Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America.

A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic.

Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report.

Background: People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care.

A Mixed-Methods Evaluation of Patient Education Materials for Colorectal Cancer.

Background: Patient education materials are created by professional organizations to inform patients about their disease and its treatment. However, it remains unclear if these materials are appropriate for patients.

Objective: This study aims to broadly evaluate the education materials for patients with colorectal cancer.

Usability Evaluation for the Amulet Wearable Device in Rural Older Adults with Obesity.

Mobile health (mHealth) interventions hold the promise of augmenting existing health promotion interventions. Older adults present unique challenges in advancing new models of health promotion using technology including sensory limitations and less experience with mHealth, underscoring the need for specialized usability testing. We use an open-source mHealth device as a case example for its integration in a newly designed health services intervention.

Life with FOCUS: A qualitative evaluation of the impact of a smartphone intervention on people with serious mental illness.

Objective: A growing body of literature indicates that mobile health (mHealth) interventions that utilize smartphones for illness management are feasible, acceptable, and clinically promising. In this study, we examine how individuals with serious mental illness use a mHealth intervention-FOCUS-to self-manage their illnesses. Additionally, we explored participant perceptions of the intervention's impact on their subjective illness experience.

Beyond "Med Management".

Today, outpatient psychiatric care is commonly referred to as "medication management" and is often delivered in 15- to 20-minute visits by psychiatric care providers who receive little workflow support from technology or medical assistants. This Open Forum argues that this current state of psychiatric care delivery is a problem, comments on how psychiatry got here, and suggests that, through reframing and redesign, psychiatric professionals can improve care for those delivering and for those receiving this needed service.

Developing the WorkingWell mobile app to promote job tenure for individuals with serious mental illnesses.

Objective: Individuals living with serious mental illnesses are key stakeholders in user experience design and the development of the mobile app to enhance on-the-job follow-along support. In this study, Individual Placement and Support (IPS) consumers identify challenges in sustaining employment, provide data regarding their use of technology, and suggest technology-based solutions for coping on the job to inform app development.

Method: Focus groups were conducted in 3 agencies providing IPS services to examine consumers' perspectives on supported employment, work, and their preferences for technology-based supports.

A qualitative study of career exploration among young adult men with psychosis and co-occurring substance use disorder.

Objective: This article explores the meaning and importance of career exploration and career development in the context of integrated treatment for young adults with early psychosis and substance use disorders (i.e., co-occurring disorders).

Long-term sobriety strategies for men with co-occurring disorders.

Objective: Roughly half of people with severe mental disorders also experience a co-occurring substance use disorder, and recovery from both is a critical objective for health care services. While understanding of abstinence initiation has grown, the strategies people with co-occurring disorders use to maintain sobriety are largely unknown. This article reports strategies for relapse prevention as described by men with co-occurring disorders who achieved one or more years of sobriety.

The potential of technology for enhancing individual placement and support supported employment.

Topic: The potential of technology to enhance delivery and outcomes of Individual Placement and Support (IPS) supported employment.

Purpose: IPS supported employment has demonstrated robust success for improving rates of competitive employment among individuals with psychiatric disabilities. Still, a majority of those with serious mental illnesses are not employed (Bond, Drake, & Becker, 2012).

Recovery in a family context: experiences of mothers with serious mental illnesses.

Objective: Adults with mental illness are as likely as those without mental illness to be parents. Yet parenting and family life have received considerably less attention than employment, housing, and community integration in psychiatric rehabilitation and mental health services research. This ethnographic pilot study aimed to understand the lived experiences of urban low-income African American mothers diagnosed with serious mental illnesses.

Principles for enhancing the role of state vocational rehabilitation in IPS-supported employment.

Objective: Research has established the Individual Placement and Support (IPS) model of supported employment as an effective approach for persons with severe mental illnesses. This article examines strategies for Vocational Rehabilitation (VR) to enhance employment outcomes through better collaboration with IPS programs.

Methods: Twenty-one focus groups were conducted in rural and urban locations in Illinois with mental health consumers, VR counselors, IPS specialists, and mental health professionals.

Awareness of stigma among persons with schizophrenia: marking the contexts of lived experience.

This article investigates the subjective experience of stigma attached to schizophrenia-related disorders. We examine data from anthropological interviews from a community sample of 90 out-patients residing in a metropolitan area of the United States. Patients were under treatment with atypical antipsychotic medication, and their symptoms were for the most part relatively well controlled.

Stigma despite recovery: strategies for living in the aftermath of psychosis.

In this article, we identify an array of creative strategies used by persons diagnosed with schizophrenia-related illness to deflect and resist social stigma, and address the lived experience of deploying these strategies in the intersubjective context of everyday life. The data are derived from anthropological interviews and ethnographic observations of ninety persons who received treatment at community mental health facilities in an urban North American locale. Nearly all were keenly aware of stigma that permeated their lives.

Ethnocultural variations in mental illness discourse: some implications for building therapeutic alliances.

Objective: In the delivery of mental health services over the past decade, the field has attempted to shift from paternalism to client-centered care, in which treatment and recovery are based on client-practitioner collaboration. Such a shift requires that providers elicit and work with clients' discursive accounts of their illness experiences and understand these accounts in the context of clients' ethnocultural backgrounds. The purpose of this ethnography was to elucidate ethnocultural aspects of illness accounts and interactions with the mental health system.

Cultural competence reexamined: critique and directions for the future.

This Open Forum aims to stimulate productive dialogue about cultural competence in providing mental health care. The authors examine recent calls for culturally competent care in mental health practice and give a brief overview of the context in which demands for such care have arisen. Using select examples from anthropology, the authors provide evidence of the importance of culture in the production, presentation, and experience of psychic distress.