Social Support Structures Research Articles

THE COVID-19 EFFECT: ADAPTING FAMILY CARE TO A PANDEMIC CONTEXT

Abstract The COVID-19 pandemic carries risk for severe complications and mortality among older adults, placing their family caregivers in key support roles in helping their care recipients stay safe, maintain function, and abide by preventative recommendations. Yet such preventative safety precautions, changes to social support structures, and impacts on healthcare access may pose challenges with which caregivers must cope. This symposium considers how family caregivers adapted their care practices and adjusted to care-related challenges during the COVID-19 pandemic. First, Dr. Amanda Leggett presents data on pandemic-specific care-related challenges and supports experienced by dementia caregivers and their association with well-being and stress process outcomes. Ms. Sara Masoud shares mixed-methods data from persons living with dementia, caregivers, and healthcare professionals on their health and quality of life during the pandemic. Mr. Jiaming Liang presents dyadic findings from the National Study of Caregiving on persons living with dementia and their caregivers’ perceptions of COVID-19 and personal and social COVID-specific preventative behaviors. Finally, Dr. Sheria Robinson-Lane offers a diverse caregiving perspective by presenting dyadic qualitative data on COVID-19 patients who were intubated in the hospital and their family caregiver, and offering themes on how caregivers adjusted to their new care role. To conclude, our discussant Dr. Laura Gitlin will offer insight on cross-cutting implications across studies and offer perspective on how lessons learned through pandemic caregiving may inform the field more broadly and enhance caregiver well-being beyond pandemic contexts.

Entrepreneurship education in TVET institutions and entrepreneurial intentions of female students in Ghana: the social support factor

Technical and vocational education and training (TVET) is increasingly engaging the attention of governments in both developing and developed countries as a mechanism through which skilled graduates are produced for self-employment and for the labour market. This study was undertaken to examine the objective, pedagogy, and assessment procedures of the programme and its effect on entrepreneurial intentions of female students in Ghana, taking into consideration the moderating role of social support systems. The research design used was cross-sectional survey with concurrent mixed methods approach. The sample was 376. A questionnaire and an interview guide were the instruments used for data collection. The quantitative data were analysed using Hayes moderation process analysis while the qualitative data were analysed manually using open coding. The study revealed that entrepreneurship course is able to influence female students’ entrepreneurial intentions. Nevertheless, this influence becomes stronger when the students are exposed to social support systems. It is recommended to management of the universities to sustain the course and also periodically review the course by ensuring that it is more practical and need-centred. The government through its agencies can also put in place effective and targeted social support structures that will help starters to take-off with ease.

Support needs of people living with obesity during transition from tertiary obesity treatment to community care.

BackgroundAs the number of people living with obesity increases, the maintenance of treatment outcomes is especially pertinent. Treatment at tertiary obesity services have proven to be successful, but patients need to be transitioned out of these services to community-based care to accommodate the influx of new patients. Little is known about the support needs of patients after transition from acute tertiary obesity services. It is important to establish the supports needed by these patients, especially in the context of maintaining treatment outcomes and ensuring continuity of care. MethodsA qualitative study was conducted to identify the support needs of people with obesity as they transition to community care. Patients and clinicians recruited from a tertiary obesity clinic participated in semi-structured interviews and focus groups to explore factors influencing transition and supports needed in the community. Data was collected through audio recordings, transcribed verbatim and analysed thematically. ResultsA total of 16 patients and 7 clinicians involved in the care of these patients participated between July 2020 and July 2021. Themes identified included the influence of clinic and individual factors on transition, the benefits of phased transition, patient-centred communication, and the role of social support. It was found that dependency and lack of self-efficacy, as well as low social support, hindered transition efforts. It was also identified that patients required substantial integrated professional and social support structures in the community to adequately address their care needs both during and following transition. ConclusionInterventions are needed to provide social community services following transition to ensure adequate community care that can support the maintenance of treatment outcomes. Such services should be integrated and address the social needs of people living with obesity.

Providing ambulatory healthcare for people aged 80 and over: Views and perspectives of physicians and dentists from a qualitative survey.

