Robert A. C. Ruiter

Background: Family peers (FPs) have lived experience of parenting a child with mental health needs and specialized training to support other caregivers. They provide informational, emotional, affirmational, and instrumental support and are reimbursable by Medicaid in many states. While there have been positive results of FP support in randomized trials, there is little understanding of the mechanisms through which FP support improves caregiver and child outcomes. While observational coding is considered the gold standard for measuring psychosocial interventions, it has not been acceptable to FPs. This makes it necessary to explore other strategies for measuring intervention delivery. Objective: This study will (1) identify common FP intervention components across a range of FP programs and models, (2) delineate potential causal mechanisms for FP success related to child and caregiver outcomes, and (3) develop a pragmatic measure to capture use of these common FP intervention components to support larger-scale testing. Methods: This study will use intervention mapping to examine one-to-one FP support for caregivers of children aged 5-17 years in outpatient clinic, community, and home-based settings. We will survey 50 FPs and 50 caregivers across FP models. We will purposively select 48 participants to complete qualitative interviews (32 FPs and 16 caregivers). We will identify common FP components and their associated mechanisms and organize them in a logic model (aim 2). We will then create a corresponding tool to capture use of these components (aim 2), which we will validate with 200 FPs (aim 3). Of these FPs, 40 will complete up to 2 role plays of an FP encounter alongside the tool, which we will compare with observational coding. Another subset of 40 FPs and caregivers will be asked to complete a parallel self-report tool to report on the content of a selected session. Results: The study was funded in September 2025 by the National Institute of Mental Health (NIMH). Recruitment for aim 1 began in August 2026, with 4 participants enrolled in August 2026. The project will end in August 2029. We will submit deidentified study data collected in aims 1 and 3 to the NIMH Data Archive for participants who consent to data sharing. Conclusions: This study will advance our understanding of the common intervention components of FP support and associated mechanisms of change that go on to impact caregivers and children. This study will also result in a tool to measure this content across a range of outpatient programs and models. Results will inform a larger experimental trial to test the identified mechanisms of effective FP support. International Registered Report Identifier (IRRID): DERR1-10.2196/104843

BACKGROUND Family peers (FPs) have lived experience of parenting a child with mental health needs and specialized training to support other caregivers. They provide informational, emotional, affirmational, and instrumental support and are reimbursable by Medicaid in many states. While there have been positive results of FP support in randomized trials, there is little understanding of the mechanisms through which FP support improves caregiver and child outcomes. While observational coding is considered the gold standard for measuring psychosocial interventions, it has not been acceptable to FPs. This makes it necessary to explore other strategies for measuring intervention delivery. OBJECTIVE This study will (1) identify common FP intervention components across a range of FP programs and models, (2) delineate potential causal mechanisms for FP success related to child and caregiver outcomes, and (3) develop a pragmatic measure to capture use of these common FP intervention components to support larger-scale testing. METHODS This study will use intervention mapping to examine one-to-one FP support for caregivers of children aged 5-17 years in outpatient clinic, community, and home-based settings. We will survey 50 FPs and 50 caregivers across FP models. We will purposively select 48 participants to complete qualitative interviews (32 FPs and 16 caregivers). We will identify common FP components and their associated mechanisms and organize them in a logic model (aim 2). We will then create a corresponding tool to capture use of these components (aim 2), which we will validate with 200 FPs (aim 3). Of these FPs, 40 will complete up to 2 role plays of an FP encounter alongside the tool, which we will compare with observational coding. Another subset of 40 FPs and caregivers will be asked to complete a parallel self-report tool to report on the content of a selected session. RESULTS The study was funded in September 2025 by the National Institute of Mental Health (NIMH). Recruitment for aim 1 began in August 2026, with 4 participants enrolled in August 2026. The project will end in August 2029. We will submit deidentified study data collected in aims 1 and 3 to the NIMH Data Archive for participants who consent to data sharing. CONCLUSIONS This study will advance our understanding of the common intervention components of FP support and associated mechanisms of change that go on to impact caregivers and children. This study will also result in a tool to measure this content across a range of outpatient programs and models. Results will inform a larger experimental trial to test the identified mechanisms of effective FP support. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/104843

This study aimed to assess veterinarians’ knowledge, attitudes, and practices (KAP) regarding AMS and to identify system level drivers influencing antibiotic prescribing in the Udupi district of coastal Karnataka, India.

