Helen Omuya

Introduction: Peace is a key determinant of health, especially for marginalized populations facing racism, socioeconomic inequities, and chronic stress. This study explored how Black adults define and experience peace to inform culturally grounded, equity-focused health interventions. Methods: As part of the community-engaged Nurses4BlackWellbeing project, 482 Black adults from a low-income community responded to the open-ended question, “What is peace?” via written or verbal formats. Inductive content analysis was conducted using NVivo. Results: Four interconnected categories emerged: (a) peace as an inner state of harmony and emotional balance; (b) peace as freedom from racism, violence, and unmet needs; (c) peace as enjoyment of good things in life; and (d) peace as engagement with spirituality. Discussion: Peace is a multifaceted, culturally meaningful concept for Black adults. Promoting peace through structural change, relational support, and spiritual engagement may foster well-being. Findings can guide strength-based, culturally relevant interventions and policies to reduce health disparities.

Background: Currently, there is no validated instrument that assesses a patient’s reported deprescribing experiences and outcomes. This study reports the third phase of refining such an instrument, the Deprescribing Evaluation and Quality Improvement instrument (DEQI), using cognitive interviews. Cognitive interviews have been used in the development of many survey tools; however, there is limited evidence of their use in pharmacy research, particularly in deprescribing studies involving older adults. The aim of this phase of the DEQI instrument development is to evaluate and refine the individual items to enhance their clarity to accurately reflect patient-reported experiences and outcomes after deprescribing interventions. Methods: A draft DEQI Instrument was tested through two rounds of cognitive interviews conducted four weeks apart, involving 16 Veteran adults aged 65 or older who were on multiple medications. Interviews lasted about 60–90 min. Two cognitive interviewing techniques, “think-aloud” and “verbal probing,” were used. Data from the interviews were independently analyzed by four coders employing two coding techniques: interaction coding and the cognitive classification scheme (CCS) to identify problematic questions in the DEQI instrument. Based on the analysis of the first round, the items were revised and then administered again in a second round. The improvement in clarity was evaluated. Results: Participants were mostly male (88%) and non-Hispanic White (69%), with a mean age of 73.4 years (range 64–84). About 38% had some college or technical school education. The classification coding scheme identified 102 problematic items in the first round, with approximately 70% related to the comprehension and communication code, and around 14% related to response selection. After modifications and readministration in the second round, the number of identified problems dropped significantly from 102 to 21. Following the revision in the second round, the proportion of “immediately codable” answers increased significantly (from 0.68 to 0.80), while the proportions of “uncodable” answers and “items requiring clarification” decreased. Conclusions: This study demonstrates the use of interaction coding and CCS to refine an effective evaluation instrument to improve deprescribing interventions with an older Veteran population. Through iterative refinement of items based on cognitive interviews, over half of the DEQI instrument’s items were improved, resulting in clearer items and reduced confusion among participants. Clinical trial number: Not applicable.

Introduction: Cardiovascular disease is the leading cause of death in the Black population, accounting for over 22% of fatalities. Health equity science aims to explore this for evidence of social determinants that can eliminate cardiovascular health disparities. Methods: This study explored associations between three American Heart Association constructs of positive psychological health that reflect cultural strengths (environmental well-being, Black identity, and spirituality) with three modifiable health behaviors (blood pressure checking, exercise, and physical activity) in 470 Black adults living in racially marginalized communities. Results: Environmental well-being significantly predicted physical activity (β = 0.033, p = .04) and exercise (β = 0.045, p < .001). Black identity and spirituality demonstrated weaker and non-significant associations with the measured behaviors. Discussion: Environmental well-being emerged as a key cultural strength promoting physical activity and exercise among Black adults. Black identity and spirituality may play nuanced roles influenced by systemic factors. Findings emphasize incorporating culturally relevant strategies into heart health promotion.

Background: Reports from patient experience and satisfaction surveys are currently being used to target health quality improvement. The patient’s healthcare experience is indicative of the interpersonal quality of care and significantly correlates with patient satisfaction as an evaluative measure. Guided by Self-Determination Theory (SDT), this study aims to explore the association of predictor constructs in the theoretical model of STD—perceived provider communication (PPC) and other innate psychological constructs of competence and autonomy with self-rated health (SRH) and healthcare satisfaction (HS). Of particular interest is the SDT construct of relatedness. For this study, it was operationalized as the perceived health communication of a provider. Items relevant to SDT in the Health and Retirement Study (HRS) survey were tested, first, for whether they fall into the predicted SDT constructs and, second, whether and how these constructs were associated with self-reported health and patient HS. Methods: Two-stage data were analyzed using subsamples from the 2018 and 2019 HRS. Independent variables included items measuring SDT constructs about PPC, psychological well-being, and self-efficacy. Outcome variables included SRH and dimensions of HS, such as cost, quality, and providers. In the first stage, descriptive analyses and exploratory factor analysis were performed to identify the underlying factor structure. Principal axis factoring was used to extract factors. In the second stage, these factors were used in structural equation modeling to examine the relationship between SRH and HS. Results: Three factors with high internal consistencies (a > 0.8) and item-total correlations (r > 0.5) were identified. Data from the sample fit the structural model (χ2 = 0.00, CFI = 0.954, TLI = 0.946, RMSEA = 0.058, SRMR = 0.047). The structural phase indicated that PPC and competence were positively associated with SRH and HS. However, autonomy was only significantly associated with SRH but not with HS. Discussion/Conclusion: Individuals who rated PPC behaviors and their sense of competence more highly also showed higher satisfaction with multiple healthcare domains and their SRH status. Patient-centered determinants of health outcomes are complex, and more studies are needed to understand their nuances.

Background: Mixed findings about deprescribing impact have emerged from varied study designs, interventions, outcome measures and targeting sub-categories of medications or morbidities. This systematic review controls for study design by reviewing randomised-controlled trials (RCTs) of deprescribing interventions using comprehensive medication profiles. The goal is to provide a synthesis of interventions and patient outcomes to inform healthcare providers and policy makers about deprescribing effectiveness. Objectives: This systematic review aims to (1) review RCT deprescribing studies focusing on complete medication reviews of older adults with polypharmacy across all health settings, (2) map patients’ clinical and economic outcomes against intervention and implementation strategies and (3) inform research agendas based on observed benefits and best practices. Methods: The PRISMA framework for systematic reviews was followed. Databases used were EBSCO Medline, PubMed, Cochrane Library, Scopus and Web of Science. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials. Results: Fourteen articles were included. Interventions varied in setting, preparation, use of interdisciplinary teams, validated guidelines and tools, patient-centredness and implementation strategy. Thirteen studies (92.9%) found deprescribing interventions reduced the number of drugs and/or doses taken. No studies found threats to patient safety in terms of primary outcomes including morbidity, hospitalisations, emergency room use and falls. Four of five studies identifying health quality of life as a primary outcome found significant effects associated with deprescribing. Both studies with cost as their primary outcome found significant effects as did two with cost as a secondary outcome. Studies did not systematically study how intervention components influenced deprescribing impact. To explore this gap, this review mapped studies’ primary outcomes to deprescribing intervention components using the Consolidated Framework for Implementation Research. Five studies had significant, positive primary outcomes related to health-related quality of life (HRQOL), cost and/or hospitalisation, with four reporting patient-centred elements in their intervention. Conclusions: RCT primary outcomes found deprescribing is safe and reduces drug number or dose. Five RCTs found a significant deprescribing impact on HRQOL, cost or hospitalisation. Important future research agendas include analysing (1) understudied outcomes like cost, and (2) intervention and implementation components that enhance effectiveness, such as patient-centred elements.