Search Results (141)

Background/Objectives: This study evaluates the effects of a personalized exercise program on symptoms (pain, fatigue, sleep, cognitive function, physical function), resilience, and health-related quality of life (HRQOL) and compares the effectiveness of in-person versus telehealth delivery. Methods: A secondary data analysis was conducted on two 12-week randomized control pilot studies for solid tumor cancer survivors. One study involved in-person home visits with telephone follow-ups. The second utilized weekly exercise recommendations via a smartphone app. Both studies had control participants who received the standard care. Symptoms, resilience, and HRQOL were measured at baseline and after 12 weeks. Paired t-tests were conducted for intervention effects and ANCOVA for group differences, adjusting for age and education. Results: The analysis included 75 program completers: 15 in-person (iHBE), 38 telehealth (TEHE), and 22 who received standard care. Those receiving exercise interventions reported improvements in physical (t = 3.0, p < 0.01) and mental fatigability (t = 3.1, p < 0.01) at program completion compared to baseline. Comparing the mean changes between participants receiving exercise interventions in-person and via telehealth, there were no significant differences between the two delivery methods except perceived visuo-perceptual cognitive difficulty (F = 3.55, p = 0.027), where telehealth showed a slight advantage. Conclusions: The study provides initial evidence of the effectiveness of a telehealth personalized exercise on fatigability and cognitive difficulty, suggesting it is a potential viable alternative to in-person intervention. Further research with a larger cohort is essential to ascertain the effects of these interventional modalities on cancer-related health outcomes. Full article

Much U.S. research supports the effectiveness of parenting education delivered via the home visiting method. Home visitors are essential to reaching fathers in this context, but not all have favorable attitudes toward father engagement or feel confident working with fathers. Given that father involvement is important for a wide range of child and adolescent outcomes and that fathers benefit from parenting education, it is important to better understand the forces that shape home visitors’ attitudes toward fathers, and thus their subsequent efforts to include them in publicly funded programming. Using survey data from 95 home visitors in Tennessee, this study explores whether home visitors’ beliefs about fathers and attitudes toward father engagement vary as a function of home visitor or agency characteristics. Results suggest training in social work, reporting father-friendly organizational attitudes and behaviors at one’s agency, and reporting supervisor support specifically for father engagement relate to various favorable fathering attitudes. Home visitors’ strategies to engage fathers in home visiting are presented, including strategies for before, during, and after the home visit. Overall, family service agency administrators are in key positions to make decisions that can improve agency father-friendliness, home visitor attitudes toward fathers, and subsequent outcomes for fathers, mothers, and children. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article

School social work practice in the South African context is a growing field; however, there is limited research regarding the roles and responsibilities of school social workers, particularly in the Gauteng province. This province is unique in that school social workers are employed by multiple institutions, including individual schools and the education and social development departments. This study aimed to explore and describe the roles and responsibilities of school social workers in the Gauteng province, recognizing them as critical specialists in addressing learners’ psychosocial needs within school settings. An explorative qualitative design was used in this study. Data were collected from 22 purposively selected participants, comprising school social workers, supervisors, and provincial managers of school social work programs. Semi-structured interviews were conducted to collect data, and thematic analysis was employed to identify themes. The findings revealed context-specific roles of school social workers, including the creation of conducive teaching and learning environments, advocacy for social justice and child protection, conducting interviews and psychosocial assessments, providing counseling and trauma debriefing, conducting home visits and offering family services, removing abused learners from harmful environments, including their respective homes, and providing parental skills training and support. As a conclusion, this study highlights the need for standardized national and provincial guidelines to formalize and support school social work practice. It is recommended that the identified roles be incorporated into future practice frameworks. Furthermore, it is suggested that a uniform assessment tool be developed to promote consistency and guide school social workers in the initial evaluation processes. Full article

