How do autistic adults and their families experience, understand, and manage gastrointestinal (GI) symptoms in daily life? A qualitative manuscript from the GI Wanna Talk About Autism Study

medRxiv · 2026-01-18

Background: Gastrointestinal (GI) symptoms are common, chronic, and often disabling among autistic individuals. Research has largely focused on children, with limited attention to experiences in adulthood. Prior qualitative work highlights substantial unmet GI-related healthcare needs among autistic children, including negative care experiences and limited access to autism-informed services. Methods: Using a community-based participatory research (CBPR) framework, we conducted qualitative interviews with 26 participants (21 autistic adults, 5 parents reporting on behalf of an adult autistic child), of varying race, sexual orientation, genders, socioeconomic and educational statuses, and ages. Interviews were conducted on Zoom, ranging from 22-110 minutes long, exploring the physical, emotional, and functional impacts of GI symptoms; how these experiences relate to autism; barriers to treatment; and participants' needs and priorities for improving GI health care (priorities reported elsewhere). We conducted a reflexive thematic analysis following Braun and Clarke, using an interpretivist-constructivist epistemological stance. Coding and theme development were inductive and data-driven. Themes were refined collaboratively through repeated engagement with the data, analytic memoing, and discussion of areas of interpretive uncertainty until shared meaning and coherent thematic structure were achieved. Once the codebook and thematic structure were finalized, all transcripts were systematically coded for analysis. Results: Participants described gastrointestinal symptoms as chronic, unpredictable, and highly consequential, shaping physical functioning, emotional wellbeing, daily routines, autonomy, and social participation. Symptoms were understood as arising from interacting biological, sensory, emotional, and contextual factors, with triggers often difficult to identify or anticipate. Experiences with healthcare were frequently characterized by dismissal, communication barriers, system complexity, and prior trauma, contributing to delayed or avoided care and heightened distress. In response, autistic adults and caregivers relied on individualized, trial-and-error management strategies - including avoidance of triggers, routine and environmental planning, dietary and pharmacologic approaches, and sensory or emotional regulation - alongside social support and peer communities to cope with persistent uncertainty and limited clinical guidance. Conclusion: GI symptoms in autistic adults frequently have dramatic negative impacts on everyday life, reducing both quality of life and restricting the ability to fully engage in society and desired activities. Despite the clear magnitude of impact, knowledge and support are lacking and management remains difficult, confusing, and often unsuccessful. Improving care will require multi-layered, neurodiversity-informed approaches that recognize autistic adults as central knowledge-holders and active partners in research and clinical decision-making.

Association Between Education Attainment and Hypertension Among Community-Dwelling Older Black and White Adults: The National Health & Trends Study

Journal of Applied Gerontology · 2026-01-08

ObjectiveOur study examined the association between educational attainment and hypertension among older Black and White adults.MethodsA sample of older Black and White adults (N = 3,212) from the National Health & Aging Trends Study (NHATS). The predictor variable, educational attainment, was measured with three education categories (less than high school, high school or equivalent, and greater than high school). The dependent variable, hypertension, was measured by asking respondents if their doctor diagnosed them with hypertension. Covariates included demographics and health-related variables. We conducted logistic regressions to identify the association between educational attainment and hypertension.ResultsAdjusted stratified models showed that older Black adults with beyond high school educational attainment had 20% higher odds of having hypertension, compared to older Black adults with an educational attainment of high school and lower. Adjusted stratified models showed that older White adults had 8% lower odds of having hypertension, compared to older White adults with an educational attainment of high school and lower.ConclusionThere are notable differences in hypertension among older Black and White adults which are associated with higher levels of educational attainment.

Community health workers fostering trust and engagement in a community-based intervention for depressive older adults in Peru: a qualitative study

