BACKGROUND:Variation in how nursing students conceptualise mental health (MH) has significant implications for curriculum design and patient care. While phenomenography is well-established for mapping such variation, clarity on how variations are derived is often lacking. Marton and Booth's (1997) structure of awareness (SoA) framework provides a method for sophisticated analysis of a concept and, in this study, was employed to derive the components and configuration of students' awareness. OBJECTIVE:This study aimed to illustrate and advance the application of the SoA framework in phenomenographic analysis, uncovering both the range and the formation of undergraduate nursing students' understandings of MH. METHODS:A qualitative, phenomenographic design was employed. Nineteen diverse undergraduate nursing students from an Australian Bachelor of Nursing program participated in individual, semi-structured interviews. Data were analysed using Dahlgren and Fallsberg's 7-phase process, with systematic application of Martin and Booth's SoA framework to each emergent category. RESULTS:Seven hierarchical categories of description were identified, representing a progression from fear-based and stigma-based views to holistic, inclusive conceptions of MH. Each category's SoA foregrounded different aspects of MH, reflecting influences such as cultural context, personal experience, and educational exposure. CONCLUSIONS:Applying the SoA framework enriched phenomenographic analysis by revealing not only what students understood about MH but how their awareness was constructed and enacted. The insights assisted in the development of targeted strategies to enhance MH literacy, reduce stigma, and support the development of holistic, person-centred care in nursing education.
Background: Transmasculine individuals are less likely to complete cervical cancer screening than cisgender individuals, thus increasing their risk for cervical cancer. Multidimensional socioecological determinants may contribute to cervical cancer disparities for transgender people. Objective: This study explored cervical cancer screening barriers and facilitators, acceptability of high-risk human papillomavirus (hrHPV) at-home self-sampling cervical cancer screening, and cervical cancer health promotion methods among transmasculine individuals. Methods: This qualitative description examined socioecological factors affecting cervical cancer screening in transmasculine individuals in 2022 to 2023. Through purposive sampling, 9 participants were interviewed in-depth using semi-structured interviews. Data were analyzed using thematic analysis. Results: Cervical cancer screening decisions were shaped by socioecological barriers and facilitators, including dysphoria, negative healthcare experiences, and exclusionary clinical spaces, alongside healthcare provider support and social network encouragement. At-home hrHPV self-sampling was conditionally acceptable and valued for autonomy and privacy. Affirming communication and culturally competent healthcare providers were central to effective cervical cancer screening promotion. Conclusion: Addressing these findings requires an approach that integrates healthcare provider and staff LGBTQ+-specific training, cultural humility, patient-centered care, affirming healthcare provider communication, targeted LGBTQ+-specific education, hrHPV self-sampling options, inclusive clinical environments, cervical cancer screening cost and coverage solutions, and healthcare systems that identify cervical cancer screening eligibility by anatomy. By addressing multilevel socioecological barriers while amplifying patient-identified facilitators such as autonomy, privacy, trusted provider recommendations, and social support; healthcare providers and systems can improve equitable access to cervical cancer screening and reduce preventable cervical cancer disparities among transmasculine and other underscreened populations.