People aged 80 and over frequently face complex chronic conditions and health limitations, including oral health problems, which are primarily addressed by ambulatory (i.e., outpatient) healthcare. This demographic development is expected to affect the provision of care. However, few studies have investigated physicians' and dentists' views across the various medical disciplines in non-institutional settings. This study investigated how healthcare providers perceive caring for very old people, and how they feel healthcare should be designed for this patient group. A qualitative online survey comprising nine open-ended items was conducted among physicians and dentists practicing in the ambulatory healthcare sector in North Rhine-Westphalia, Germany. Apart from child and adolescent healthcare, no medical specialties were excluded. The results were analysed using Kuckartz' approach of structuring qualitative content analysis. A descriptive codebook was developed first. After coding all the material, recurring patterns between the topics were investigated and compared between two groups of participants, physicians and dentists. N = 77 cases were included in the analysis, from which n = 21 originated from the field of ambulatory general practice care and internal medicine, n = 19 from specialties (e.g., neurology, urology), and n = 37 from dentistry. Caring for patients aged 80 and over was perceived as challenging because of complex health conditions and treatments such as multimorbidity and polypharmacy, and patients' cognitive and physical limitations. In characterizing good care in older age, both groups found individual care important, as well as empathetic interactions and good collaboration in networks of healthcare providers. Inadequate reimbursement and limited resources and time were the most important barriers to providing good care, while one of the most important facilitators was healthcare providers' attitude and motivation. Physicians' and dentists' conceptions of good healthcare are in line with the conceptualization of patient-centred care. However, the transfer in everyday care delivery is hampered by the current design of healthcare structures. Healthcare providers feel overstrained by the increasing demands placed on them. Adaptations for improvement should focus on building strong networks of cooperating health professions, especially including dental care, and local social support structures.

Meaningful Activities and Sources of Meaning for Community-Dwelling People Living with Dementia.

To examine how people living with dementia at home engage in meaningful activities, a critical component of quality of life. Ethnographic study design using semistructured interviews, participant-observation, and ethnographic analysis. Home setting. People living with dementia were recruited through 3 geriatrics programs in the San Francisco Bay Area, along with 1 primary live-in care partner for each. Participants were purposively sampled to maximize heterogeneity of dementia severity and life experience. We asked participants to self-identify and report meaningful activity engagement prior to dementia onset and during the study period using a structured questionnaire, semistructured dyadic interviews, and observed engagement in activities. Home visits were audio-recorded, transcribed, and inductively analyzed using thematic analysis. Twenty-one people living with dementia (mean age 84years, 38% women) and 20 care partners (59years, 85% women), including 40% professionals, 35% spouse/partners, and 15% adult children. Overarching theme: specific activities changed over time but underlying sources of meaning and identity remained stable. As dementia progressed, meaningful activity engagement took 3 pathways. Pathway 1: Activities continued with minimal adaptation when engagement demanded little functional or cognitive ability (eg, watching football on TV). Pathway 2: care partners adapted or replaced activities when engagement required greater functional or cognitive abilities (eg, traveling overseas). This pathway was associated with caregiving experience, nursing training, and strong social support structures. Pathway 3: care partners discontinued meaningful activity engagement. Discontinuation was associated with severe caregiver burden, coupled with illness, injury, or competing caregiving demands severe enough to impact their ability to facilitate activities. For people living with dementia at home, underlying sources of meaning and identity remains stable despite changes in meaningful activity engagement. Many of the factors associated with adaptation vs discontinuation over time are modifiable and can serve as targets for intervention.

Factors Influencing Teacher’s Technostress Experienced in Using Emerging Technology: A Qualitative Study

