Search Results (428)

Introduction: Adolescents and young adults (AYAs), especially those from underserved communities, often face barriers to sexual and reproductive health (SRH). This pilot study evaluated the implementation of mobile health technologies to promote SRH care, including the integration of the Rapid Adolescent Prevention Screening^TM (RAAPS) and the Health-E You/Salud iTu^TM (Health-E You) app at a School-Based Health Center (SBHC) in Los Angeles using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: This multi-method pilot study included the implementation of an integrated tool with two components, the RAAPS electronic health screening tool and the Health-E You app, which delivers tailored SRH education and contraceptive decision support to patients (who were sex-assigned as female at birth) and provides an electronic summary to clinicians to better prepare them for the visit with their patient. Quantitative data on tool usage were collected directly from the back-end data storage for the apps, and qualitative data were obtained through semi-structured interviews and in-clinic observations. Thematic analysis was conducted to identify implementation barriers and facilitators. Results: Between April 2024 and June 2024, 60 unique patients (14–19 years of age) had a healthcare visit. Of these, 35.00% used the integrated RAAPS/Health-E You app, and 88.33% completed the Health-E You app only. All five clinic staff were interviewed and expressed that they valued the tools for their educational impact, noting that they enhanced SRH discussions and helped uncover sensitive information that students might not disclose face-to-face. However, the tools affected clinic workflows and caused rooming delays due to the time-intensive setup process and lack of integration with the clinic’s primary electronic medical record system. In addition, they also reported that the time to complete the screener and app within the context of a 30-min appointment limited the time available for direct patient care. Additionally, staff reported that some students struggled with the two-step process and did not complete all components of the tool. Despite these challenges, clinic staff strongly supported renewing the RAAPS license and continued use of the Health-E You app, emphasizing the platform’s potential for improving SRH care and its educational value. Conclusions: The integrated RAAPS and Health-E You app platform demonstrated educational value and improved SRH care but faced operational and technical barriers in implementing the tool. These findings emphasize the potential of such tools to address SRH disparities among vulnerable AYAs while providing a framework for future implementations in SBHCs. Full article

Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of illness, this study aims to assess the symptom burden, treatment goals, and information needs of younger women complaining of prolapse by analyzing questionnaire responses from an existing electronic Personal Assessment Questionnaire—Pelvic Floor (ePAQ-PF) dataset. Methods: Mixed-methods content analysis was conducted using free-text data from an anonymized multi-site ePAQ-PF dataset of 5717 responses collected across eight UK NHS trusts (2018–2022). A quantitative, deductive approach was first used to identify younger women (≤50 years old) with self-reported prolapse. ePAQ-PF scores for younger women with prolapse were compared with those aged >50 years, using Mann–Whitney tests. Free-text response data were analyzed inductively to qualitatively explore younger women’s symptom burden, treatment goals, and information needs. Results: Of the 1473 women with prolapse identified, 399 were aged ≤50 years. ePAQ-PF scores of the younger cohort demonstrated significantly greater symptom severity and bother than those aged >50, particularly in bowel, prolapse, vaginal, body image, and sexual health domains (p < adjusted threshold). Qualitative analysis undertaken to understand women’s concerns and priorities produced five health-related themes (physical health; functionality; psychosocial and emotional wellbeing; reproductive and sexual health; and healthcare journeys) and a sixth intersecting theme representing information needs. Conclusions: The findings highlight the substantial symptom burden of younger women with prolapse, as well as treatment goals and information needs specific to this population. The development of age-specific resources is identified as a requirement to support this group. Full article

Background/Objectives: Human immunodeficiency virus (HIV) has evolved from a fatal disease to a manageable chronic condition. However, stigma persists, affecting the lives and sexuality of HIV-positive people, particularly in the gay population. Research on their sexuality is limited, highlighting the need for studies that address their experiences and needs. The aim of the study is to explore the individuals’ experiences of sexuality in serodiscordant gay couples. Methods: A descriptive study was conducted using thematic content analysis. Data collection was carried out through in-depth interviews. Six gay men who have been and/or are in a serodiscordant relationship for at least one year participated in the research. Results: Five sub-themes were identified grouped into two main themes as follows: sexuality: a complex concept accentuated by HIV and the impact of serodiscordance on partners. Conclusions: It is essential to promote accurate information and health services tailored to the needs of people living with HIV while fostering gender equity and combating stigma related to HIV and the gay community. Experiencing sexuality in this context is not only possible but can be full and satisfying when adequate resources are available. Full article

Background/Objectives: Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. This study aimed to (i) validate a multidimensional measure—the Satisfaction with Information Provided to Young Oncology Patients Scale (SIPYF-CPS)—to assess the specific informational needs of young adult female cancer survivors; and (ii) explore preferences regarding the provision of information and counseling. Methods: A total of 124 women (M[age] = 38.18; SD = 5.49; range 21–45), 76.6% diagnosed with breast cancer, participated in the study. Psychometric analyses included exploratory factor analysis and correlation coefficients to assess reliability and construct validity. Convergent validity was evaluated through standardized measures of anxiety, reproductive concerns, and quality of life. Results: A final 22-item measure demonstrated strong reliability and validity, capturing four factors: (i) Disease-Related Information, (ii) Symptoms and Functional Limitations, (iii) Implications for Fertility and Parenthood, and (iv) Support Services. Participants expressed low satisfaction with information on fertility preservation, sexual health, and support services. Lower satisfaction was moderately associated with higher anxiety and depression while positively related to quality of life. Most participants preferred phased, face-to-face communication throughout the illness trajectory. Conclusions: The SIPYF-CPS is a valid, multidimensional tool that captures the complex and evolving informational needs of young female cancer survivors. Its clinical use may promote earlier, personalized, and emotionally responsive communication—supporting psychological well-being, informed decision-making, and long-term survivorship care. Full article

Background and Objectives: Chronic kidney disease frequently progresses to end-stage renal disease, requiring dialysis, which imposes significant physical, psychological, and social burdens. Age is a key factor influencing symptom experience and quality of life in dialysis patients, yet findings on its impact remain mixed. This study aimed to examine how age relates to a broad range of health domains—including fatigue, pain, cognition, mental health, sexual satisfaction, bowel control, visual impairment, social support, and quality of life—among hemodialysis patients. Materials and Methods: A cross-sectional study was conducted at a single dialysis center in Poland, involving 79 adult patients undergoing maintenance hemodialysis. Standardized, validated psychometric instruments were used, including the Modified Fatigue Impact Scale (MFIS), Perceived Deficits Questionnaire (PDQ), Pain Effects Scale (PES), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS), Sexual Satisfaction Scale (SSS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), and WHOQOL-BREF for quality of life. Spearman’s or Pearson’s correlation coefficients were used to evaluate relationships between age and scale scores. Full and abbreviated versions of scales were also compared. Results: Age showed moderate positive correlations with fatigue (ρ = 0.44–0.53), cognitive deficits (ρ = 0.37–0.45), pain (r = 0.41), bowel control issues (ρ = 0.32), and visual impairment (ρ = 0.37), all statistically significant (p < 0.01). No significant associations were observed between age and mental health (MHI), perceived social support (MSSS), or quality of life (WHOQOL-BREF). Abbreviated versions of the scales showed strong correlations with their full versions (ρ > 0.9). Conclusions: While age is linked to increased symptom burden in select domains such as cognition, fatigue, and pain, it does not significantly affect mental health, perceived social support, or overall quality of life in hemodialysis patients. These findings support the use of age-sensitive, multidimensional assessments to inform individualized care strategies. Full article

Background/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York to inform strategies for engaging young adolescents in sexual health research. Methods: This qualitative descriptive study was conducted from April 2022 to June 2023. Seventeen community stakeholders, including health education teachers, youth counselors, and adolescent health providers, participated in semi-structured in-depth interviews. Data were analyzed using conventional content analysis, managed by MAXQDA 2020. The rigor and trustworthiness of the data were ensured through triangulation with observations, peer debriefing, team analysis, and respondent validation. Results: Participants were predominantly female (94.1%), 52.9% Black/African American, 41.2% White, and 5.9% Caucasian–Indian American, and aged 23–59 years. Four themes emerged: perspectives on conducting sexual health research with young adolescents, recruitment strategies, sexual health questions appropriate for young adolescents, and building readiness for participation in sexual health research. Participants reported the need for sexual health research with young adolescents and recommended building a trusting relationship and involving schools, parents, and trusted community organizations in the research process. Suggested research questions included those related to awareness of sex, STIs, available resources, experiences with sexual education, and desired support. The findings also revealed the need to initiate sexual health conversations early when children start asking questions, as a foundation for meaningful participation in sexual health research. Conclusions: The findings suggest that sexual health research with young adolescents is feasible and necessary, with implications for the design of developmentally appropriate sexual health research and interventions grounded in trust and community collaboration. Future research should explore the perspectives of caregivers and young adolescents to inform studies and programs that are attuned to young adolescents’ developmental needs. Full article