Background/Objectives: Persistent breathlessness impacts people living with advanced chronic obstructive pulmonary disease (COPD) and carers. Accessible services are limited. This translational pilot study evaluated the feasibility, impacts on patient and carer-reported outcomes, and hospital use of a home-based breathlessness intervention service (BLIS). Methods: People with stable COPD, ≥1 COPD-related hospital admissions in the previous year, and persistent breathlessness participated in a pre–post study. The BLIS program involved home visits/phone contacts by a nurse/physiotherapist (average 8 contacts, 7 weeks). Uptake, retention, and fidelity were recorded prospectively, and participant experience was explored (post-program interviews). Breathing discomfort (Multidimensional Dyspnea Profile A1 scale), threat (Brief Illness Perception Questionnaire), and carer stress/strain (Zarit Burden Interview) were compared pre- and post-program (week 9, 3 and 6 months) using mean difference and 95% confidence intervals (CIs). Hospital use for COPD-related causes in 12 months before/after participation was reported. Results: A total of 16/19 eligible people agreed to participate, and 15/16 completed the program. In participants with COPD (73 [9] years, FEV1%pred 42% [15], mean [SD]; a median of 3 COPD-related hospital admissions in the previous year) and carers (n = 6), BLIS was highly (in 95%) acceptable. Compared to pre-program, breathing discomfort was reduced in week 9 and 6 months; breathlessness threat was reduced in week 9 and 3 months; and carer burden was reduced at 6 months. Compared to the 12 months prior, hospital admissions decreased in the 12 months post-program. Conclusions: Translation of this service to the local setting was feasible, with high program uptake and retention. Post-program improvements in key patient- and carer-reported outcomes and a reduction in public hospital admissions support the implementation of the BLIS program for this cohort in this setting. Full article

Background: Early rehabilitation is crucial for predicting post-stroke outcomes. In rural Thailand, previous works identified limited access to prompt rehabilitation services, discontinuity of home visits, and a lack of interdisciplinary management, hindering comprehensive resolution. Objective: This participatory action research-based pilot quasi-experimental study investigated the effects of personalized intermediate care (IMC) programs led by physical therapists on clinical outcomes in post-ischemic stroke older adults living in rural areas. Methods: Participatory stakeholders (two physical therapists, a physician, a nurse, and a nutritionist) convened to coordinate with relevant stakeholders (community leaders, village health volunteers (VHVs), and family caregivers (CGs)). Thirty-four acute post-stroke patients were included in the study. The interventions consisted of three action research cycles (planning, action, observation, and reflection) of home-based neurorehabilitation and comprehensive treatments by a healthcare professional network for six months and another six-month follow-up. The primary outcome was the Barthel index for activities of daily living (BI-ADL). The modified Rankin scale (mRS) was a secondary outcome for assessing disability levels. Results: Results showed that the BI-ADL gradually and significantly increased from a baseline median (IQR) of 55 (15) to 100 (20) after 6 months (p < 0.05). This improvement of the BI-ADL was maintained after 12 months (100 (15)). Furthermore, the mRS at 6 months post-discharge reduced considerably from the first month of rehabilitation (p < 0.05). Conclusions: In conclusion, the early and continuous personalized IMC rehabilitation program effectively enhanced ADL and reduced disability levels and should be disseminated to the community. Full article

This study aimed to evaluate the effects of community nursing simulation education on the nursing core competencies, clinical performance, and clinical judgment in home-visit nursing of nursing college students. A nonequivalent control group pretest–post-test design was used. Data were collected in August 2024 from the control group (n = 65) and in February 2025 from the experimental group (n = 64), with both groups comprising fourth-year students older than 20 years and from the same nursing college in Korea. Data analysis included an independent t-test carried out using SPSS 25.0 software. We found significant differences between the control and experimental groups in terms of the students’ nursing core competence (t = 4.88, p < 0.001, Cohen’s d = 0.86), clinical judgment (t = 4.53, p < 0.001, Cohen’s d = 0.80), and clinical competence (t = 4.52, p < 0.001, Cohen’s d = 0.00). The simulation education program applied in this study can be utilized as an intervention for nursing college students and be further developed for nursing students from other universities. Full article

