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As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under difficult conditions, practicing trauma-informed care (TIC) may mitigate negative effects on mental health and well-being. This secondary qualitative analysis of a larger mixed methods study sought to understand the pandemic's impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US and assess changes in prioritization of TIC. RWC administrators, providers, and staff were asked about impacts on clinic operations/culture, HCW well-being, institutional support for well-being, and prioritization of TIC. HCWs described strenuous work environments and decreased well-being (eg, increased stress, burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel responses to disruptions of clinic operations and culture to encourage continuity in care and promote HCW well-being. Despite increased awareness of the need for TIC, prioritization remained variable. Implementing and institutionalizing trauma-informed practices could strengthen continuity in care and safeguard HCW well-being during public health emergencies.

Abstract Background Scaling evidence-based interventions are key to impacting population health. The National DPP lifestyle change program is one such intervention that has been scaled across the USA over the past 20 years; however, enrollment is an ongoing challenge. Furthermore, little is known about which organizations are most successful with program delivery, enrollment, and scaling. This study aims to understand more about the internal and external organization factors that impact program implementation and reach. Methods Between August 2020 and January 2021, data were collected through semi-structured key informant interviews with 30 National DPP delivery organization implementers. This study uses a qualitative cross-case construct rating methodology to assess which Consolidated Framework for Implementation Research (CFIR) inner and outer setting constructs contributed (both in valence and magnitude) to the organization’s current level of implementation reach (measured by average participant enrollment per year). A construct by case matrix was created with ratings for each CFIR construct by interviewee and grouped by implementation reach level. Results Across the 16 inner and outer setting constructs and subconstructs, the interviewees with greater enrollment per year provided stronger and more positive examples related to implementation and enrollment of the program, while the lower reach groups reported stronger and more negative examples across rated constructs. Four inner setting constructs/subconstructs (structural characteristics, compatibility, goals and feedback, and leadership engagement) were identified as “distinguishing” between enrollment reach levels based on the difference between groups by average rating, the examination of the number of extreme ratings within levels, and the thematic analysis of the content discussed. Within these constructs, factors such as organization size and administrative processes; program fit with existing organization services and programs; the presence of enrollment goals; and active leadership involvement in implementation were identified as influencing program reach. Conclusions Our study identified a number of influential CFIR constructs and their impact on National DPP implementation reach. These findings can be leveraged to improve efforts in recruiting and assisting delivery organizations to increase the reach and scale of the National DPP as well as other evidence-based interventions.

This article uses a case study design to explore attempted intimate femicide in metropolitan São Paulo, Brazil. We conducted 30 in-depth interviews with adult women on community and personal relationship experiences, health-care services, and national legislation about violence against women. Through a thorough transcript review, we identified two participants, Maria* and Raquel*, whose intimate partners attempted to kill them. We used a modified grounded theory approach to code the entire sample, and further analysed these transcripts to identify missed opportunities for intervention in both the prevention of- and responses to intimate partner violence (IPV), and the antecedents of attempted intimate femicide. Both women had normalized experiences of violence, and experienced psychological abuse prior to the attempted intimate femicide. Social and familial networks were sources of shame for Raquel and support for Maria. Neither woman expressed confidence in law enforcement’s ability to protect women and girls from IPV. These cases illustrate the need for multi-tiered interventions to prevent femicide in Brazil, which boasts one of the highest global female homicide rates. Although anti-femicide laws exist, better mechanisms are needed to integrate health, legal and social services for IPV and femicide prevention. In addition, community- and interpersonal- level interventions that counteract the Brazilian ‘culture of violence’ and machismo may provide support for at-risk women and girls. *pseudonyms have been used to protect the identity of the participants