In this era of rapid technology growth, many countries have begun to adopt emerging technologies into their educational systems to improve learning outcomes. The aim of this study is to explore the factors influencing teachers’ experiences of technostress while using new technology in academic classrooms and how it might be mitigated. Prior research has not focused on how technostress develops among individuals over time or how it can be mitigated in an individual context; the intention of this study is to contribute to the technostress literature in these particular areas. To address the research gap, we conducted a qualitative study that collected data through the use of an open-ended question questionnaire. Seventy teachers of different backgrounds and locations responded to the survey. We used thematic analysis to analyze their responses and reveal how lack of school support and their professional identities influence their levels of technostress. Technology characteristics, including the complexity and the benefits of a given technology, and privacy concerns play a crucial role in teachers’ experiences of technostress. Moreover, we found that colleague support in using new technology and open educational resources each contributed to mitigating teachers’ technostress levels. Our study extends technostress research to examine a new learning environment and context. This focus allowed us to highlight the need to develop open educational resources and better social support structures for teachers and to rethink the professional identities of developing teachers to mitigate their levels of technostress. Suggestions for further research that resulted from this work include using a mixed methods research approach in future studies and including more teachers in future work to determine the relationships among the factors identified by this study.

Perceptions of Entrepreneurship and Online Learning During the Coronavirus-2019 (COVID-19) Pandemic

Coronavirus-2019 (COVID-19) restrictions significantly influenced the learning and delivery of educational programs, especially traditionally hands-on educational programs. Entrepreneurship education and training (EET) studies on learners’ perceptions have so far focused on formal EET in university settings or Massive Open Online Courses (MOOCs). This paper explores youth perceptions of a non-formal, online EET program conducted during the pandemic. Perceptions matter since they tend to translate into attitudes, which in turn potentially translate into achieving learning outcomes (or not). Using hermeneutic content analysis (HCA), transcripts from 35 youth participants were analyzed, where the participants were categorized into four groups based on completion of the program and household income. Individual motivations were very important for all and the lack of social support was a concern for low-income youth. Almost a third of the dropouts who were part of the study did so to actually start their own business during the pandemic versus only one out of 18 of non-dropouts. The pandemic was disruptive to livelihoods and to their families, which sometimes made learning more difficult. Future online EET programs should relate learners’ motivations for learning entrepreneurship with learning outcomes by instilling social support structures and taking contextual influences into consideration.

From Physical Distancing to Social Loneliness among Gay Men and Other Men Having Sex with Men in Belgium: Examining the Disruption of the Social Network and Social Support Structures.

Since the start of the SARS-CoV-2 pandemic, levels of loneliness have increased among the general population and especially among sexual minorities, such as gay men and other men who have sex with men, who already experienced more problems with social isolation before the pandemic. We analyzed how the disruption of the social network and social support structures by containment measures impact loneliness among gay and other men having sex with men. Our sample consisted of gay and other men having sex with men who had in person communication with family as well as heterosexual friends and homosexual friends before the lockdown (N = 461). Multivariate regression analyses were performed with social provisions (social interaction and reliable alliance) and loneliness as dependent variables. A change from in-person communication with gay peers before the pandemic to remote-only or no communication with gay peers during the pandemic, mediated by change in social integration, was related to an increased feeling of loneliness during the pandemic compared with before the pandemic. There were some unexpected findings, which should be interpreted in the specific social context of the SARS-CoV-2 pandemic. On average, social integration and reliable alliance among MSM increased during the lockdown, even though in-person communication decreased and loneliness increased. Our results show it is critical to maintain a view of social support and social loneliness as lodged within larger social and cultural contexts that ultimately shape the mechanisms behind them.

Perception of mothers about Acute Respiratory Infections (ARIs) and risk factors affecting children Under 5 Years (U5Ys) in Fiji

PurposeTo explore the perception of mothers about Acute Respiratory Infections (ARIs) and their risk factors affecting children Under 5 Years (U5Ys) in Fiji. DesignThis was a qualitative study done in the Integrated Management of Childhood Illness (IMCI) Clinic in Ba Hospital, Fiji. Mothers who had brought in their children with ARIs were selected through a purposive sampling method. A semi-structured open-ended questionnaire was used to guide in-depth interviews. The interviews were transcribed and the thematic analysis was done to look at the themes and sub-themes that emerged. ResultsA total of 30 mothers were interviewed. There were five themes that were derived from the interviews including the mothers' perception of ARIs; treatment methods; perceived barriers; services provided by IMCI clinic; and recommendations and suggestions. The mothers were familiar with the causes, risk factors and able to recognize severity of ARIs based on the local context. They mostly relied on traditional and home remedies for ARIs. Most mothers preferred injections for treatment for their child. There were many perceived barriers of ARIs prevention such as traditional norms and poor social support. Most mothers stayed in rural areas which caused poor accessibility to health care services. Few mothers had issues with poor attitude and skills of health care workers. ConclusionsThere are multiple factors that are barriers in reducing the risks of ARIs. There needs to be policies implemented to support the health of children in the communities as well as social support structures. Practice implicationsThis study provides a clear picture of the perception of the mothers regarding ARIs in children under five years old. With this information at hand, it is easier to answer the question regarding the perceptions of the mothers of ARIs and the risk factors and design tailored interventions to prevent ARIs among children.