The adolescent years are pivotal in reproductive and sexual development and maturation, yet the experience of migration can severely disrupt this period, inhibiting young immigrants’ knowledge, access, and engagement with sexual and reproductive health (SRH) services. Further, young immigrants and minority populations often face persistent intersectional barriers, including language difficulties, cultural stigma, and systemic exclusion, that result in adverse SRH outcomes. Recent advances in SRH care, particularly in digital health and community-based interventions, show promise in improving access to culturally appropriate SRH services and information. Co-designing SRH programs with families and young immigrants to adequately acknowledge the unique cultural norms and barriers in SRH is essential in ensuring a high outreach of interventions. Shifts in traditional health policies are needed to ensure that immigrant and minority adolescents are not overlooked and that SRH programs incorporate culturally relevant content that is easily and widely accessible. Despite positive shifts, several barriers remain: limited disaggregated data on diverse populations, inadequate policy attention, and the insufficient scalability and funding of promising interventions. Future research and promotional efforts must prioritise the co-creation of SRH interventions with stakeholders and affected communities, ensuring that services are sustainable, culturally appropriate, and accessible to all adolescents. Full article

Sexual dysfunction is a prevalent and often under-addressed concern among prostate cancer survivors, significantly affecting quality of life for patients and their partners. The True North Sexual Health and Rehabilitation eClinic (SHAReClinic) is a virtual, biopsychosocial intervention developed to improve access to sexual health support for prostate cancer survivors and their partners. This study used a qualitative descriptive design to examine barriers and facilitators influencing the integration of SHAReClinic into oncology care across nine Canadian health care centres. Semi-structured interviews were conducted with 17 knowledge users, including health care providers and institutional leaders. Data were analyzed using a hybrid deductive–inductive thematic approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Participants described SHAReClinic as a much-needed resource, particularly in the absence of standardized sexual health pathways in oncology care. The virtual format was seen as accessible and well suited to addressing sensitive topics. However, limited funding, lack of institutional support, and workflow integration challenges emerged as primary barriers to implementation. Findings offer practical, theory-informed guidance for integrating SHAReClinic into oncology care and highlight key considerations for developing sustainable and scalable survivorship care models. Full article

Background: Suicidal ideation among adolescents remains a major public health challenge. Exposure to neighborhood violence is associated with increased risk of mental health distress and school-related vulnerabilities. This study investigates the predictors of suicidal ideation among U.S. adolescents who have witnessed neighborhood violence. Methods: Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative survey of high school students in the United States. A subsample of 3495 adolescents who reported witnessing neighborhood violence was analyzed. Key variables included sociodemographic characteristics, mental health symptoms, perceived school safety, and experiences of victimization. Multivariable logistic regression was used to identify factors associated with suicidal ideation, defined as seriously considering suicide in the past year. Analyses were conducted using Jamovi (version 2.6), with statistical significance set at p < 0.05. Results: The prevalence of suicidal ideation in the sample was 34.2%. Bisexual adolescents had significantly higher odds of suicidal ideation compared to heterosexual peers (OR = 2.34, p < 0.001). Depressive symptoms were the strongest predictor (OR = 7.51, p < 0.001). Both perceived lack of safety at school and differences in ethnic and population backgrounds were significant. Black and Hispanic/Latino adolescents had lower odds compared to White peers. Conclusions: Findings highlight sexual identity, depressive symptoms, school safety concerns, and ethnic and population background differences as key correlates of suicidal ideation. Culturally responsive, trauma-informed interventions are urgently needed for youth exposed to community violence. Full article

Objectives: Health disparities among transgender and gender-diverse individuals are partly attributed to the limited knowledge and preparedness of healthcare providers. This study aims to assess the level of knowledge of transgender health among residents in obstetrics and gynecology and family medicine. Methods: A multicenter, cross-sectional study was conducted with obstetrics and gynecology (OBGYN) and family medicine (FM) residents from two different centers. Data were collected using a 21-item questionnaire. The questionnaire assessed participants’ demographic information, knowledge of sexual orientation and gender identity, clinical and anatomical effects of gender-affirming hormone therapy, knowledge of gender-affirming surgery, and knowledge of risk-based screening for TGD individuals. Results: The study, which included 85 residents (62 FM, 23 OBGYN), found that 76.6% of respondents indicated that SOGI should be routinely assessed. However, 68.3% of the participants reported inadequate knowledge regarding the clinical implications of gender-affirming hormone therapy, and 74.1% reported insufficient knowledge about gender-affirming surgeries. Furthermore, 62.4% of the participants indicated that they had not received any health education specifically tailored to address the needs of transgender individuals. Only 23.5% reported receiving training during their residency programs. Notably, 84.7% of the participants expressed a desire for formal education in this area. Conclusions: FM and OBGYN residents have significant knowledge gaps regarding TGD health. The integration of TGD health topics into the curricula of medical schools and residency programs is needed to improve access to healthcare for individuals with TGD. Full article