BACKGROUND:Beliefs about childbirth shape women's expectations, decisions, and experiences. Although several tools assess related constructs such as fear or self-efficacy, few instruments focus specifically on childbirth beliefs. The Birth Beliefs Scale (BBS) addresses this gap by measuring 2 dimensions: beliefs in childbirth as a natural event and as a medical event. OBJECTIVE:We sought to adapt the BBS to the Portuguese context and evaluate its psychometric properties. METHODS:This methodological study involved cross-cultural adaptation and psychometric testing. The adaptation followed internationally recognized guidelines, including translation, synthesis, back-translation, expert review, and pretesting. Psychometric evaluation included exploratory and confirmatory factor analysis. The sample comprised 241 pregnant women enrolled in childbirth preparation programs in central Portugal. FINDINGS:The original two-factor structure was partially confirmed following the removal of 3 items with low psychometric performance, including 2 related to labor pain. The Portuguese version (BBS-pt) demonstrated acceptable internal consistency for the Natural subscale (α = 0.68) and lower consistency for the Medical subscale (α = 0.58), suggesting cultural and contextual nuances in how birth beliefs are expressed. CONCLUSION:The BBS-pt is a promising instrument for assessing birth beliefs among Portuguese women. While further refinement is needed, particularly regarding pain-related items, the scale provides a valuable foundation for both research and clinical practice. It may assist nurse-midwives and other maternity care providers in tailoring antenatal education and intrapartum support to women's individual belief patterns, thereby contributing to more personalized and woman-centered care.
OBJECTIVES:The purpose of this study was to describe the experiences of women with pelvic congestion syndrome (PCS). We aimed to (1) explore the experiences before receiving a PCS diagnosis, (2) describe the experience of being diagnosed and living with PCS, and (3) identify challenges with ongoing pelvic pain after PCS treatment. METHOD:A descriptive qualitative design with a purposive sampling method was used. Women with PCS were recruited from a Facebook PCS support group between October 2023 and February 2024. Participants completed a demographic survey, then participated in a semi-structured interview via Zoom. Data were transcribed verbatim and verified for accuracy. A modified iterative seven-step descriptive data analysis method was used to examine data, compare codes, challenge patterns, and inductively and deductively develop themes. RESULTS:Nine women completed the study. Six essential themes characterized the experience of living with CPP after treatment for PCS: (1) life before diagnosis; (2) diagnosis journey; (3) pain descriptors and co-occurring symptoms; (4) impaired quality of life; (5) being a burden to family and friends; and (6) losing all faith in women's healthcare and the system. CONCLUSIONS:This was the first qualitative study of women with ongoing and recurring pelvic pain after treatment for PCS. Findings highlighted the significant challenges women faced even after treatment for PCS, indicating a need for improved assessment strategies that better capture the severity and complexity of PCS symptoms.
BACKGROUND:Dementia represents a growing global public health challenge, with increasing reliance on informal family caregivers to support individuals living with the condition. Caregiving responsibilities may affect caregivers' psychological well-being, resilience, and overall quality of life (QoL). PURPOSE:This study aimed to examine caregiver burden, resilience, and QoL among family caregivers of people with dementia in primary care settings and to explore the association of these outcomes with key sociodemographic characteristics. METHODS:A cross-sectional study was conducted between September 2023 and January 2024 among 150 family caregivers recruited from primary care settings in Larissa, Greece. Participants completed validated instruments including the Zarit Burden Interview, the Connor-Davidson Resilience Scale, and the Short-Form Health Survey-36. Descriptive statistics, correlation analyses, and multivariable regression models were used to examine relationships between caregiver characteristics and study outcomes. RESULTS:Caregivers reported moderate levels of resilience and QoL and moderate-to-severe caregiver burden. Higher burden was associated with older age, rural residence, lower educational level, and being the patient's spouse. Conversely, higher education and urban residence were associated with higher resilience and better QoL. A modest positive correlation between caregiver burden and QoL was observed. CONCLUSIONS:Family caregivers of people with dementia experience substantial psychosocial challenges. Sociodemographic factors, particularly education, marital status, and place of residence, appear to influence caregiver outcomes. These findings highlight the need for targeted support strategies for caregivers, particularly those at higher risk of burden.