Disparities and intersectionality in social support networks: addressing social inequalities during the COVID-19 pandemic and beyond

The COVID-19 pandemic has brought social injustice and inequalities to the forefront of global public health. Members of marginalised communities, such as racial/ethnic and sexual minorities, and persons with disabilities, have been shown to be more vulnerable to certain consequences of the pandemic. Research suggests a protective role of social support in health and wellness promotion, yet little is known about the disparities in specific social support sources (i.e., family, friends, and a significant other) between marginalised populations and their counterparts. Also unclear is the role of intersections of these marginalised identities in social support structures affected by the pandemic. Hence, it is crucial to capture and characterise such differences and intersectionality in order to address social inequalities in a time of global crisis. To that end, we surveyed U.S. adults across 45 states to examine their social support from family, friends, and a significant other. Results revealed the disproportionate impacts of the pandemic on social support among racial/ethnic and sexual minorities and persons with disabilities. Additionally, we found that White individuals with a marginalised identity received less social support than their White counterparts but received a similar level of social support when compared with racial/ethnic minorities without additional marginalised identities. This article seeks to elucidate the social support disparities associated with disproportionately increased social isolation for marginalised populations due to socioeconomic disadvantages. Specific recommendations are provided for addressing issues around social disparities and inequalities. With the experience and awareness attained working with marginalised populations, mental health professionals, public health officials, and community stakeholders should be poised to attend to social capital inequalities for diversity, equity, and inclusion now and in the post-pandemic era.

Two years after lockdown: reviewing the effects of COVID-19 on health services and support for adolescents living with HIV in South Africa.

IntroductionSouth Africa's progress towards the 95‐95‐95 goals has been significantly slower among adolescents living with HIV (ALHIV), among whom antiretroviral therapy (ART) adherence, retention in care and viral suppression remain a concern. After 2 years of living with COVID‐19, it is important to examine the direct and indirect effects of the pandemic on healthcare resources, access to HIV services and availability of support structures, to assess their impact on HIV care for ALHIV.DiscussionThe COVID‐19 response in South Africa has shifted healthcare resources towards combatting COVID‐19, affecting the quality and availability of HIV services—especially for vulnerable populations, such as ALHIV. The healthcare system's response to COVID‐19 has threatened to diminish fragile gains in engaging ALHIV with HIV services, especially as this group relies on overburdened public health facilities for their HIV care. Reallocation of limited health resources utilized by ALHIV disrupted healthcare workers’ capacity to form and maintain therapeutic relationships with ALHIV and monitor ALHIV for ART‐related side effects, treatment difficulties and mental health conditions, affecting their ability to retain ALHIV in HIV care. Prevailing declines in HIV surveillance meant missed opportunities to identify and manage opportunistic infections and HIV disease progression in adolescents. “Lockdown” restrictions have limited access to healthcare facilities and healthcare workers for ALHIV by reducing clinic appointments and limiting individual movement. ALHIV have had restricted access to social, psychological and educational support structures, including national feeding schemes. This limited access, coupled with reduced opportunities for routine maternal and sexual and reproductive health services, may place adolescent girls at greater risk of transactional sex, child marriages, unintended pregnancy and mother‐to‐child HIV transmission.ConclusionsAdolescent HIV care in South Africa is often overlooked; however, ART adherence among ALHIV in South Africa is particularly susceptible to the consequences of a world transformed by COVID‐19. The current structures in place to support HIV testing, ART initiation and adherence have been reshaped by disruptions to health structures, new barriers to access health services and the limited available education and psychosocial support systems. Reflecting on these limitations can drive considerations for minimizing these barriers and retaining ALHIV in HIV care.

