Gwen Latendresse

Background: Women who did not meet their breastfeeding goals often experience breastfeeding grief (BG) and may be likely to have postpartum depression (PD). Furthermore, PD is nearly twice as common in African American (AA) women as in Non-Hispanic White women. No research exists on BG and its role in PD. This study examined AA women’s experiences of BG and its possible contributions to PD symptoms. Methods: A convergent parallel mixed methods design was used. A purposive sample of 16 AA women with children aged 6 months to 2 years with BG participated in individual semi-structured interviews about their experiences of BG and completed an online survey including the Edinburgh Postnatal Depression Scale (EPDS). Qualitative and quantitative data were analyzed using reflexive thematic analysis and descriptive statistics, respectively. Both data were integrated using joint display of data and side-by-side comparison. Results: Participants’ mean age was 29.5 years. Four meaning-based themes about BG were generated including: We looked forward to breastfeeding, But it did not go as expected , So we grieve , and These would have helped. From quantitative results, 87.5% of participants reported a history of PD symptoms and almost 44% had EPDS scores >11. All participants reported that experiencing BG contributed to their PD symptoms. Findings suggest that BG influenced PD symptoms in AA women without prior diagnosis of depression. Conclusions: Qualitative and quantitative findings from this novel exploratory study revealed an overlap that AA women with BG report PD symptoms. Clinicians should support women to achieve their breastfeeding goals to prevent BG and PD.

Background: Nurses are key stakeholders in telehealth intervention implementation. Nurses are also instrumental in the management of perinatal depression, a common complication during pregnancy and postpartum. Telehealth interventions are a promising approach to addressing perinatal depression; however, its successful integration into routine maternal care remains challenging, particularly across diverse clinical settings. This qualitative study examined how registered nurses in the United States and other clinical staff perceived and navigated the implementation of a telehealth perinatal depression prevention program. Methods: A qualitative descriptive study was conducted with a purposive sample of 24 participants including nurses, medical assistants, lactation consultants, community health workers, and hospital administrators at rural and urban health facilities. Seven virtual focus groups were conducted with participants between March and December 2024. To foreground workflow integration, we focused on nonprovider clinical staff directly involved in patient flow. Focus groups were video‐ and audio‐recorded, transcribed, and analyzed in NVivo (Version 14) using codebook thematic analysis, guided by the Theoretical Domains Framework. Rigor was established and maintained throughout the study. Results: Facilitators included provider endorsement, training, workflow alignment, and perceived patient benefit. Barriers included stigma, limited technology access and literacy, competing workflow demands, and inconsistent provider engagement. Rural clinical staff underscored privacy concerns and structural digital access barriers, whereas urban staff emphasized provider endorsement and electronic health record integration as central implementation levers. Recommendations focused on strengthening endorsement, improving education and workflow integration, enhancing marketing strategies, and increasing flexibility in intervention delivery. Conclusions: Addressing barriers is critical for successful integration of telehealth perinatal depression prevention into routine maternal care. Context‐sensitive implementation strategies may mitigate rural–urban inequities in access to digital maternal mental health support. Implications for Nursing Management: Nurse managers should address workflow constraints and evaluate duty allocation to facilitate smooth incorporation of the telehealth perinatal depression prevention program into routine maternal care.

Background: Significant life events (SLEs) correlate with perinatal depression (PD) risk; however, little is known about this association in rural populations. Objectives: Using the Neuman systems model, we hypothesized that individuals with higher SLEs would have higher PD risk, and we evaluated this association with data collected from six of Utah’s diverse rural health districts. Design/Methods: This cross-sectional study included pregnant and postpartum individuals visiting six rural public health clinics who completed screening with the Edinburgh Postnatal Depression Scale (EPDS) and an 8-item SLE assessment in Spanish or English. Multinomial logistic regression assessed the association between SLEs (0, 1, and ⩾2) and PD risk status (EPDS ⩾9). Results: Data from 4245 screening surveys identified 2 primary racial groups: white (79.8%) and American Indian/Alaska Native (7.6%), with 20.2% of individuals identifying as Hispanic. Overall, 49.4% of individuals reported one SLE and 10.5% reported two or more SLEs. Significant predictors for PD risk included 1 SLE (OR = 1.84, 95% CI [1.56, 2.15]) or ⩾2 SLEs (5.18, 95% CI [4.31, 6.23]), regardless of racial/ethnic background. Conclusion: Screening for PD risk in a rural population should include an assessment of SLEs, given the relationship between the two. Improving culturally appropriate local resources to support individuals and their families during the childbearing year should be considered, particularly for those experiencing SLEs.