BMC Health Services Research · 2026-02-21

Innovative community-driven approaches, such as task-sharing interventions with Community Health Workers (CHWs), are essential to reduce the mental health care gap. This study explored how CHWs’ actions, experiences, knowledge, and resources contributed to fostering the acceptability and feasibility of a community-based mental health intervention (VIDACTIVA) for older adults. We examined the role of CHWs (n = 16) delivering VIDACTIVA, an evidence-based CHW-led intervention for older adults with depression. VIDACTIVA integrates Problem-solving therapy and Behavioral Activation in eight home-based sessions. Data included in-depth interviews and field notes collected across a 3-year period of piloting, adaptation, and implementation. An inductive thematic analysis identified key CHW practices that enhanced the intervention’s engagement. Sixteen CHWs (aged 39–72, median 60 years) participated. Three main themes emerged as central: (1) establishing trust with older adults through active listening, empathy, and addressing urgent needs; (2) adapting session settings and creatively introducing tools to sustain engagement; and (3) fostering strong peer support networks that enhanced CHWs’ confidence, learning, and commitment throughout implementation. CHWs play a pivotal role in community-based mental health interventions by building trust with participants, leveraging their community knowledge, and working as a collective that supports learning, self-care, and teamwork, factors that humanize care and strengthen the sustainability of programs. The current trial registration number is NCT06065020, which was registered on September 26, 2023.

Cervical cancer information access and dissemination strategies among rural Kenyan women: A mixed methods study

Journal of Public Health in Africa · 2026-01-26

Background: Cervical cancer (CC) remains a leading cause of cancer-related deaths among women in sub-Saharan Africa. In rural Kenya, screening uptake is particularly low, partly because of limited access to reliable health information and other structural barriers such as the unavailability of screening equipment and the cost of screening. Aim: To examine the relationship between access to CC information and screening uptake, and to identify information needs, preferences and dissemination strategies among women with low educational attainment in resource-limited rural settings. Setting: Rural communities in Bomet and Kericho Counties, Kenya. Methods: = 21). Quantitative data were analysed using logistic regression, and qualitative data using thematic analysis. Findings were integrated during interpretation. Results: Participants had a mean age of 45 years; 88.5% were from low-income households. Although 82.2% had heard of CC - primarily via news media (36.8%), health workers (24.1%) and social networks (21.3%) - only 6.3% had been screened. Health workers and the radio were the most trusted information sources. Access to each additional information source was associated with 4.66 times higher odds of screening (95% confidence interval: 1.19-18.25). Despite this, 92% felt inadequately informed. Integrated findings underscored the need for culturally relevant, literacy-sensitive approaches. Conclusion: Screening uptake remains low but improves with exposure to diverse, trusted information sources. Contribution: This study highlights the importance of tailored, community-based strategies to enhance CC screening in underserved rural populations.

Barriers and Opportunities for HPV Self-Sampling in Underserved Rural Communities: Insights from a Mixed Methods Study

International Journal of Environmental Research and Public Health · 2025-05-15

Cervical cancer is the leading cause of cancer-related deaths among women in sub-Saharan Africa, especially in rural areas with limited access to screening. This study explored factors influencing rural Kenyan women's willingness to self-collect samples for HPV-DNA testing. Data were drawn from a mixed methods study in two Kenyan rural counties, including surveys with 174 women and interviews with 21 participants. The mean age of the survey sample was 45.2 (SD = 13.2) years. Only 6.4% had ever been screened, yet 76.9% expressed willingness to self-collect samples for testing. Increased willingness was associated with cervical cancer awareness (OR = 3.49, 95% CI = 1.50-8.11), relying on health workers as primary sources of health information (OR = 1.88, CI = 1.23-2.86), or the news media (OR = 2.63, CI = 1.27-5.48). High cervical cancer stigma (OR = 0.71, CI = 0.57-0.88) and longer travel times of 30-120 min to a health facility (OR = 0.44, CI = 0.20-0.93) were linked to reduced willingness. Integration of the findings showed that comprehensive health promotion-through education, health worker endorsement, and mass media campaigns-may improve HPV self-sampling uptake and reduce the cervical cancer burden in rural Kenya.

Race and Incident Dementia Among Older Black and Older White Men

Journal of Aging and Health · 2025-03-01

The objective of this study was to determine if racial differences exist between older Non-Hispanic Black (NHB) and White (NHW) men in incident dementia over 11 years (2011-2022) in the National Health and Aging Trends Study (NHATS). The analytic sample included 2395 community-dwelling NHB and NHW men free of dementia at baseline who self-identified as Non-Hispanic Black (NHB) and White (NHW). Dementia was assessed at each visit using a validated algorithm developed by NHATS. After adjusting for demographics, place, and health-related characteristics in the Cox proportional hazard models, older NHB men had an increased risk of dementia (hazard ratio: 1.63, 95% confidence interval: [1.22-2.17]) compared to older NHW men. There may be unique factors such as stressors, patterns of genes, or perhaps nutrition that older NHB men possess and experience throughout their lives that contribute to the increased incident dementia.

Applying Mixed Methods to Enhance Health Equity in Research on Dementia and Cognitive Impairment

Journal of Aging and Health · 2025-03-01 · 2 citations

ObjectivesThe NIA health disparities research framework details a life course approach that considers multilevel environmental, sociocultural, behavioral, and biological factors. Mixed methods are well-suited to study complex problems like structural racism, combining the benefits of generalizability with contextualization.MethodsWe draw on experience as faculty in the Mixed Methods Research Training Program for the Health Sciences to introduce mixed methods research on health equity and disparities in dementia and cognitive impairment.ResultsWe describe common reasons why health science investigators may use mixed methods, provide examples of mixed methods designs, and discuss challenges and practicalities of mixed methods research.DiscussionMany risk factors for dementia are modifiable, so the emphasis of research turns from description to intervention studies that enhance health equity. The information and insights acquired from the use of mixed methods are central in tailoring interventions to populations most affected by Alzheimer's disease and related dementias.

“It’s Usually Not Dementia That’s the Focus”: Barriers and Facilitators of Dementia Care in Primary Care

Journal of General Internal Medicine · 2025-04-14 · 1 citations

Barriers and Opportunities for HPV Self-Sampling in Underserved Rural Communities: Insights from a Mixed Methods Study

Preprints.org · 2025-03-26

Cervical cancer is the leading cause of cancer-related deaths among women in Sub-Saharan Africa, especially in rural areas with limited access to screening. This study examined factors influencing rural Kenyan women's willingness to self-collect samples for HPV-DNA testing. Data were drawn from a mixed-methods study in two Kenyan rural Couties, including surveys with 174 women and interviews with 21 participants. The mean age of the survey sample was 45.2 (SD=13.2) years. Only 6.4% had ever been screened, yet 76.9% expressed willingness to self-collect samples for testing. Increased willingness was associated with cervical cancer awareness (OR=3.49, 95% CI=1.50–8.11), receiving health information from health workers (OR=1.88, CI=1.23–2.86) or the news media (OR=2.63, CI=1.27–5.48). High stigma (OR=0.71, CI=0.57–0.88) and travel time of 30–120 minutes to a health facility (OR=0.44, CI=0.20–0.93) were linked to reduced willingness. Integration of findings showed that a comprehensive health promotion—through educa-tion, health worker endorsement, and mass media campaigns—may im-prove HPV self-sampling uptake and reduce cervical cancer burden in rural Kenya.

Enhancing PTSD Management in Veterans: A Longitudinal Study of the Therapeutic Role of Psychiatric Service Dogs

Journal of Archives in Military Medicine · 2025-03-29 · 2 citations

Background: Post-traumatic stress disorder (PTSD) remains a significant mental health challenge among veterans, with traditional treatments often yielding mixed results. Emerging research suggests that psychiatric service dogs may serve as valuable therapeutic adjuncts. However, longitudinal studies examining their effectiveness in PTSD management remain limited. Objectives: This study investigates the impact of psychiatric service dog partnerships on PTSD symptoms, depression, social functioning, and overall health-related quality of life (HRQoL) among veterans, compared to usual care alone. Methods: A longitudinal study was conducted with 190 veterans diagnosed with PTSD, comparing those paired with psychiatric service dogs (n = 95) to a waitlist control group (n = 95). Participants completed standardized assessments measuring PTSD severity, depression (PHQ-9), HRQoL, and social engagement at baseline, 1-month, and 3-month follow-ups. Difference-in-differences (DiD) regression analysis was applied to assess changes over time between groups. Results: Veterans with service dogs demonstrated significant reductions in PTSD symptom severity at both 1-month (P = 0.002) and 3-month (P = 0.001) follow-ups, compared to the waitlist group. Depression scores improved more significantly in the service dog group (DiD Coef. = -3.07, P < 0.001), with corresponding increases in social participation and HRQoL measures. No significant differences were found at baseline between groups, confirming comparability. Conclusions: Findings suggest that psychiatric service dogs provide meaningful mental health benefits for veterans with PTSD, particularly in reducing symptom severity and improving overall well-being. These results support the potential integration of service dog partnerships as complementary interventions in PTSD treatment plans. Future research should explore long-term outcomes and optimize service dog training models for veteran-specific needs.