Volunteer-Based Social Support Structures and Program Exposure Outcomes in an Adolescent Young Adult Palliative Care Peer Support Program.

Objective: To conduct a social network analysis (SNA) of patient-volunteer networks and assess the impact of patient characteristics on network measures. Background: Volunteers play a critical role in providing peer support to adolescent and young adult (AYA) palliative care patients. Streetlight at UF Health is a peer support palliative care program for hospitalized AYAs that aims at forming positive peer relationships through volunteer visits, events, and a virtual online health community. Methods: Data were collected on patient characteristics, hospitalizations, average length of stays (LOS), and volunteer visitation records. Egocentric SNAs were conducted on each patient to calculate network outcomes. Study participants were AYA patients (N = 69), enrolled in the US-based Streetlight program at UF Health Shands Hospital. Results: The LOS was significantly associated with network size (B = 0.583; 95% confidence interval; CI [0.463 to 0.702]). Autoimmune patients had smaller network sizes when controlling for LOS. Total hospital admissions predicted - 0.172 ([- 0.263 to - 0.080]) lower average repeat visits. Higher average repeat visits were predicted for patients who had cancer (B = 0.246 [0.046 to 0.447]) and awaiting organ transplantation (B = 0.370 [0.082 to 0.658]). Although cystic fibrosis patients received more visits (B = 0.364 [0.003 to 0.724]) compared with other illness populations, the network density was lower (B = - 0.580 [1.01 to - 0.155]). Cancer patients had networks with a higher diversity in volunteer repeat visits (B = 0.714 [0.312 to 0.920]). Conclusions: Significant relationships between patient characteristics and network outcomes highlight the differences in social support service delivery among diverse populations. These analyses can be utilized in practice to guide program delivery for high-need patients.

Health-related quality of life in cancer immunotherapy: a systematic perspective, using causal loop diagrams

PurposeSystem science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the health-related quality of life (HRQoL) of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for HRQoL of cancer immunotherapy patients.MethodsWe first applied a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively reviewed and enhanced the CLD through interviews with subject matter experts.ResultsBased on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL.ConclusionThe CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains.

“My children do not deserve it”: Understanding how epiphanies instigate support-seeking practices among veteran families living with PTSD in Denmark

Post-deployment posttraumatic stress disorder (PTSD) does not merely affect veterans. A growing body of literature highlights the detrimental impact of veteran PTSD on entire families. One area less studied pertains to how PTSD affects veterans’ parenting skills and engagement with social support structures in response to family struggles. Through an interpretative phenomenological analysis, we addressed this gap by drawing on qualitative research with six Danish veteran families affected by PTSD. We applied a theoretical lens of epiphanies as turning points to explore the interface between experiences of the impact of PTSD on the family system and support-seeking practices within the families’ social networks. Aided by Denzin’s notion of epiphany, we locate and report on the occurrence of four types of epiphanies that instigate help-seeking. The epiphanies reveal details about parents’ experiences of the effect of PTSD on family life, as well as their needs and responses to struggles of parenting and children’s distress. The epiphanies also serve as critical enablers of PTSD-affected veterans and their families’ engagement in support-seeking practices. Social support services aiming to help veteran families should consider how parenting experiences and epiphanies can mobilize pathways to social support.

Healthcare Providers' Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study.

Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs and seeks to identify strategies for preventing them. Physicians, nurses, paramedics, and health administrators with experience in managing rural patients with PPHs were recruited from southern Tasmania, Australia. Semi-structured telephone interviews were conducted, and reflexive thematic analysis was used to analyse the data. Participants linked health literacy, limited access to primary care, and perceptions of primary care services with PPH risk. The belief that patients did not have a good understanding of where, when, and how to manage their health was perceived to be linked to patient-specific health literacy challenges. Access to primary healthcare was impacted by appointment availability, transport, and financial constraints. In contrast, it was felt that the prompt, comprehensive, and free healthcare delivered in hospitals appealed to patients and influenced their decision to bypass rural primary healthcare services. Strategies to reduce PPHs in rural Australian communities may include promoting health literacy, optimising the delivery of existing services, and improving social support structures.