Mental health disparities among those who self-identify as gay men in Peru remain a pressing public health concern, yet predictive models for early identification remain limited. This research aims to (1) develop machine learning and deep learning models to predict mental health issues in those who self-identify as gay men, and (2) evaluate the influence of demographic, economic, health-related, behavioral and social factors using interpretability techniques to enhance understanding of the factors shaping mental health outcomes. A dataset of 2186 gay men from the First Virtual Survey for LGBTIQ+ People in Peru (2017) was analyzed, considering demographic, economic, health-related, behavioral, and social factors. Several classification models were developed and compared, including Logistic Regression, Artificial Neural Networks, Random Forest, Gradient Boosting Machines, eXtreme Gradient Boosting, and a One-dimensional Convolutional Neural Network (1D-CNN). Additionally, the Shapley values and Layer-wise Relevance Propagation (LRP) heatmaps methods were used to evaluate the influence of the studied variables on the prediction of mental health issues. The results revealed that the 1D-CNN model demonstrated the strongest performance, achieving the highest classification accuracy and discrimination capability. Explainability analyses underlined prior infectious diseases diagnosis, access to medical assistance, experiences of discrimination, age, and sexual identity expression as key predictors of mental health outcomes. These findings suggest that advanced predictive techniques can provide valuable insights for identifying at-risk individuals, informing targeted interventions, and improving access to mental health care. Future research should refine these models to enhance predictive accuracy, broaden applicability, and support the integration of artificial intelligence into public health strategies aimed at addressing the mental health needs of this population. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

Sexual minority women (SMW) are a resilient yet vulnerable population who may experience poor psychosocial outcomes due to minority stress associated with their marginalized status and traumatic experiences resulting from interpersonal and structural violence. When SMW are incarcerated, the trauma of this experience can exacerbate existing mental health challenges. Self-concept is a key measure of mental health that is associated with increased self-efficacy and positive psychosocial outcomes. This analysis explores the ways in which incarceration impacts the self-concept of SMW. Secondary data analysis of three qualitative interviews with formerly incarcerated SMW was conducted. Specifically, Gilligan’s Listening Guide was used to create “I poems” that articulate the participants’ narratives and contrapuntal voices. These poems were then analyzed to build knowledge about participants’ self-concept. This analysis informs our understandings of self-concept among SMW, violence against women, the vulnerability of binary constructs, and the ways in which people negotiate past, present and future selves. The findings can inform interventions that seek to mitigate the psychosocial risks faced by SMW and formerly incarcerated people and improve outcomes for these populations. Full article

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18–40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders revealed a barrier theme with six subthemes, and a facilitator theme with seven subthemes. The barrier subthemes included discrimination, dominant culture centric, unsupportive socio-political environment, lack of patient-centered care, avoidance/concealment of sexual identity, and socio-economic challenges. The facilitator subthemes included supportive socio-political environment, advance identification of LGBTQ-affirming HCPs, patient-centered care, HCP identity similar to patient, social support, re-engagement with care after bad experiences, and socio-economic advantages. This study provides insight into the lived experiences of cisgender SMW that can help improve knowledge about health care disparities and inform health care interventions for this population. Full article

Background/Objectives: Syphilis remains a significant public health challenge worldwide. Accurate and efficient diagnostic tools are essential to controlling the spread of the disease. Current diagnostic approaches primarily rely on serologic treponemal tests (TTs) and nontreponemal tests (NTTs). The aim of this study was to evaluate the diagnostic properties of various serological methods for syphilis diagnosis. Methods: Samples were collected from participants of the Health, Information, and Sexually Transmitted Infection Monitoring (SIM study) between March 2020 and May 2023, using convenience sampling at a mobile health unit in Porto Alegre, Brazil. A total of 250 individuals were tested using the point-of-care (POC) lateral flow treponemal test, Venereal Disease Research Laboratory (VDRL) test, Rapid Plasma Reagin (RPR) test, Enzyme-Linked Immunosorbent Assay (ELISA), and Treponema pallidum hemagglutination assay (TPHA). Of these, 125 participants tested positive for syphilis in the POC screening. Diagnostic properties such as sensitivity, specificity, and predictive values were assessed for the POC test, ELISA, and VDRL test. The TPHA was used as the reference standard for the TT, and the RPR test as the reference standard for the NTT. Results: Among individuals with positive POC test results, 97.6% (122/125) were also positive by the ELISA, and 85.6% (107/125) were positive by the TPHA. Additionally, 48.0% (60/125) and 42.4% (53/125) tested positive by the VDRL and RPR tests, respectively. Using the TPHA as a reference, TT tests showed sensitivities of 97–98% and specificities of 93–95% for detecting anti-Treponema pallidum antibodies using the ELISA and POC test, respectively. For the NTT, the VDRL test demonstrated a sensitivity of 98% and a specificity of 95% compared to the RPR test. The kappa coefficients were 0.85 for the POC test vs. the TPHA, 0.81 for the ELISA vs. the TPHA, and 0.89 for the VDRL vs. the RPR tests, indicating substantial agreement. Conclusions: This study highlights a good diagnostic performance and high agreement levels among the evaluated serological tests for syphilis, reinforcing their utility in clinical and public health settings, as well as epidemiological studies. Full article