Introduction: Perinatal depression affects approximately 20% of childbearing individuals and is associated with adverse perinatal outcomes. Nonpharmacological therapies are effective for mild to moderate depression, but multiple access barriers exist, including financial constraints and the inconvenience of in‐person appointments. Remote access (ie, telehealth) to services is a promising option, but few studies have evaluated the effectiveness of this approach. The objective of this study was to use a mixed methods approach in a randomized controlled trial to evaluate the effectiveness of a group videoconference intervention to reduce symptoms of perinatal depression.Methods: Participants were assigned to a videoconference intervention group (VCI; mindfulness‐based cognitive behavioral therapy) or an attention control group (AC; childbirth preparation or early parenting education) via a videoconference system. Groups of 4 to 6 pregnant and postpartum individuals with mild to moderate symptoms of depression attended a one‐hour session for 9 weeks using an electronic device from their own home. The Edinburgh Postnatal Depression Scale (EPDS) measured depression symptoms before and after intervention with follow‐up to 8 months. Focus groups assessed participants’ telehealth experiences and were analyzed for common themes.Results: From May 2020 through May 2022, 81 participants were randomized, and 69 (85.2%) ultimately initiated study participation (36 in VCI, 33 in AC group). Participants in both groups had a significant decrease in EPDS score of 3.36 (95% CI, 4.55‐2.17) that was maintained 8 months postintervention. There were no significant interactions between time and intervention group (all P >.249). In the focus group analysis, themes of connection, shared experience, empowerment, and community building were consistent between the 2 intervention groups.Discussion: Both intervention groups had clinically meaningful improvement in EPDS scores up to 8 months postintervention. Anchored in the common themes in the qualitative analysis, our results suggest that participation in telehealth group sessions, regardless of session content, may be beneficial in reducing depression symptom burden.

Purpose: The aim of this narrative review was to map the current literature on culturally informed breastfeeding interventions for African American women. Background: Breastfeeding is associated with positive health outcomes for women and infants. Nonetheless, despite interventions aimed at improving breastfeeding for African American women, they continue to have lower breastfeeding rates compared to Hispanic and Non-Hispanic White women. Therefore, there is a need for culturally informed interventions to promote exclusive breastfeeding in African American women. Methods: PubMed, EmCare, CINAHL complete, APA PsycInfo, Scopus and Web of Science were systematically searched for articles published between 2001 and 2024. Preprints were searched in medRxiv; dissertations were searched in ProQuest Dissertations & Theses and EBSCO Open Dissertations; and other gray literatures were searched in governmental/organizational websites. Hand searches of reference lists were conducted. Data were synthesized using narrative synthesis. Results: Sixteen articles that met inclusion criteria were included. Randomized controlled trial design was used in 7 studies and community-based participatory research design was used in 4 studies. Multilevel breastfeeding education and support provided mostly in-person across 4 socioecological levels (individual, interpersonal, community, and culture) was associated with increased breastfeeding knowledge, self-efficacy, intention, initiation, duration, and exclusivity in African American women. No policy-level intervention was identified. Seven different terms were used to describe the incorporation of culture into breastfeeding interventions. Conclusion: This narrative review provides evidence on the utility and essence of culturally informed breastfeeding interventions for African American women. Multilevel breastfeeding education provided across the perinatal period is effective to promote breastfeeding outcomes in African American women.

Background: Diabetes self-management education and support (DSMES) is a crucial component of diabetes care associated with improved clinical, psychosocial, and behavioral outcomes. The American Association of Diabetes Care and Education Specialists, the American Diabetes Association, and the American Academy of Family Physicians all recommend DSMES yet accessing linguistically and culturally appropriate DSMES is challenging in rural areas. The Diabetes One-Day (D1D) program is an established DSMES group intervention that has not been adapted or evaluated in rural communities. Objective: The specific aims of this paper are (1) to adapt the existing D1D program for use in rural communities, called rural D1D (R-D1D); and (2) to conduct a patient-level randomized controlled trial to examine the effects of R-D1D and standard patient education, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Methods: This is a protocol for a pilot type II hybrid implementation-effectiveness trial of a culturally adapted virtual DSMES program for rural populations, R-D1D. We will use Boot Camp Translation, a process grounded in the principles of community-based participatory research, to adapt an existing DSMES program for rural populations, in both English and Spanish. Participants at 2 rural primary care clinics (4 cohorts of N=16 plus care partners, 2 in English and 2 in Spanish) will be randomized to the intervention or standard education control. The evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Patient-level effectiveness outcomes (hemoglobin A1c, diabetes distress, and diabetes self-care behaviors) will be assessed using patient-reported outcomes measures and a home A1c test kit. Practice-level and patient-level acceptability and feasibility will be assessed using surveys and interviews. Results: This study is supported by the National Institute of Nursing. The study procedures were approved, and the adaptation processes have been completed. Recruitment and enrollment started in July 2021. Conclusions: To our knowledge, this will be the first study to evaluate both effectiveness and implementation outcomes for virtually delivered DSMES, culturally adapted for rural populations. This research has implications for delivery to other rural locations where access to specialty diabetes care is limited. Trial Registration: ClinicalTrials.gov NCT04600622; https://clinicaltrials.gov/ct2/show/NCT04600622 International Registered Report Identifier (IRRID): DERR1-10.2196/34255