Anticipated stigma—the fear that an HIV diagnosis and disclosure may lead to negative social consequences that undermine engagement in HIV care, even in the era of universal test-and-treat (UTT). This study aimed to estimate the prevalence of anticipated stigma and identify its predictors among newly HIV-diagnosed adults in Johannesburg, South Africa, where treatment is available. We conducted a cross-sectional survey among 652 adults (≥18 years) newly diagnosed with HIV between October 2017 and August 2018 at four primary healthcare clinics in Johannesburg. Participants (64.1% female; median age 33 years, IQR 28–39) were interviewed immediately after receiving their HIV test results. Anticipated stigma was measured using an adapted five-item, four-point scale assessing concerns related to HIV disclosure and concealment (Cronbach’s alpha = 0.82). Mean scores were categorized as low-to-medium (≤2.5) or high (>2.5). Modified Poisson regression was used to identify predictors of high anticipated stigma, reported as adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). Overall, 55% of participants reported high anticipated stigma. Prevalence was higher among males (55.8%) and young adults aged 18–29 years (61.1%), and lower among married individuals (43%). Compared to married participants, those in unmarried relationships were more likely to report high anticipated stigma (aRR 1.10, 95% CI: 1.01–1.18). Lower anticipated stigma was observed among older individuals (aRR 0.94 for ages 30–39 vs 18–29), those whose primary home was in another province or country, those living in their current home for five or more years, individuals with fewer ART-related concerns, and those reporting lower perceived social support. Despite universal access to HIV treatment, over half of newly diagnosed adults reported high anticipated stigma. These findings underscore the need for targeted interventions to address persistent drivers of stigma, strengthen coping skills, and support social integration to promote engagement in HIV care.

Background: Older adults frequently present to the Emergency Department (ED). In response, a Swiss university hospital introduced age‐friendly interventions and achieved Geriatric Emergency Department Accreditation (GEDA) by the American College of Emergency Physicians (ACEP). However, the impact of previously introduced interventions and the reasons behind emergency clinicians' varying uptake or lack of continued use remain unclear. To further improve patient outcomes, conducting a contextual analysis to identify implementation barriers and facilitators is crucial, followed by the development of tailored implementation strategies supporting the sustainable uptake of all age‐friendly program elements. The project's overall aim is to systematically promote the uptake and sustainable re‐implementation of the existing age‐friendly ED program. The first study phase outlined in this protocol (“Phase A”) focuses on 2 key objectives: (1) to assess current age‐friendly interventions in the ED and identify barriers and facilitators affecting their reach, adoption, implementation, and maintenance; (2) to develop tailored implementation strategies for re‐implementing program elements. Methods: This project uses a modified implementation mapping in 5 Steps across 2 Phases. Phase A includes Steps 1–4: (1) conducting a contextual analysis using a mixed‐methods design combining observations, interviews, patient chart reviews, E‐survey and a Gemba walk; (2) identifying expected intervention and implementation outcomes, performance objectives; (3) adapting, extending, or developing tailored implementation strategies based on the Expert Recommendations for Implementing Change taxonomy; and (4) co‐designing an implementation protocol to guide re‐implementation. The follow‐up Phase B will involve the re‐implementation of the intervention elements and co‐designing the evaluation protocol (Step 5) for the implementation process. Conclusion: Age‐friendly EDs are essential for person‐centered emergency care, enhancing safety and quality of care for older adults. This study will provide insights into adaptable, evidence‐informed implementation strategies that support behavioral change among emergency clinicians to increase patient reach and sustainability of age‐friendly interventions for complex ED settings.

Background: Functional impairment caused by mental illness, known as psychosocial disability, significantly impacts the quality of life and socioeconomic well-being of individuals, particularly in Nigeria, where mental health challenges are escalating. Objective: This study aims to conduct a literature review on the intersectionality of mental illness and sexual and reproductive health (SRH) in Nigeria, focusing on the policies, strategies, and interventions that affect access to SRH services for individuals with mental illness. Methods: A systematic literature review was conducted using academic databases like PubMed, Google Scholar, and the WHO library. We used specific keywords related to mental health and SRH access in Nigeria. We included peer-reviewed articles, government reports, and credible publications relevant to our research. Results: Our findings show significant gaps in health policies and service delivery. Cultural beliefs and legal frameworks negatively impact access to SRH services for individuals with mental illness. Despite policies promoting inclusivity, barriers such as insufficient government funding, poor agency coordination, and societal stigma continue to exist. Conclusions: To improve access to essential health services in Nigeria, we need comprehensive policy reforms and targeted interventions that address the needs of marginalized populations.

Healthcare workers (HCWs) have notably low influenza vaccination coverage rates (VCR) despite influenza being one of the world's deadliest viruses. Interventions have attempted to tackle this issue, yet they have been unsuccessful in reaching desirable HCW VCR. In a systematic review, we aimed to understand and examine the specific behavior change methods of interventions that impact HCW VCR. Based on 86 studies, we identified 35 different behavior change methods. Although meta-analyses were not possible, the results suggest that interventions using rewards, nudging, or mass-media persuasion were most effective. Mandates, though one of the most effective methods, was not the most effective. Additionally, in the studies from 2016 onward there was a shift away from mandates and toward more autonomy-supportive methods. Ultimately, more research is needed to understand what methods are best for increasing HCW VCR globally. What is essential is the correct fit between identified psychosocial determinants and the method for change, considering the parameters of those methods in their application.