Access to healthcare services in rural areas of Peru remains a challenge, with marked differences compared to urban areas. Despite the importance of primary healthcare (PHC) in these communities, the rural population has a negative perception of the role of nursing staff. This study aimed to assess the perceptions of residents in the highland communities of Huata and Ichu, Province of Puno, located in southern Peru, regarding the role of nursing professionals. The general perception of the residents was first analyzed, followed by an evaluation of two dimensions (Fieldwork and Health Education), which allowed for the development of the REFCO (Role of the Nursing professional in the community) scale. The sample included 329 rural adults, mainly between 30 and 59, predominantly female, with incomplete secondary education. The results showed an unfavorable perception (54%) of nursing staff performance. The fieldwork dimension reported low visibility of nursing activities in the community, such as home visits and health programs. The second dimension demonstrated that educational interventions were perceived as infrequent and of low impact, with insufficient adaptation to local needs. These results highlight the need to strengthen the presence and educational strategies of nursing staff in alignment with the cultural and demographic realities of rural communities. Furthermore, it suggests a greater need for interinstitutional collaboration and a more personalized approach to community activities to improve the perception and effectiveness of healthcare services in these areas. Full article

There have been significant breakthroughs in developing highly functional myoelectric prostheses, yet individuals who have experienced upper-limb loss consistently report low levels of satisfaction when performing daily tasks while using myoelectric prostheses. This research aims to evaluate the change in the user’s experience after completing a training program in which tasks are designed to facilitate adaptation to the myoelectric arm in performing the activities of daily living. One participant with a left transradial limb difference was recruited for this project. The user’s experience was evaluated by comparing task completion time, trunk and shoulder angles, object control, movement smoothness, vertical ground reaction forces, the center of pressure location, and selected muscle activation of her affected arm between baseline and post-training. The data collection was performed through a motion capture system, a pressure mat, and wireless EMG modules. While indications of potential improvements in balance, muscle efficiency, and functionality were present, the data were inconclusive as to the effectiveness of the training procedure. One outcome measure that showed improvement across most tasks was the task completion time, which, on average, for the targeted Box and Block Test (tBBT) task was reduced by 24.0 s, box lifting by 1.6 s, bottle pouring by 9.0 s, and the pulley task by 8.4 s. This project serves as part of a larger multi-visit study evaluating the effects of home-based functional training on facilitating users’ adaptation to the myoelectric arm. Full article

Background/Objectives: Randomized controlled trials (RCTs) are needed to evaluate the impact of food is medicine (FIM) programs, such as medically tailored groceries (MTGs) to treat hypertension among diverse populations. Partnerships between academic centers’ student-run organizations (SROs) and community-based organizations (CBOs) offer critical safety nets for historically underserved groups, positioning these organizations to effectively undertake FIM programs among populations disproportionately affected by hypertension. We conducted an unblinded pilot RCT whose objectives were to assess the feasibility and acceptability of an SRO-coordinated, CBO-partnered MTGs intervention targeting blood pressure (BP) and food insecurity (FI) in underserved groups. Methods: Adult Black/African American and Hispanic/Latinx patients in Durham, North Carolina, where essential hypertension and FI were randomized (parallel arm, computerized 1:1 ratio) to 12 weeks of home-delivered, hypertension-focused MTGs plus in-person nutrition education sessions with compensation (intervention) versus data collection sessions with compensation (control). We offered transportation, childcare, and home visits to facilitate session attendance. The primary outcomes were the eligibility, enrollment, and retention rates (feasibility), and the survey feedback from the participants and CBO partners (acceptability). The secondary outcomes included the changes in the mean BP and median FI score with associated 95% confidence intervals. Results: Medical record screening identified 1577 eligible participants. Of the 94 reached to confirm eligibility, 77 met the enrollment criteria, and 50 were randomized (82% post-screen eligibility, 65% enrollment). A conventional content analysis of 15 participant surveys and CBO partner feedback affirmed the acceptability, noting intervention components that enhanced the retention (e.g., home delivery, transportation support, home visits). Pre–post analyses of secondary outcomes for 13/25 intervention and 15/25 control participants completing ≥2 sessions ≥2 months apart were performed. The intervention was associated with an average change in systolic BP of −14.2 mmHg (−27.5, −4.5) versus −3.5 mmHg (−11.7, 5.9) in the control group. The FI scores improved by −2 (−2.2, −0.5) in the intervention group and −1 (−1.3, −0.2) in the control group. No adverse events were reported. Conclusions: SRO-CBO partnerships could be feasible and acceptable avenues for conducting FIM trials among underserved populations. This multi-component FIM approach enhanced the study equity by addressing the participants’ disease-related social needs and warrants expansion into a powered RCT. Full article

