Laurene Tumiel-Berhalter

Background/Objectives: Chronic Kidney Disease (CKD) is a prevalent condition requiring ongoing patient counseling and engagement, yet little is known about how physicians communicate with patients about CKD in routine clinical practice. We conducted a qualitative study to examine physician communication approaches related to CKD and to assess how these approaches align with Picker’s principles of patient-centered care framework. Methods: Semi-structured interviews were conducted with primary care physicians and nephrologists practicing in community and safety-net settings. Using directed content analysis, we identified patterns in how clinicians describe educating patients, contextualizing clinical information, and deferring aspects of counseling to other providers. Results: Physicians predominantly emphasized information-giving and the use of laboratory data to explain disease status. In contrast, practices such as explicit patient preference elicitation, addressing fear, anxiety, or physical comfort, and involving family or support persons were infrequently described. Mapping these communication behaviors to patient-centered care principles highlighted specific elements that are routinely enacted and others that remain underutilized in everyday CKD counseling. Conclusions: These findings identify concrete, feasible opportunities to strengthen patient-centered communication through brief, practice-ready strategies such as plain-language explanations, teach-back, values checks, and shared decision-making prompts. Enhancing these communication practices represents a pragmatic opportunity to improve the quality and patient-centeredness of CKD care.

Background Veggie Van (VV) is a multi-level mobile produce market intervention that increased fruit and vegetable (F&V) consumption in lower-income communities in an efficacy study. The aim of this study was to understand the impact of the VV intervention delivered by multiple community partners on food security and diet-related behaviors. Methods This cluster-randomized trial was conducted in partnership with nine organizations across four states in the United States. Partner organizations selected 33 community sites that reached lower-income individuals with limited access to healthy food. Eligible study participants were age 18+, the primary household shopper, and lived near/frequented the community site; 699 participants were enrolled across all communities. Sites were randomized in pairs to receive the VV intervention (n = 17 sites) or a planning condition (n = 16 sites) for one year. Trial registration This trial was registered at www.clinicaltrials.gov on January 29, 2020 (NCT04246593).

The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.

Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents’ experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16–17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens’ transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.

This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16–20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents’ asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.

Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets.