Browsing by Author "Johnson, Nicole L."
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Item ‘Had I gone into the office, they would have caught it a little bit sooner’: Narrative problematics in U.S. pandemic birth stories(T&F, 2022) Scott, Susanna Foxworthy; Johnson, Nicole L.; Brann, Maria; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsIndividuals who gave birth during the COVID-19 pandemic experienced an increased risk for premature births, stillbirths, depression, and lower access to care. Their stories provide valuable information that can inform clinical care, particularly due to loss of in-person support resulting from visitor restrictions in hospitals. Grounded in a theory of narrative problematics, we explored how elicited birth narratives were affected by COVID-19 and how stories can be used as material evidence to inform healthcare systems. We facilitated seven focus group discussions with 65 women from 19 states who had given birth between March and July 2020. Three themes emerged from our qualitative thematic analysis: (1) navigating disrupted access to healthcare; (2) experiencing loss of co-construction of birth experience; and (3) recognizing fissures in the mask-wearing master narrative. Practical implications for improving healthcare include developing spaces for individuals to process birth stories for cathartic benefit due to significant disruption, improving hospital policies about in-person support to avoid loss of co-construction of experience, and centering hospitals and the providers that work within them as audiences for interventions around preventive measures during a disease outbreak.Item “I’m Not Comfortable With COVID, But …”: Dilemmas and Decision-Making to Mitigate Risks Among Mothers Who Gave Birth During the COVID-19 Pandemic(Sage, 2024) Johnson, Nicole L.; Brann, Maria; Scott, Susanna F.; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsIndividuals have faced unprecedented uncertainty and risk surrounding the COVID-19 pandemic, and decision-making dilemmas have been complicated by quickly evolving and often contradictory recommendations for staying healthy. Using tenets of problematic integration theory and risk orders theory, we analyzed interview data from 50 mothers who gave birth during the pandemic to understand how uncertainty and risk perceptions shaped their decision-making about keeping themselves and their infants healthy in the first year after birth. Results describe how some mothers in our sample made sense of their decision-making to prioritize first-order risks to their own and their family’s physical health, and other mothers prioritized second-order risks to their relationships and identities. We also discuss the social nature of mitigating risk during the COVID-19 pandemic and the catalysts for shifting risk perceptions. Theoretical and practical implications include improving public health messaging and clinical conversations to enable individuals to effectively manage social and identity needs alongside serious threats to physical health.Item “I’m Not Gonna Pull the Rug out from under You”: Patient-Provider Communication about Opioid Tapering(Elsevier, 2017) Matthias, Marianne S.; Johnson, Nicole L.; Shields, Cleveland G.; Bair, Matthew J.; MacKie, Palmer; Huffman, Monica; Alexander, Stewart C.; Department of Medicine, School of MedicineIn response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many healthcare organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients on long-term opioids who perceive benefits and are using their medications as prescribed. Given the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) Explaining—Patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential; 2) Negotiating—Patients needed to have input, even if it was simply the rate of tapering; 3) Managing difficult conversations—When patients and providers did not reach a shared understanding, difficulties and misunderstandings arose; 4) Non-abandonment—Patients needed to know that their providers would not abandon them throughout the tapering process.Item Narrative Sense-Making During COVID-19: Using Stories to Understand Birth in a Global Pandemic(Taylor & Francis, 2024) Brann, Maria; Bute, Jennifer J.; Foxworthy Scott, Susanna; Johnson, Nicole L.; Communication Studies, School of Liberal ArtsWomen who gave birth in the spring and summer of 2020 contended with a host of challenging factors. In addition to facing pregnancy, labor, and delivery during an emerging global pandemic, women grappled with health care restrictions that altered their birth experience. To explore how women made sense of their birth during COVID-19, we analyzed written narratives from 71 women who gave birth in the United States from March to July 2020. Based on tenets of communicated narrative sense-making, the themes that emerged from our data suggest that women framed the role of the pandemic as either completely overshadowing their birth experience or as an inconvenience. Women also wrote about threats to their agency as patients, mothers, and caregivers, as well as the evolving emotional toll of the pandemic that often prompted feelings of fear and sadness, along with self-identified anxiety and depression. We discuss these findings in light of the literature on birth stories as essential sites of narrative sense-making for women and their families.Item “Our Birth Experiences are What Binds Us”: Women’s Motivations for Storytelling about Birth to Build Motherwisdom(Taylor & Francis, 2020) Johnson, Nicole L.; Scott, Susanna F.; Brann, Maria; Communication Studies, School of Liberal ArtsChildbirth is widely considered to be a bonding experience among women. Women often feel compelled to share their story, and this research highlights communicative and reflexive aspects of storytelling as a means for meaning-making and relationship-building. This inductive thematic analysis explored 22 women’s motivations for engaging in storytelling about birth across five focus groups and two one-on-one interviews. Findings demonstrate one primary theme, building motherwisdom, a term coined here to reflect the uniqueness of the birth storytelling context. We also identified three secondary themes for motivation to engage in birth storytelling: (1) fulfilling a sense of responsibility to share one’s story to normalize a variety of birth experiences and to listen to learn about birth, (2) empowering women, and (3) seeking validation. Women receive positive therapeutic benefit from storytelling, and this may be particularly important in maintaining and improving mental health during the postpartum period. Our work informs the environments we can create to motivate mothers to share and listen to birth stories to foster this benefit.Item Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial(Springer, 2020) Matthias, Marianne S.; Bair, Matthew J.; Ofner, Susan; Heisler, Michele; Kukla, Marina; McGuire, Alan