Burnout and resilience among pharmacy technicians: A Singapore study

BackgroundBurnout describes emotional exhaustion (EE), depersonalization (DP), and low personal achievement caused by work and is known to bring about negative consequences to practitioners, patients, and health systems. Various organizational and personal factors, such as organizational strategies and resilience, have been associated with this phenomenon. However, there is a paucity of data describing the prevalence of burnout among pharmacy staff within Singapore and Asia, especially in the pharmacy technician (PT) population. ObjectivesThis study aimed to (1) quantify burnout in PTs in patient-care sectors in Singapore and (2) explore factors that may be associated with burnout. MethodsA cross-sectional survey among PTs in patient-care areas in Singapore, which includes hospitals, primary and secondary care institutions, and retail pharmacies, across both public and private sectors was conducted from February to April 2020. The Maslach Burnout Inventory – Human Services Survey and Brief Resilience Scale were used to assess burnout and resilience among participants. Demographic, employment, and well-being information were also collected and summarized. Univariate analysis and multivariate logistic regression were used to assess associations between burnout and potential risk and impact factors. ResultsSlightly more than half (52.0%) of PTs reported burnout (EE score ≥27 or DP ≥10 or both). Statistically significant factors associated with burnout include resilience, age, years of experience, ethnicity, marital status, nationality, highest qualifications, pharmacy-related certification, full-time employment status, and work hours. Impact associated with burnout includes intent for job change, job satisfaction, sleep, and presence of mental conditions. Statistically significant reported reasons for burnout and ways to build resilience were also elucidated. ConclusionBurnout affects most PTs in Singapore and is primarily driven by workload and nature of their work, low resilience, and poor social support structures. National and organizational efforts are needed to arrest the vicious cycle that propagates burnout in PTs.

The Association between Technology Capacity and Prenatal Care during COVID‐19 Pandemic: The Modifying Role of Social Support

Research ObjectiveThe Centers for Disease Control and Prevention called for telehealth uptakes to avoid disruption of routine prenatal care (PNC) during the COVID‐19 pandemic. Yet, lack of technology capacity may hinder telehealth access and disrupt PNC. Social support could serve as a protective factor against technology barriers and moderate the association between technology capacity and attending PNC. To date, little data are available regarding the associations between technology capacity, social support, and PNC. This study assessed the associations of technology capacity with PNC provider continuity and overall PNC experience and to examine whether social support modifies such associations.Study DesignA nationwide survey was completed from 5/4/2020–5/6/2020 by 668 U.S. pregnant women, 18–44 years of age and being at least 8‐week gestation. Two aspects of PNC were studies: 1) pregnant women's overall rating of PNC experience, ranging from very poor (1) to outstanding (5), and 2) PNC provider continuity, defined as whether a woman stayed with the same PNC provider during the pandemic. Technology capacity was measured as the total scores of participants' confidence and necessary skills for telehealth use (range: 2–10). Social support was assessed using the modified Medical Outcomes Study Social Support Survey and categorized to three levels (low, medium and high) with mean +/− one standard deviation. Multivariable linear regressions and logistic regression were used to examine the associations between technology capacity and PNC outcomes and the modifying roles of social support.Population Studied668 women who were > 8 weeks pregnant, aged 18–44 years, living and planning to give birth in the United States, and having initiated PNC were included in the analysis.Principal FindingsA total of 668 pregnant women have initiated PNC by 5/6/2020. They were mostly aged 25–34 years (91.8%), diverse (44.3% non‐Hispanic Black, 8.5% Hispanic, 44.3% non‐Hispanic White and 6.6% other non‐Hispanic race), urban residents (86.4%), and full‐time employed (63.9%). Technology capacity and social support were positively associated with PNC experience and provider continuity (Ps < 0.01). However, technology capacity was positively related to PNC experience (β = 0.31, 95% CI 0.16 to 0.45; P < 0.001) and PNC provider continuity (OR = 1.80, 95% CI 1.52 to 2.14; P < 0.001) only among women with low social support, but not among women with high social support.ConclusionsTechnology capacity had positive associations with overall rating of PNC experience and provider continuity. These relationships were stronger among women with lower social support.Implications for Policy or PracticeThere is a need to improve technology capacity and/or promote and incentivize social support structures for pregnant women, especially those who lack technology capacity and social support. Clinical healthcare providers may consider providing technology support in the meantime of deploying telehealth resources, in collaboration with communities that can reach out to pregnant women in need. Policymakers and insurers should develop complementary policies to ensure both the supply and demand sides benefit from wide‐spread telehealth use for prenatal care.Primary Funding SourceUniversity of South Carolina vice president for research.

