Sara Ellis Simonsen

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.

Despite a large number of African-born individuals residing in the United States, there is a significant disparity in how this community accesses and utilizes mental health treatment. Low screening rates for common mental health concerns is one crucial part of ongoing inequities in mental healthcare access. Willingness to engage in screening is negatively impacted by a lack of culturally responsive ways to make screening more acceptable and stigma with mental health. This study therefore aimed to examine the perceived acceptability and utility of community-developed patient vignettes created to increase willingness to be screened for common mental health concerns. Employing a qualitative approach, a community advisory board (CAB) (n = 5) was enlisted to co-develop vignettes outlining an African community member’s symptoms of anxiety and subsequent help-seeking behavior. Two focus groups of community members (n = 18) provided qualitative feedback on the vignettes and shared their general attitudes towards mental health and recommendations for mental health screening and treatment in the African community. Using a hybrid inductive and deductive qualitative descriptive approach and classifying responses based on the socioecological model, four major themes emerged from the data: (1) between support and strain: the role of family; (2) reducing stigma: community voices as education; (3) culture as a barrier and a bridge; and (4) the importance of stories that reflect lived experience. Overall, participants were receptive to the culturally-responsive mental health vignettes and provided fruitful suggestions for how these stories can be used to reduce stigma and increase willingness to seek screening and treatment in African-born residents of the United States.

Background: Latinas in the U.S. experience higher rates of sleep disturbances and shorter sleep durations compared to non-Hispanic White women. This study employed community-engaged research methods to explore sleep-related knowledge, beliefs, attitudes, and behaviors within the Latina socio-cultural context, utilizing insights from focus groups with Latina community health workers (CHWs). Methods: CHWs served on a community advisory board (CAB) to develop focus group questions addressing sleep among diverse women. CHWs from four racial/ethnic groups, including Latinas, conducted three focus groups. CAB members facilitated participant recruitment and focus groups. Thematic analysis guided coding of emergent themes. We conducted sessions in Spanish and were recorded, transcribed, and analyzed collaboratively. Results: Thirty-one Latinas participated, revealing four overarching cultural themes influencing sleep behaviors: (1) Familismo , prioritizing family needs over personal well-being; (2) Marianismo, self-sacrifice and duty to maternal and spousal roles, often neglecting sleep; (3) Confianza , the importance of trust, particularly in healthcare relationships; and (4) Self-reliance , addressing sleep concerns through culturally accepted solutions. Conclusion: Findings underscore the connection between culture and sleep-health behaviors, highlighting the necessity of culturally sensitive interventions. CHWs demonstrated confidence in advocating for sleep health within their communities. Building trust with CHWs facilitated actionable insights for future development of effective sleep interventions.

Introduction: The 2-1-1 system is a nationwide social service provider that connects callers with unmet needs to appropriate community resources. Every year, over two million Americans experiencing food insecurity (FI) seek help from 2-1-1. Yet, little is known about the FI experiences among 2-1-1 callers seeking food-related support, specifically, who they are, the circumstances that lead them to contact 2-1-1, and the strategies they believe could help reduce FI. Methods: To address this gap, we interviewed 30 food-related callers (20 in English and 10 in Spanish) to the Utah 2-1-1 system between November 2024 and January 2025. Results: Thematic analysis revealed three primary reasons for seeking food-related help from 2-1-1: (1) ineligibility for federal nutrition and financial assistance programs; (2) facing non-income-related barriers to accessing food; and (3) experiencing unexpected life events. Callers suggested strengthening and adapting federal nutrition assistance programs, improving emergency food provision systems, and enhancing informational support. Conclusion: Based on these insights, we provide suggestions on how to leverage the 2-1-1 system to intervene on FI.

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 Little is known about the menopause-related healthcare of Indigenous people of the United States and Canada. This scoping review mapped the existing literature on Indigenous, integrative, and biomedical healthcare for U.S.- and Canada-based perimenopausal Indigenous populations. Methods We followed the JBI Manual for Evidence Synthesis. The protocol was registered on Open Science Framework. Eligibility criteria included records focused on Indigenous people of the U.S. and Canada perimenopause/postmenopause healthcare. Medline and eight other data bases were searched on June 1, 2023, and updated November 21, 2024. Covidence was used for selecting and extracting data. Findings After screening 6,684 records, 45 met inclusion criteria. These focused on Indigenous people’s experiences, care barriers, symptom reporting, and treatment preferences. Traditionality, community roles, and cultural beliefs influenced symptom experience and healthcare-seeking. Many participants preferred Indigenous or integrative interventions, sometimes in combination with biomedical care. Barriers included rushed encounters, language and cultural disconnects, and systemic inequities. Interpretation Findings highlight the need for culturally responsive, patient-centered care during the menopausal transition with an emphasis on evidence-based interventions including Indigenous and integrative health approaches. Additional research, stronger community engagement, and healthcare-provider training will help improve perimenopause health outcomes for Indigenous populations in the United States and Canada Funding The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article. The first author received support from the National Clinician Scholars Program (NCSP) as a postdoctoral fellow at the University of Pennsylvania. Additionally, she was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number F31NR020431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Indian Health Service. The authors were supported by a grant from the University of Utah office of the Vice President for Research. Evidence before this study Before undertaking this scoping review, the review team identified several sentinel articles. No prior evidence reviews nor protocols on our topic were identified in searches conducted on February 22, 2023 in PROSPERO, Open Science Framework, PubMed, Cochrane Library, Campbell Systematic Reviews, CINAHL, and Sociological Abstracts. We then conducted comprehensive searches across nine databases—Medline (Ovid) 1946-2024, Embase (Elsevier) 1974-2024, CINAHL Complete (EBSCOhost) 1937-2024, Ageline (EBSCOhost) 1966-2024, Alt HealthWatch (EBSCOhost) 1984-2024, APA PsycInfo (EBSCOhost) 1872-2024, Scopus (Elsevier) 1977-2024, Web of Science Core Collection (Clarivate) 1900-2024, and the Native Health Database (1900-2024). Searches were initially conducted on June 1, 2023, and repeated on November 21, 2024. We also reviewed reference lists of included studies. Search strategies combined keywords and subject headings related to menopause, healthcare, and Indigenous populations. Only English-language records were included due to funding constraints. We excluded books and cancer-related studies to focus on natural or surgical menopause not induced by chemotherapy. No quality assessment of included studies was conducted in accordance with scoping-review methodology. Added value of this study This is the first known scoping review to synthesize literature on perimenopause and postmenopause healthcare among Indigenous peoples in the United States and Canada. It maps Indigenous, integrative, and biomedical treatment practices; highlights structural and cultural barriers to care; and identifies the influence of traditional knowledge, community roles, and colonization on symptom interpretation and treatment-seeking. It also summarizes patient-centered recommendations for improving perimenopause healthcare delivery, and outlines key research gaps. Implications of all the available evidence Findings from this review, combined with existing literature, emphasize the urgent need for culturally responsive, community-informed healthcare for Indigenous midlife populations. Interventions should consider traditional knowledge systems, language and literacy needs, and preferences for Indigenous and integrative treatments. Healthcare providers must engage in shared decision-making and address systemic barriers to care. Future research should center Indigenous perspectives, investigate disparities in symptom experiences, and help to improve access to perimenopause healthcare for Indigenous peoples.

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.