B.; Adams, Jasma; Kempf, Carol; Pierce, Emilee; Menen, Tetla; McCalley, Stephanie; Johnson, Nicole L.; Daggy, Joanne; Medicine, School of MedicineBackground: Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resources. Objective: To test a peer coach-delivered pain self-management program for chronic pain. Design: Randomized controlled trial. Participants: Veterans with chronic musculoskeletal pain. Intervention: Intervention patients were assigned a trained peer coach for 6 months. Coaches, who were volunteers, were asked to contact their assigned patients, either by phone or in person, twice per month. Coaches and patients were given an intervention manual to guide sessions. The control group was offered a 2-hour pain self-management class. Main measures: The primary outcome was total pain, assessed by the Brief Pain Inventory (BPI). Secondary outcomes were anxiety, depression, pain catastrophizing, self-efficacy, social support, patient activation, health-related quality of life, and healthcare utilization. Outcomes were measured at baseline, 6 months, and 9 months. Key results: Two hundred fifteen patients enrolled (120 intervention, 95 control). Adherence to intervention protocol was low, with only 13% of patients reporting having at least the recommended 12 peer coach meetings over the 6-month intervention. BPI total decreased from baseline to 6 months and baseline to 9 months in both groups. At 9 months, this change was statistically significant (intervention, - 0.40, p = 0.018; control, - 0.47, p = 0.006). There was not a statistically significant difference between groups on BPI at either time point. No secondary outcomes improved significantly in either group after adjusting for multiple comparisons. Conclusions: Patients randomized to peer support did not differ from control patients on primary and secondary outcomes. Other peer support models that do not rely on volunteers might be more effective.Item Persistent Disparities in Cervical Cancer Screening Uptake: Knowledge and Sociodemographic Determinants of Papanicolaou and Human Papillomavirus Testing Among Women in the United States(Sage, 2020) Johnson, Nicole L.; Head, Katharine J.; Foxworthy Scott, Susanna; Zimet, Gregory D.; Communication Studies, School of Liberal ArtsObjectives: Cervical cancer is the second-most common type of cancer among women aged 15-44, and racial, ethnic, and economic disparities exist in survival rates despite widely available screening tests and early treatment options. The objective of this study was to describe the association among knowledge, sociodemographic characteristics, and cervical cancer screening, with the goal of developing interventions to prevent cervical cancer in populations at risk of the disease. Methods: In 2017, we conducted a nationwide survey of women in the United States aged ≥18 who had ever received a Papanicolaou (Pap) test (N = 630). We conducted t tests and one-way analysis of variance to determine sociodemographic differences (age, education, race, ethnicity, income, type of health insurance) in knowledge about cervical cancer screening (Pap test and human papillomavirus [HPV] test). We used logistic regressions to define significant determinants of cervical cancer screening behaviors in the previous 5 years. Results: Of 629 respondents, 407 (64.7%) had an annual household income <$30 000, and 322 of 536 (60.1%) respondents had government-provided health insurance. Of 630 women who had ever had a Pap test, 425 (67.5%) had an HPV test. Hispanic and non-Hispanic white women were more likely than Hispanic and non-Hispanic black women (odds ratio [OR] = 2.49; 95% CI, 1.12-4.54; P = .02) and women with government-provided health insurance (OR = 1.91; 95% CI, 1.08-3.37; P = .03) were more likely than women with private health insurance to have received a Pap test in the previous 5 years. Knowledge of HPV was a significant predictor of having received an HPV test in the previous 5 years (OR = 1.37; 95% CI, 1.22-1.54; P < .001). Conclusion: Disparities in cervical cancer screening among sociodemographic groups of women suggest the need for targeted interventions to improve knowledge about Pap and HPV tests.Item Rapid HIV testing and counseling for residents in battered women’s shelters(Taylor and Francis, 2015-03) Burke Draucker, Claire; Johnson, Dawn M.; Johnson, Nicole L.; Kadeba, Myriam T.; Mazurczyk, Jill; Zlotnick, Caron; School of NursingOver one million Americans live with the human immunodeficiency virus (HIV), and roughly 20 percent of those living with HIV are unaware of their status. One way to decrease this epidemic is community-based rapid testing with high-risk populations. One high-risk population that has received limited attention is victims of intimate partner violence who seek shelter. In an effort to gain foundational information to implement rapid HIV testing and counseling services in domestic violence shelters, the current study conducted a series of focus groups with eighteen residents and ten staff of local shelters from October 15 to December 12, 2012. Participants provided valuable insight into how HIV rapid testing and counseling might be best implemented given the resources and constraints of shelter life. Despite identifying some potential barriers, most believed that the promise of quick results, the convenience and support afforded by the shelter venue, and the timing of the intervention at a point when women are making life changes would render the intervention acceptable to residents. Further insights are discussed in the article.Item Rapid HIV testing and counseling for residents in domestic violence shelters(Taylor & Francis, 2015-04) Burke Draucker, Claire; Johnson, Dawn M.; Johnson, Nicole L.; Kadeba, Myriam T.; Mazurczyk, Jill; Zlotnick, Caron; IU School of NursingOver one million Americans live with the human immunodeficiency virus (HIV), and roughly 20 percent of those living with HIV are unaware of their status. One way to decrease this epidemic is community-based rapid testing with high-risk populations. One high-risk population that has received limited attention is victims of intimate partner violence who seek shelter. In an effort to gain foundational information to implement rapid HIV testing and counseling services in domestic violence shelters, the current study conducted a series of focus groups with eighteen residents and ten staff of local shelters from October 15 to December 12, 2012. Participants provided valuable insight into how HIV rapid testing and counseling might be best implemented given the resources and constraints of shelter life. Despite identifying some potential barriers, most believed that the promise of quick results, the convenience and support afforded by the shelter venue, and the timing of the intervention at a point when women are making life changes would render the intervention acceptable to residents. Further insights are discussed in the article.