Promoting child well-being and development requires a multidimensional approach, including the right to adequate food practices. Socially vulnerable children are more exposed to adverse experiences, such as inadequate food consumption due to poverty. In this context, home-visiting programs are an important strategy for nutritional and health care education to provide relevant guidelines. This study describes breastfeeding and food consumption of children aged 0 to 24 months assisted by the Happy Child Program (Programa Criança Feliz—PCF) and aimed to investigate their association with socioeconomic factors and adherence to the program. This is an observational study, with a cross-sectional design, carried out with children assisted by the PCF in the Federal District, Brazil. Multivariate analysis was performed to identify sociodemographic and income factors, and household visits characteristics associated with breastfeeding, dietary diversity, and the consumption of ultra-processed food. A total of 301 children were assessed, 51.16% of whom were female. In 58.99% of households, the reference person was the mother; 86.20% were unemployed, and 27.08% had a low education degree. About 62.65% of beneficiaries lived on up to USD 200.00 per month and the majority faced food insecurity. The child’s age, and the mother’s current work situation were independently associated with the current breastfeeding situation, especially higher among women who did not work (p = 0.015). The minimum dietary diversity among children over 6 months old was 62.21% and presented a positive association with adherence to the program (p = 0.005). On the other hand, the consumption of ultra-processed foods was 77.21% and was associated with a longer follow-up time within the program (p = 0.047). The associations observed revealed the need to integrate family food choices and nutritional education into public policies for early childhood. Full article

Background: Sleep care is crucial for the health and development of infants, with proper sleep patterns reducing the risk of sudden infant death syndrome (SIDS) and other sleep-related incidents. Educational interventions targeting caregivers are essential in promoting safe sleep practices. Methods: This systematic review adhered to PRISMA guidelines, searching databases such as PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria focused on studies involving home-based interventions for infants aged 0–12 months, including parental education and behavioral interventions. Exclusion criteria included studies in clinical settings and non-peer-reviewed articles. Data extraction and synthesis were performed by two independent reviewers, using a narrative approach to categorize interventions and outcomes. Results: Twenty-three studies met the inclusion criteria. Key findings indicate that home-based educational interventions, including hospital-based programs, home visits, and mobile health technologies, significantly improve parental knowledge and adherence to safe sleep practices. These interventions also enhance parental satisfaction and contribute positively to infant health outcomes. Conclusions: Educational interventions have demonstrated effectiveness in promoting safe sleep practices among caregivers, particularly in home settings. These interventions, including hospital-based programs, home visits, and digital tools, improve parental knowledge, adherence to guidelines, and overall satisfaction. The impact is evident in the reduction of unsafe sleep behaviors and enhanced infant health outcomes. However, variability in the intervention methods and delivery, cultural contexts, and geographic focus suggest a need for more tailored, long-term, and comprehensive studies. Future research should standardize outcome measures and assess the sustained impact of these educational strategies on infant sleep patterns and caregiver practices over time. This will provide deeper insights into the trends and long-term effectiveness of educational patterns and methods in diverse home environments. Full article