BACKGROUND:Multimorbidity may reduce quality of life due to physical limitations, treatment burden, and self-management challenges. Although self-efficacy is associated with improved quality of life in chronic conditions, its role in multimorbidity remains unclear. OBJECTIVE:This study aimed to examine the relationship between self-efficacy and quality of life in individuals with multimorbidity and to evaluate the role of sociodemographic and clinical factors in this relationship. METHODS:This cross-sectional study was conducted at a single center in Türkiye with 366 participants. Data were collected face-to-face using a patient information form, the Short Form-12 Health Questionnaire, and the Chronic Diseases Self-Efficacy Scale. Relationships between variables were analyzed using correlation analysis and structural equation modeling. RESULTS:Self-efficacy was strongly associated with both physical (β = 0.661; P < .001) and mental (β = 0.667; P < .001) components of quality of life. Self-efficacy also mediated the associations between sociodemographic and clinical variables and quality of life. Age (β = -0.188 for physical; β = -0.190 for mental), educational level (β = -0.216 for physical; β = -0.218 for mental), marital status (β = 0.055 for both components), and number of chronic conditions (β = -0.197 for physical; β = -0.199 for mental) showed significant indirect associations with quality of life through self-efficacy (all P < .001). CONCLUSIONS:Self-efficacy was strongly associated with both physical and mental components of quality of life and played a mediating role in the associations between sociodemographic and clinical factors and quality of life. Interventions targeting self-efficacy may help improve the quality of life in individuals with multimorbidity.
BACKGROUND:High-risk pregnancy often triggers diverse traumatic-related psychological responses, which can affect postpartum depression outcomes. Identifying these response patterns is key to developing targeted interventions. OBJECTIVE:We sought to classify traumatic psychological response profiles in high-risk pregnant women and examine their associations with postpartum depression. METHODS:We recruited 518 high-risk pregnant women from obstetric departments. Participants completed the Post-Traumatic Growth Inventory and Post-Traumatic Stress Disorder Checklist-Civilian Version during the third trimester, along with assessments of demographic characteristics, coping strategies, and pregnancy stress. Postpartum depression was assessed at 6 to 8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Latent profile analysis was employed to identify profiles. RESULTS:Three latent profiles were identified: High Growth (34.0%), Traumatic Distressed (27.2%), and Moderate Combined (38.8%). Residence, education level, family income, coping strategies, and higher pregnancy stress are influencing factors in the Traumatic Distressed profile. Postpartum depression differed significantly across profiles (F = 62.97, P < .001). CONCLUSION:Distinct traumatic response profiles exist among high-risk pregnant women, with the Traumatic Distressed profile showing the greatest risk for postpartum depression. Conversely, High Growth was linked to favorable outcomes. Tailored interventions addressing psycho-social and socioeconomic vulnerabilities are warranted.
BACKGROUND:Persons with disabilities (PWD) are as likely as their nondisabled peers to become pregnant, yet their experiences of pregnancy and early parenthood remain poorly understood. We aimed to explore the experiences of PWD during pregnancy and the postpartum period, with particular attention to managing their health and their children's health, and to parenting with a disability. METHODS:This qualitative descriptive study was part of a mixed-methods study focused on psychosocial risks and maternal-infant outcomes among PWD. We completed semi-structured interviews with 45 PWD who were currently or recently pregnant. FINDINGS:We identified 3 interrelated themes. Pregnancy-Related Changes Shaping Disability Experiences and Psychological Well-Being described how pregnancy destabilized strategies for managing disability symptoms, leading to symptom exacerbation and uncertainty with limited disability-informed health guidance. Forced Tradeoffs Between Maternal Health, Functioning, and Fetal or Infant Well-Being captured participants' experiences weighing medication use, mobility, and symptom control against risks to fetal development and infant safety, often without clear clinical evidence or support. Parenting Within Contexts of Surveillance, Self-Advocacy, and Systemic Gaps in Support reflected heightened scrutiny, fears of child protective services involvement, and reliance on self-advocacy and informal networks to compensate for gaps in formal supports. CONCLUSION:Together, these findings demonstrate that perinatal and early parenting experiences for people with disabilities are shaped by interacting social, clinical, and structural barriers. For nurses, these findings underscore the importance of disability-informed perinatal systems that integrate accessible clinical guidance, inclusive care practices, and structural supports that value the expertise and parenting capacities of PWD.
BACKGROUND:Alcohol-related media exposure is strongly associated with adolescents' psychosocial factors, but the mechanisms underlying drinking intention and potential sex differences remain unclear. OBJECTIVES:This cross-sectional study examined the associations between alcohol-related media exposure and rural Thai adolescents' drinking intention, focusing on psychosocial mediators-perceived drinking norms, attitudes, and perceived behavioral control-and the moderating role of biological sex. METHODS:A total of 474 rural Thai adolescents (mean [±SD] age: 14.54 ± 0.92; 50.63% male) from 8 public district schools in Chiang Mai Province, Thailand, completed a self-administered survey. Data were analyzed using structural equation modeling with weighted least squares and variance-adjusted estimator. RESULTS:Attention to pro-drinking messages was significantly associated with adolescents' perceived drinking norms (β = 0.76, P < .001), attitudes (β = 0.72, P < .001), and perceived behavioral control (β = -0.66, P < .001), which in turn were associated with greater drinking intention. Mediation effects were similar across sexes, but the negative effect of exposure on perceived behavioral control was stronger for males (βmale = -0.76 vs βfemale = -0.58). CONCLUSION:Pro-drinking message attention was strongly associated with adolescents' drinking intention, mainly through perceived drinking norms and perceived behavioral control. Nurse-led prevention should enhance media literacy and strengthen adolescents' control over alcohol use.
BACKGROUND:Reliable longitudinal measurement is essential for tracking quality of life (QoL) in sickle cell disease (SCD). The multiple domains of the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) have not been evaluated for their longitudinal consistency across repeated observations in real-world SCD cohorts with chronic pain. OBJECTIVE:We sought to evaluate the consistency of ASCQ-Me scores across repeated observations over 18 months and to examine their association with average pain intensity. METHODS:We used a repeated-measures longitudinal observational study among adults with SCD. Participants (N = 186, mean (±SD) age: 36.6 ± 11.7 years, 62% female) completed ASCQ-Me measures at 4 time points, approximately 6 months apart. Average pain intensity (API; 0-10) was computed as the mean of pain now, the least pain in the last 24 hours, and the worst pain in the last 24 hours. Analysis included Cronbach's alphas, intraclass correlation coefficient (ICC), and linear regression mixed models. RESULTS:Cronbach's alphas were high and stable across all domains (0.73-0.92), except for Pain Episodes Severity (α = 0.63). Means across time varied by no more than 2.2 points with moderate-to-high ICC (0.42-0.68), indicating consistent score behavior across time points. Average pain intensity was strongly associated with every ASCQ-Me subscale (P < .001 for all, except Pain Episodes Severity, P = .002). CONCLUSION:ASCQ-Me scores were consistent over 18 months and demonstrated clinically coherent associations with pain burden in adults with SCD. Findings support the use of ASCQ-Me for monitoring QoL trajectories and for clinical studies targeting SCD symptoms and function.
BACKGROUND:Engaging end users through co-design is essential for developing effective and sustainable hypertension prevention interventions, while rigorous evaluation helps identify and address barriers to enhance acceptability and impact. METHODS:A feasibility study was conducted using a convergent mixed-methods design. A convenience sample participated in a community-based Health Literacy Program. Instruments included the Thai Hypertensive Health Literacy and Health Behaviors Questionnaire (Thai HLHBQ), the Information and Support for Health Action Questionnaire (ISHA-Q), a hypertension knowledge test, a satisfaction survey, and an interview guide. Data were analyzed using paired t-tests, Wilcoxon signed-rank tests, and repeated measures ANOVA. RESULTS:The sample comprised ten adults with prehypertension, one nurse practitioner, and one public health officer. The attendance rate of participants with prehypertension during the 6-week period was 100%. Participants completed a baseline assessment at Week 0. The intervention was delivered over a 5-week period (Weeks 1-5), and post-intervention assessments were conducted at Week 6. Post-intervention, significant improvements were observed in knowledge, health literacy, and blood pressure readings. Knowledge increased from 6.8 to 9.3/10 (Hedges' g = 2.65, P < .001). Health literacy scores increased by 10 points (HLHBQ; Hedges' g = 1.05, P = .005) and 32.5 points (ISHA-Q; r = 0.66, P = .037). Systolic blood pressure decreased from 129.3 to 123.9 mmHg (η2p = 0.43, P < .004) and diastolic from 83.9 to 79.9 mmHg (η2p = 0.41, P < .001). CONCLUSION:The results provide evidence that the intervention was both feasible and acceptable for implementation in a rural Thai community.
BACKGROUND:Constipation is a common symptom among people with neurodegenerative diseases (PWND), with prevalence ranging from 25.2% to 70%. This is linked to cognitive decline, poor quality of life (QOL), and reduced survival. Although various non-pharmacological interventions exist, their methods and effects are inconsistent, highlighting the need to map current evidence. OBJECTIVE:This scoping review aimed to systematically map evidence on non-pharmacological interventions in PWND, identify gaps, and provide recommendations for future research. METHODS:A bibliographic search of PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library was conducted in March 2026 without date restrictions. Studies on non-pharmacological interventions for constipation in PWND were included. RESULTS:Of 2,024 identified studies, 13 were included. The included studies targeted people with multiple sclerosis (n = 7), Parkinson's disease (n = 5), and dementia (n = 1), using various diagnostic criteria for constipation. The most frequently used non-pharmacological interventions were abdominal massage (n = 4) and acupuncture (n = 4), followed by biofeedback (n = 2), bowel training (n = 1), foot reflexology (n = 1), and ginger supplementation (n = 1). The type, provider, duration, and frequency of each intervention varied across studies. Improvements were observed in constipation-related outcomes (n = 10), disease-related outcomes (n = 2), QOL outcomes (n = 3), and other outcomes (n = 3), with diverse measurement tools and findings reported. CONCLUSION:Non-pharmacological interventions may improve constipation and overall well-being in PWND. However, heterogeneity in protocols highlights the need for standardized, disease-specific, nurse-led approaches to support clinical integration. PROTOCOL REGISTRATION:The review protocol was registered in the Open Science Framework (https://osf.io/tu7k3).
BACKGROUND:Nursing interns are the next generation of nurses, and their employment status affects nursing team stability. Interns often face career development difficulties and attrition. Cognitive flexibility may help students adapt to the workplace and clarify their work self-definition, and future work self-salience may relate to career adaptability. However, these relationships are unclear in the Chinese context. OBJECTIVE:We aimed to explore the mediating effect of future work self-salience between cognitive flexibility and career adaptability among nursing students during their internship. METHODS:Using a cross-sectional study design with convenience sampling, nursing interns from a tertiary general hospital in Nanjing, China, were selected between November and December 2024. Data were collected using a general information questionnaire, the Cognitive Flexibility Inventory (CFI), the Future Work Self-Salience Scale (FWSS), and the Career Adapt-Abilities Scale (CAAS). Of 201 questionnaires distributed, 195 were valid (97.0%). Descriptive statistics, Spearman's correlation, and structural equation modeling were used to test the mediating effect. RESULTS:The CFI, FWSS, and CAAS scores were 68.74 ± 10.22, 13.45 ± 2.91, and 91.97 ± 16.58, respectively. Cognitive flexibility positively predicted career adaptability, and future work self-salience played a partial mediating role (mediation effect: 20.92%). CONCLUSION:Cognitive flexibility is directly associated with nursing interns' career adaptability and also is indirectly associated through future work self-salience. Nursing educators may enhance interns' career adaptability by fostering both cognitive flexibility and future work self-salience.