BACKGROUND Diabetes self-management education and support (DSMES) is a crucial component of diabetes care associated with improved clinical, psychosocial, and behavioral outcomes. The American Association of Diabetes Care and Education Specialists, the American Diabetes Association, and the American Academy of Family Physicians all recommend DSMES yet accessing linguistically and culturally appropriate DSMES is challenging in rural areas. The Diabetes One-Day (D1D) program is an established DSMES group intervention that has not been adapted or evaluated in rural communities. OBJECTIVE The specific aims of this paper are (1) to adapt the existing D1D program for use in rural communities, called rural D1D (R-D1D); and (2) to conduct a patient-level randomized controlled trial to examine the effects of R-D1D and standard patient education, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. METHODS This is a protocol for a pilot type II hybrid implementation-effectiveness trial of a culturally adapted virtual DSMES program for rural populations, R-D1D. We will use Boot Camp Translation, a process grounded in the principles of community-based participatory research, to adapt an existing DSMES program for rural populations, in both English and Spanish. Participants at 2 rural primary care clinics (4 cohorts of N=16 plus care partners, 2 in English and 2 in Spanish) will be randomized to the intervention or standard education control. The evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Patient-level effectiveness outcomes (hemoglobin A1c, diabetes distress, and diabetes self-care behaviors) will be assessed using patient-reported outcomes measures and a home A1c test kit. Practice-level and patient-level acceptability and feasibility will be assessed using surveys and interviews. RESULTS This study is supported by the National Institute of Nursing. The study procedures were approved, and the adaptation processes have been completed. Recruitment and enrollment started in July 2021. CONCLUSIONS To our knowledge, this will be the first study to evaluate both effectiveness and implementation outcomes for virtually delivered DSMES, culturally adapted for rural populations. This research has implications for delivery to other rural locations where access to specialty diabetes care is limited. CLINICALTRIAL ClinicalTrials.gov NCT04600622; https://clinicaltrials.gov/ct2/show/NCT04600622 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/34255

Introduction: Perinatal depression occurs in 12% to 18% of childbearing women. Telehealth is a promising platform for delivering perinatal mental health care, particularly during a pandemic when in‐person services have been significantly curtailed. However, there is little research to document the feasibility of telehealth to address perinatal depression. This pilot study evaluated the feasibility and preliminary results of an 8‐week facilitated group videoconference intervention.Methods: The study enrolled pregnant and postpartum women into an 8‐week group mindfulness‐based cognitive behavioral intervention, delivered via videoconference platform. Women receiving care at outpatient clinics who either screened positive for perinatal depression symptoms or had risk factors predictive of perinatal depression were invited to participate. Women attended weekly one‐hour group sessions using their own electronic device and completed the Edinburgh Postnatal Depression Scale (EPDS) at several time points. Session attendance and survey completion rates were evaluated.Results: A total of 47 women enrolled (8 postpartum; 39 prenatal) into groups of 4 to 6. Twenty‐four (51.1%) women were currently experiencing mild to moderate perinatal depression symptoms (EPDS score of 10‐20), whereas 23 (48.9%) women had EPDS scores less than 10 but were at high risk for developing perinatal depression due to health history and significant life events. Seventy percent of women attended at least 5 of the 8 sessions. Trajectories of EPDS measures were promising (ie, downward among those with current perinatal depression symptoms and stable among those at high risk for developing perinatal depression).Discussion: These observational results are promising, suggesting further study of effectiveness for women with symptoms of perinatal depression, as well as for women at high risk for developing perinatal depression. Randomized trials could evaluate the effectiveness of the intervention, compared with standard of care approaches. Telehealth interventions can be tailored to meet the needs of different communities, and increase access to care, regardless of where women live or inability to receive in‐person services.