Background: The Heart Failure Post-Acute Care [HF-PAC] program is a specialized healthcare program aimed at providing comprehensive care and support for patients with heart failure [HF] as they transition from acute hospital settings to home. But the impact of the coronavirus disease 2019 [COVID-19] pandemic on the HF-PAC program remains unknown. Furthermore, the effects of the comprehensive COVID-19 vaccination program on these patients with HF-PAC warrants further investigation. Methods: A total of 265 patients with acute decompensated HF were admitted to the hospital between May 2020 and October 2022. Of these, 159 patients underwent planned HF-PAC follow-up for 6 months, followed by scheduled follow-up visits every 3 months and unscheduled telephone randomized visits for at least another 6 months. Results: The program completion rate was nearly 92%. COVID-19 significantly impacted patients with HF-PAC, leading to an increased mortality [13.3%] compared to before the pandemic [6.5%]. In our patient cohort, 83% had received at least 1 dose of vaccine and 61% had received > 3 doses. Of these patients with HF-PAC, 34% contracted COVID-19 infection post discharge, and 8.8% died owing to the infection. Of the mortality group, 42.9% patients were not vaccinated, and 28.6% received 1 vaccine dose, and their vaccination rate was lower than in the survival group [p = 0.01]. Conclusions: The COVID-19 pandemic had a significant impact on patients enrolled in the HF-PAC program; receiving more than 3 doses of the COVID-19 vaccine was associated with a significant reduction in mortality rates among these patients. Full article

(1) Background: The evidence to support transitional care in reducing acute hospital utilization is variable. Despite changes in the healthcare landscape with a rapidly aging population, there is a lack of local and regional studies to evaluate the effectiveness of transitional home care programs. This study investigates whether a transitional home care program delivered by an acute tertiary hospital can reduce acute hospital utilization. (2) Methods: A pre-post design was used to evaluate the effectiveness of the program. A total of 2004 enrolments from 1679 unique patients that fulfilled the criteria of enrolment were included. The transitional care program is delivered through telephone follow-up and home visits. The Wilcoxon Signed-Rank Test was used to assess the differences between the three periods of baseline, enrolment, and post-enrolment. (3) Results: All 2004 enrolments were analyzed. The re-attendances at the emergency department reduced significantly by 31.2% and 71.9% during enrolment and post-enrolment (p < 0.001), respectively. Similarly, patients had a 38.7% and 76.2% reduction in hospital admissions during enrolment and post-enrolment (p < 0.001), respectively. For patients who were admitted, there was no significant difference in the length of stay between these groups (p = 0.23). (4) Conclusions: The transitional home care program can effectively reduce emergency department re-attendances and inpatient admissions. Not only was the total number of emergency department re-attendances reduced significantly, but the number of frequent re-attendances also dropped significantly. The outcomes were consistent during COVID-19 and post-pandemic phases. These findings can be used as a guide in program planning and future scalability. Full article

Background: In-home palivizumab administration programs (PH) have shown promise in reducing RSV-associated infections. These programs may be particularly beneficial for children with medical complexity (CMC) by limiting their exposure to healthcare-associated infections (HAIs) from non-RSV-related pathogens during transportation and visits to medical facilities. Methods: In this prospective study, 41 children with CMC less than 2 years of age were randomized by their health insurance to receive PH or in the clinic (PC) during the RSV season (October 2018–April 2019). Patients were stratified by home ventilation. The primary outcome was the total number of face-to-face encounters. Secondary outcomes were unscheduled clinic visits and hospitalizations secondary to the non-RSV LRTIs. Standard frequentist and Bayesian analyses were performed. Results: All demographic factors and strata were matched between PH (“n” = 13, mean age 22 mo. SD ± 1), and PC (“n” = 28, mean age: 18 mo. SD ± 1). There was a decrease in the number of total face-to-face encounters (adjusted for mechanical ventilation and baseline diagnosis) [(4.5 vs. 8.8), (RR: 1.8, 95% CI: 1.3–2.5, p = 0.001)], and hospitalizations [(0.3 vs. 1.25), (RR: 3.8, 95% CI: 1.3–11.3, p = 0.016)], in the PH vs PC groups. Bayesian analysis showed a 93% probability of benefit in favor of fewer face-to-face encounters in the PH group. Conclusions: This study suggests that PH administration may reduce healthcare utilization in CMC. Minimizing exposure to healthcare facilities and supporting home-based interventions are promising strategies for this population. Full article