Sandi Alshahwan

Background: Latino millennial caregivers comprise over one-quarter of millennial family caregivers in the United States. Latino millennial family caregivers face unique challenges due to cultural, structural, and economic burdens that may increase stress and stress-related health effects. These caregivers also report time limitations due to their multiple roles. Technology may be a way to deliver an accessible and flexible intervention to support stress management and emotional regulation in this population. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of a culturally tailored mobile health (mHealth) intervention to support stress management and emotional regulation for Latino millennial caregivers. Methods: Participants (N=30) were recruited nationally in the United States using a recruitment agency and were randomized to the intervention or waitlist control groups. The 4-week fully automated intervention included daily mindfulness exercises and journaling prompts delivered via a custom mHealth platform. The waitlist control group received a written handout with mindfulness, journaling, and support information. Feasibility data, including recruitment and retention rates and intervention adherence, and postintervention acceptability surveys were collected. Study outcome measures were collected electronically at baseline and 2, 4, and 6 weeks. Primary outcomes included caregiver burden and perceived stress, and secondary outcomes included well-being, informational support, and emotional support. Feasibility and acceptability data were analyzed descriptively alongside study outcome measure data from participants who completed week 6 data collection (n=21). No efficacy testing was conducted. Results: Enrollment was completed in 12 weeks (N=30), with a 70% (21/30) retention. Participants showed differential adherence, with 60% (6/10) completing a daily journal activity and 30% (3/10) completing a daily mindfulness activity. Adherence patterns were reflected in the acceptability findings, with journaling being preferred over mindfulness. Preliminary outcomes showed varying patterns between the intervention and control groups, with the intervention group showing decreased median burden levels from before (median 20, IQR 15-27.25) to after the intervention (median 15, IQR 10.50-28.75) but increased median stress levels from 19.50 (IQR 12-26.75) to 21 (IQR 8.75-22.75), while the control group burden and stress levels remained the same before and after the intervention. Positive affect and well-being and informational support increased for both groups. Median emotional support levels increased from 15 (IQR 12-20) before the intervention to 16 (IQR 13-19) after the intervention for the control group and decreased from 14.5 (IQR 11.5-17.75) to 14 (IQR 12-17.25) for the intervention group. Conclusions: Findings demonstrate areas for further intervention iteration to address both adherence and acceptability issues with the mindfulness component of the intervention. Intervention implementation also needs to be addressed, including participant retention rates. Our team will use lessons learned alongside feedback from Latino millennial caregivers to address these issues.

BACKGROUND Latino Millennial caregivers face unique challenges and elevated stress due to cultural, structural, and economic burdens. Culturally responsive, technology-based stress management interventions are needed to support emotional well-being in this population. OBJECTIVE To evaluate the feasibility and acceptability of a culturally tailored mobile health (mHealth) intervention to support stress management and emotional regulation for Latino Millennial caregivers. METHODS A four-week feasibility and acceptability pilot study was conducted with 21 Latino Millennial caregivers. The intervention included daily mindfulness exercises and journaling prompts, delivered via a custom mHealth platform. RESULTS The intervention was feasible, with enrollment completed in 12 weeks and 70% retention. Participants showed differential adherence with 60% of participants completing a daily journal activity and 30% completing a daily mindfulness activity. Adherence patterns were reflected in acceptability findings, with journaling being preferred more than mindfulness due to flexibility and cultural fit. CONCLUSIONS Findings support the intervention’s feasibility and highlight the importance of flexible, culturally responsive features. Tailoring mHealth tools to match caregivers’ stress demands and preferences can enhance engagement and emotional well-being. CLINICALTRIAL N/A

Background: Childhood vaccination is one of the World Health Organization's strategies to reduce vaccine-preventable diseases and children's mortality and morbidity rates. Adequate and accurate knowledge, as well as positive attitudes regarding vaccination, may increase parents’ compliance with their children’s vaccines. Objective: This study aimed to identify the determinants of parents’ knowledge, attitude, and practice toward childhood vaccination in Jordan. Methods: This is a descriptive cross-sectional study. The stratification method of sampling technique was used to split Jordan into three regions. The sample included 1477 participants. A total number of eleven Maternal and Child Health Care centers were selected as the study’s site. Results: Results showed that parents have sufficient knowledge regarding the importance of vaccines in maintaining a child’s health, with a mean percentage of correctly answered questions of 78.7%. However, they have inadequate knowledge regarding the adverse reactions (57.5%) and the contraindications of vaccines (61.8%). Parents had positive attitudes regarding the National Immunization Program where 97% agreed with it. However, 83% of parents had negative attitudes toward vaccine safety. Parents’ work, residency, income, and age are significant determinants of parents’ attitudes, knowledge, and practice regarding children's vaccines. Conclusion: The study may motivate nurses to implement more educational interventions regarding children’s vaccination to upgrade parents' knowledge with particular emphasis on parents with a low level of education and the residents of rural areas.