostics. L. A. Bare: Employee; Quest Diagnostics.

Betting on Talent: Examining the Relationship between Employee Retention and Onboarding Programs

The expectations of employees in the United States continue to evolve as generational shifts occur in the workforce. The already raging war for talent has been fueled by the 2020 pandemic, which introduced new ways to work and different types of work opportunities. As a result, employees are re-evaluating their options and seeking ways to extract more value from their professional lives. In these circumstances, employee retention is a competitive advantage, and companies must consider how to retain their most desirable talent. Research in the organizational behavior domain shows that when employees hold values like those of their employing organization, they experience greater job satisfaction, increased organizational commitment, and higher intent to stay in the organization. Onboarding programs are widely accepted in the business community as a valuable opportunity to welcome new employees and introduce them to the values and culture of the organization, but organizations assign various weights and considerations to these programs as they can be costly to develop, execute, and maintain. In this article, we examine the relationship between employee retention and onboarding programs. We study whether a robust and well-executed onboarding program can mitigate employee attrition and can serve as a catalyst for employee retention in an organization.

Bridge clinic implementation of “72-hour rule” methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care

BackgroundMethadone for opioid use disorder (OUD) treatment is restricted to licensed opioid treatment programs (OTPs) with substantial barriers to entry. Underutilized regulations allow non-OTP providers to administer methadone for opioid withdrawal for up to 72 h while arranging ongoing care. Our low-barrier bridge clinic implemented a new pathway to treat opioid withdrawal and facilitate OTP linkage utilizing the “72-hour rule.” MethodsPatients presenting to a hospital-based bridge clinic were evaluated for OUD, opioid withdrawal, and treatment goals. Eligible patients were offered methadone opioid withdrawal management with rapid OTP referral. OTPs accepted patients as direct admissions. We described bridge clinic patients who received at least one dose of methadone between March-August 2021 and key clinical outcomes including OTP referral completion within 72 h. For the subset of patients referred to our two primary OTP partners, we described OTP linkage (i.e., attended at least one OTP visit within one month) and OTP retention at one month. ResultsMethadone was administered during 150 episodes of care for 142 unique patients, the majority of whom were male (73%), white (67%), and used fentanyl (85%). In 92% of episodes (138/150), a plan for ongoing care was in place within 72 h. Among 121 referrals to two primary OTP partners, 87% (105/121) linked and 58% (70/121) were retained at one month. ConclusionsMethadone administration for opioid withdrawal with direct OTP admission under the “72-hour rule” is feasible in an outpatient bridge clinic and resulted in high OTP linkage and 1-month retention rates. This model has the potential to improve methadone access.

A Low-threshold Comprehensive Shared Medical Appointment Program for Perinatal Substance Use in an Underserved Population.

We describe retention in care, medication for opioid use disorder (MOUD) prescribing, and urine toxicology outcomes of a comprehensive perinatal shared medical appointment model that combined medication, group-based counseling, and recovery supports. We conducted a retrospective study of program retention between 11/1/16 and 3/31/20 in pregnant and postpartum women with substance dependence or use disorder. Disengagement reasons, MOUD prescribing, and urine toxicology were abstracted from medical records. A Cox proportional hazards model was used to evaluate risk factors for program disengagement. Approximately 87% of patients had OUD and 80% were pregnant at the initial visit (N = 140). Retention at 3 months, 6 months, 1 year, and 2 years was approximately 86%, 78%, 66%, and 48%, respectively. Over 97% of patients were prescribed MOUD and 88% of all urine toxicology results were negative for non-prescribed opioids. Patients enrolled after initiation of wraparound services (HR 0.52, 95% CI 0.28 - 0.96) and those attending more shared medical appointments (HR 0.90, 95% CI 0.87 - 0.93) had a lower hazard of disengagement after controlling for other covariates. Loss to follow-up was the most common disengagement reason. A low-threshold, comprehensive perinatal shared medical appointment program had high retention rates, increased access to evidence-based MOUD, and high rates of opioid-negative urine toxicology. Participants enrolled after wraparound services began had a lower hazard of disengagement. Future research in perinatal substance use should evaluate the most optimal and cost-effective components of comprehensive programs to inform standard of care.

The Impact of Subscription Programs on Customer Purchases

Subscription programs have become increasingly popular among a wide variety of retailers and marketplace platforms. Subscription programs give members access to a set of exclusive benefits for a fixed fee up front. In this article, the authors examine the causal effect of a subscription program on customer behavior. To account for self-selection and identify the individual-level treatment effects, they combine a difference-in-differences approach with a generalized random forests procedure that matches each member of the subscription program with comparable nonmembers. The authors find that subscription leads to a large increase in customer purchases. The effect of subscription is economically significant, persistent over time, and heterogeneous across customers. Interestingly, only one-third of the effect on customer purchases is due to the economic benefits of the subscription program, and the remaining two-thirds is attributed to the noneconomic effect. Evidence supports that members experience a sunk cost fallacy due to the up-front payment that subscription programs entail. Finally, the authors illustrate how firms can calculate the profitability of a subscription program and discuss the implications for customer retention and subscription programs.

Relationship Of Age And Work Experience With The Quality Of Nursing Work Life (QNWL) Nurses

Quality of Nursing Work Life (QNWL) is a nurse's perception that can increase organizational commitment and effectiveness among nurses and increase nurse productivity and performance, which consists of 4 dimensions, namely Work Life-Home Life Dimensions, Work Design Dimensions, Work Context Dimensions, and Work Dimensions. The purpose of this study was to analyze the relationship between age and work experience with QNWL. This research is a type of quantitative research. The design used correlational analytics with a cross-sectional approach. The population of all nurses in the inpatient room at Prof. Dr. H. Aloei Saboe hospital is 134 nurses with a total sample is 57 respondents who were taken using the proportional stratified random sampling technique. The analysis was used in bivariate analysis using the Spearman rank test. The results of the study obtained a significant value for the age factor (ρ = 0.001) and the work experience factor (ρ = 0.007). In conclusion, there is a relationship between age and work experience with QNWL. Suggestions for the hospital to improve the nurse retention program so as to increase QNWL.

Understanding the meanings of male partner support in the adherence to therapy among HIV-positive women: a gender analysis

ABSTRACT Background Previous literature reports that low male partner support is a barrier to women’s adherence and retention in HIV care programs. Objective This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. Methods We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. Results This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women’s capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. Conclusions This paper suggests that restrictive male-partner gender norms limit women’s power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality.