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The considerable risk of negative consequences of unprotected intercourse underscores a need to better understand how Latina adolescent girls acquire the skills to manage the risks associated with sexuality. The authors used in-depth qualitative interviews with mothers and their daughters to examine communication related to sexuality with the goal of understanding the sociocultural and family context of Latina adolescents sexual behavior and reproductive health care seeking. Mothers and daughters agree that sexual activity threatens girls health and future and that open communication about sexuality is highly valued but difficult to achieve. Communication content tends to focus on the threats of sexual activity, but process is important. Strategies of effective communicators include deliberate creation of an atmosphere of approachability and a flow of information from daughter to mother. (Contains 1 table.)

Phenomenon: Improving the learning environment (LE), particularly for students underrepresented in medicine (URM), has become an important goal for institutions that provide undergraduate and graduate medical education. Until recently, research and intervention development have been limited by the lack of comprehensive theoretical frameworks. A multi-dimensional conceptual model of the medical school environment, developed by Gruppen and colleagues in 2019, provides a useful framework for guiding research and interventions in this area. Approach: Using Gruppen et al's model, this study investigated experiences of the LE from the perspectives of both URM and non-URM students at a medical school in New York City. In examining experiences of the organizational, social, and physical domains of the LE, we sought to explore the symbolic and experiential links across domains and identify concrete needs for improvement. Findings: Institutional structures and policies, features of the built environment, and social relationships that put learning first and generated a sense of community were highly valued. Although both URM and non-URM students shared many perceptions and experiences, URM students expressed heightened vulnerability to the experiences of devaluation and exclusion. Insights: All participants in the study greatly appreciated aspects of the LE that made them feel like valued members of the community. Medical schools should approach the task of improving the LE for URM students using a comprehensive, multi-dimensional approach. [ABSTRACT FROM AUTHOR]

Objectives: Optimally, cancer is diagnosed through periodic screening or detection of early symptoms in primary care settings. However, an estimated 23%–52% of gastrointestinal (GI) cancers are diagnosed in the emergency department (ED). Cancer diagnosed in the ED has been associated with worse clinical and patient‐reported outcomes even after adjustment for cancer stage. We sought to explore patients' accounts of patient and health care system factors related to their diagnosis in the ED and their lived experience of receiving a diagnosis in this setting. Methods: Patients with an ED visit during or within 30 days of their GI cancer diagnosis at an urban academic hospital serving a largely disadvantaged population were recruited. Interviews were coded in NVivo 12 and analyzed using a thematic analysis approach. Results: Patient‐reported factors associated with their experiences included denial and avoidance of symptoms, mistrust of the health system, and lack of cancer screening knowledge. Health care system factors included misdiagnosis and delayed access to specialty care or tests. Experiences receiving a cancer diagnosis in the ED were overwhelmingly negative. Conclusions: This study highlights the unmet needs in identifying and diagnosing patients who ultimately present to the ED for evaluation and eventual diagnosis of cancer. Our results shed light on several modifiable factors, including the need for increased public awareness of the asymptomatic nature of cancer and the importance of cancer screening. Additionally, health care systems modifications beyond the ED are needed to improve access to timely care when symptoms arise. [ABSTRACT FROM AUTHOR]

South Asian (SA) Americans have a high risk of metabolic and cardiovascular disease. Prevention efforts should start in childhood and should be culturally appropriate. We sought to understand the challenges and barriers that pediatricians face in providing care for SA children to inform professional education on culturally effective care. Qualitative interviews were conducted with a diverse sample (N = 17) of pediatricians. Challenges reported included feeding problems, inadequate physical activity, and mental health concerns. Communication barriers included parents' anxiety around feeding, influence of grandparents, stigma around mental health, and cultural communication gaps. Effective strategies included clear communication, a gradual approach, ensuring buy-in from grandparents, greater attention to family history, and improved cultural knowledge in pediatrician. Addressing feeding problems was the most mentioned challenge, which is especially concerning given the high chronic disease risk in SAs. Education on culturally appropriate strategies can equip pediatricians to effectively counsel SA families to address these risks. [ABSTRACT FROM AUTHOR]

Highly effective direct-acting antiviral (DAA) agents have changed the landscape of hepatitis C virus infection (HCV) treatment and have become more available to people who inject drugs (PWID) over the past several years. Although many achieve a sustained virologic response (SVR), a small proportion will become re-infected. This study examined experiences of re-infection among participants in Project HERO, a large multi-site treatment trial designed to test alternative treatment delivery models for DAAs. Study staff conducted qualitative interviews with twenty-three HERO participants who experienced reinfection following successful treatment for HCV. Interviews focused on life circumstances and experiences with treatment/re-infection. We conducted a thematic analysis, followed by a narrative analysis. Participants described challenging life circumstances. The initial experience of cure was joyful, leading participants to feel that they had escaped a defiled, stigmatized identity. Re-infection was very painful. Feelings of shame were common. Participants with fully developed narratives of re-infection described both a strong emotional response as well as a plan for avoiding re-infection during retreatment. Participants who lack such stories showed signs of hopelessness and apathy. Though the promise of personal transformation through SVR may be motivating for patients, clinicians should be cautious about how they describe the "cure" when educating patients about HCV treatment. Patients should be encouraged to avoid stigmatizing, dichotomizing language of the self, including terms such as "dirty" and "clean." In acknowledging the benefits of HCV cure, clinicians should emphasize that re-infection does not mean failed treatment ; and that current treatment guidelines support retreatment of re-infected PWID. • The experience of reinfection with HCV has been little studied. • Our narrative study of PWID suggests reinfection can be psychologically devastating. • Patients who lack developed reinfection narratives may be especially vulnerable. • Physicians must avoid stigmatizing language in managing re-infected patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Prior studies have demonstrated that most women are comfortable with the option of receiving early abortion care in the family medicine setting, and patients who received early abortion care in this context report satisfaction with their experience. There are few qualitative studies, however, that explore abortion experiences in the family medicine setting. This study aimed to better understand influential factors in women's choices and experiences of their family medicine setting for abortion care.Methods: We conducted semi-structured interviews with 15 women who received early abortion care at an urban federally qualified health center offering full-spectrum family medicine. Transcripts were analyzed in NVivo, using editing and immersion/crystallization approaches.Results: Women who received abortion care in this setting were highly satisfied. Though many were surprised when they learned abortion care was available, their responses were favorable, and their experiences were positive. Our results indicate that connection to the clinic setting and to the provider who performed the abortion created a context of trust and comfort. Further, women in our study appreciated the privacy offered by a general medical setting as well as the convenience and continuity of care afforded by accessing abortion care in their accustomed primary care setting.Conclusions: Women in our study reported high levels of satisfaction with care and would recommend this setting to others. In a context of increasing restrictions on abortion, family physicians are well-positioned to increase access by including abortion care in the range of reproductive health services offered in their primary care practice settings. [ABSTRACT FROM AUTHOR]

Objectives: To examine the experience of patients from a low-income, ethnically diverse medically underserved population receiving acupuncture for chronic pain. Design: Qualitative analysis using inductive thematic analysis of interviews with participants from an acupuncture trial. Settings/Location: Four community health centers in the Bronx, New York. Participants: Thirty-seven adults with chronic neck or back pain or osteoarthritis who participated in a previous acupuncture trial. Interventions: Up to 14 weekly acupuncture treatments. Outcome measures: Pain and quality of life were examined in the original trial; this study examines qualitative outcomes. Results: The themes grouped naturally into three domains of the acupuncture experience: the decision-making process, the treatment experience, and the effect of acupuncture on health. Regarding decision-making, important factors were a willingness to try something new even if you do not necessary 'believe' in it or have specifically positive expectations; a sense that medications were not working for their pain, that they also caused significant adverse effects, and that natural strategies might be preferable; and a feeling of desperation. Cost and access were significant barriers to acupuncture treatment. Regarding the process of acupuncture, the open and personal communication with the acupuncturist was an important factor, as were the sense that the process of acupuncture related to a natural process of healing or correction within the body and that part of making acupuncture successful required being open to the power of the mind to generate a positive outcome. Regarding the effect of treatment, notable aspects were the deep sense of rest and relaxation participants reported during treatment as well as the benefit they experienced for conditions other than pain. Conclusions: The themes that emerged in this ethnically diverse, low-income population were very similar to those that have emerged over the past decade of qualitative research on the acupuncture experience in other patient populations. [ABSTRACT FROM AUTHOR]

Objectives. We undertook this study to understand women's perceptions of receiving contraception at Rikers Island Jail. Methods. We conducted semi-structured in-depth interviews in 2011 to 2012 with 32 women incarcerated at Rikers Island Jail. We analyzed the data using standard qualitative techniques. Results. Almost all participants believed that contraception should be pro- vided at the jail. However, many said they would hesitate to use these services themselves. Reservations were caused in part by women's negative views of health care services at the jail. Fears about the safety of birth control, difficulties associated with follow-up in the community, and desire for pregnancy were other factors that influenced interest in accepting contraception. Conclusions. Contraception at the jail must be provided by trusted medical providers delivering high quality care with the goal of allowing women to control their own fertility; this would ensure that women could access birth control and cease using birth control when desired. [ABSTRACT FROM AUTHOR]

Health promotion programs have increasingly used peers as a means of engaging vulnerable populations despite mixed evidence on effectiveness. Few peer implementation studies exist in the literature, so little is known of the degree to which implementation challenges may affect the success of peer programs. This study examines the implementation of peer intervention programs at 10 sites involved in a 5-year national HIV linkage and retention initiative for HIV-positive women of color. The article draws on qualitative data to describe sites’ challenges and facilitators to develop, implement, and evaluate peer roles. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to develop a better understanding of which patients with chronic illness tend to respond to integrative medicine interventions, by identifying a set of characteristics or qualities that are associated with a positive outcome in a randomized clinical trial of an integrative medicine approach to asthma that incorporated journaling, yoga breathing instruction, and nutritional manipulation and supplementation. Design: The study used qualitative analysis using a grounded-theory approach comparing a group of responders in the parent trial (based on the Asthma Quality of Life Scale) to a group of nonresponders. Results: Twelve (12) responders and 8 nonresponders were interviewed. Responders demonstrated an attitude of 'change as challenge;' a view of themselves as 'independent' and 'leaders;' an ability to accept one's illness while still maintaining a feeling of control over one's choices; a connection to the deeper context or meaning of complementary and alternative medicine (CAM) interventions, as opposed to just 'previous experience' of CAM; and a sense of determination, commitment, and 'willingness to fight' for what one needs from the health care system. Nonresponders were more often uncertain and anxious in their relationship to their asthma, tending to fall back on denial, and lacking a connection to the deeper context or philosophy of CAM interventions. Conclusions: It is possible to identify a set of characteristics that may predict a positive response to an integrative/lifestyle approach to asthma. These characteristics should be examined prospectively using both quantitative and qualitative methods in future integrative medicine clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: To understand perceived influences on consumption of fruits, vegetables, and fast foods for urban, low-income African Americans. Methods: Semi-structured interviews with 33 African American adults from Philadelphia, Pennsylvania, using continuous, iterative, thematic analysis. Results: Influences on dietary behaviors that emerged included economic considerations; food characteristics; health concerns and health effects; participants' personal influences; social and cultural influences; neighborhood, home, and work environments; and broader contextual influences. There were important differences by age group and gender. Conclusion: Strategies to improve dietary patterns in urban, low-income, African-American communities might make use of overall and age- and gender-specific perspectives from within the community we report. [ABSTRACT FROM AUTHOR]

Although interventions based on cognitive theories can reduce rates of unsafe sexual behavior in adolescents, effect sizes remain small. This study was a qualitative investigation of inner-city adolescents' intentions to use condoms following participation in an intensive safer sex program. In-depth interviews with 26 adolescents were analyzed using standard qualitative methods. Although participants reported strong intentions to use condoms, they described many exceptions to their intention. Condom use intentions were also trumped by the presence of alternative, often conflicting intentions. Typical barriers to condom use played a minor role compared to exceptions and competing intentions. Boys and girls differed in the ways exception to intention and alternate intentions interfered with condom use; these reflected gender roles and norms, which are often neglected in HIV/STD prevention programs. The authors conclude that the barrier model to explain non-condom use is incomplete and that the concept of intention itself may need more conceptual work. [ABSTRACT FROM AUTHOR]

Examines the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls. Reliance of teenage girls on mothers for health care and advice; Emergence of new needs and concerns at sexual debut of these girls; Failure of teenage girls to meet their specific reproductive health needs within the mother-daughter relationship.

Objective: This study describes the perceptions and experiences of family physicians when women request early intrauterine device (IUD) removal.Study Design: This qualitative study included semistructured individual interviews with 12 physicians who encountered patients seeking early IUD removal. We identified eligible participants via chart review. We analyzed interviews using deductive and inductive techniques to identify content and themes.Results: Physicians consistently referred to IUDs as the "best" or their "favorite" method, and several joked that they tried to "sell" the IUD during contraceptive counseling. Most reported having mixed or negative feelings when patients opted to remove the IUD. Most encouraged their patients to continue the IUD, hoping to delay removal until symptoms resolved so that removal was not needed. Some physicians reported feeling guilty or as if they had "failed" when a patient wanted the IUD removed. Many providers reported a conflict between valuing patient autonomy and feeling that early removal was not in the patient's best interest.Conclusions: Physicians have complex and contradictory feelings about early IUD removal. While most providers acknowledged the need for patient autonomy, they still reported encouraging IUD continuation based on their own opinion about the IUD.Implications: While IUDs are highly effective and well-liked contraceptives, providers' responses to IUD removal requests have implications for both reproductive autonomy as well as the doctor-patient relationship. More work is needed to ensure that providers remove a patient's IUD when requested. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to describe the thoughts and experiences of women who report discussing intrauterine device (IUD) removal within 9 months of insertion.Study Design: This is a qualitative study, consisting of semistructured individual interviews with 16 women who considered early elective IUD removal. We identified eligible participants via chart review. We analyzed interviews using a modified grounded theory approach.Results: While pain and bleeding were prominent reasons for removal, women also discussed many other symptoms and concerns. Most women reported a strong desire to have a successful IUD experience, and all reported waiting for symptoms to resolve prior to their visit. Some women reported that providers supported their choice, while others reported that providers preferred that they continue the IUD despite symptoms and concerns. Some women reported providers' resistance or refusal to remove the IUDs. The women who reported that their providers were neutral about IUD removal more frequently expressed satisfaction with the visit. When the provider resisted removal, women felt frustrated, even as they acknowledged their doctor's good intentions. In several cases, this may have hurt the doctor-patient relationship.Conclusions: When physicians resist early elective IUD removal, it may impact patient satisfaction and even jeopardize the doctor-patient relationship.Implications: Though IUDs are highly effective and well-liked contraceptives, some patients choose to discontinue the method. Because provision of patient-centered contraceptive care includes IUD removal when requested, providers must ensure that their counseling is unbiased and that they do not place perceived or real barriers to IUD removal. [ABSTRACT FROM AUTHOR]