Pregnant and Parenting Women's Experiences with Substance Use Disorder.

The purpose of the study was to describe and analyze the experience of women with substance use disorder during pregnancy and parenting to inform health care services that promote recovery. Interviews of pregnant or parenting women with substance use disorder were used in this qualitative descriptive study. Participants were recruited from two recovery centers serving pregnant or parenting women with substance use disorder. Participants called a study cellphone to speak with the researchers about their substance use and recovery. Four independent reviewers conducted thematic analysis and were facilitated by Atlas.ti qualitative analysis program. N = 15 women called the study cellphone; 10 met inclusion criteria and were interviewed. Researchers coded 81 themes with the common occurrence of prior trauma, multiple substances used, stigma and judgment from others, and having children as a motivation to seeking recovery. Co-occurrence of themes of positive social support and the pursuit of recovery was identified. Positive social support co-occurring with recovery supports the need for strengthened social support structures. Health care professionals should intentionally address the culture of caring for pregnant and parenting women with substance use disorder through education, practice, advocacy, and research.

Slipping through the cracks: a qualitative study to explore pathways of HIV care and treatment amongst hospitalised patients with advanced HIV in Kenya and the Democratic Republic of the Congo

ABSTRACT Advanced HIV causes substantial mortality in sub-Saharan Africa despite widespread antiretroviral therapy coverage. This paper explores pathways of care amongst hospitalised patients with advanced HIV in rural Kenya and urban Democratic Republic of the Congo, with a view to understanding their care-seeking trajectories and poor health outcomes. Thirty in-depth interviews were conducted with hospitalised patients with advanced HIV who had previously initiated first-line antiretroviral therapy, covering their experiences of living with HIV and care-seeking. Interviews were audio-recorded, transcribed and translated before being coded inductively and analysed thematically. In both settings, participants’ health journeys were defined by recurrent, severe symptoms and complex pathways of care before hospitalisation. Patients were often hospitalised after multiple failed attempts to obtain adequate care at health centres. Most participants managed their ill-health with limited support networks, lived in fragile economic situations and often experienced stress and other mental health concerns. Treatment-taking was sometimes undermined by strict messaging around adherence that was delivered in health facilities. These findings reveal a group of patients who had “slipped through the cracks” of health systems and social support structures, indicating both missed opportunities for timely management of advanced HIV and the need for interventions beyond hospital and clinical settings.

Collective memories and professional ideals: Teachers’ experiences of a disaster

Experienced collectively, disasters are also remembered collectively. Constituting a social glue among affected communities, disaster memories are essential for recovery processes. Focusing on teachers, who became frontline disaster workers, this paper explores how disasters are experienced and managed by a professional group lacking emergency management training. The study draws on in-depth interviews with school teachers about their memories of a forest fire in Sweden in 2014. As residents in, or close by, a small, rural community close to the fire, the teachers experienced the fire both as professionals and as citizens in their roles as family members and neighbours. The paper explores the role of kinship and vicinity of community reflecting the concepts of Therapeutic community and Gemeinschaft to provide a more substantial understanding of the social structures of a small, rural community without previous experiences of a disaster. The second theoretical focus and consequential contribution of the study lies within the teacher's recollections of professionalism, and how such interlinked norms and values remained intact through the disaster. In addition to convergence concerning professional ideals in the teacher collective, there was divergence in the teachers' memories of their performance and how others valued them, outlining how the social context and organizational support structures have tangible impacts on individuals' memories. Findings enable further systematic exploration of post-disaster social structures, training and organizational support, as well as the role of professional ideals, in disaster recovery processes.