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Authors:Blanca Iris Padilla, Emily Granados, Leonor Corsino Abstract: Hispanic Health Care International, Ahead of Print. Introduction: Transition of care is a critical point of care for Hispanic/Latino patients with diabetes, who face higher rates of diabetes-related complications and hospital readmission and challenges during the transition of care from hospital to the community. Methods: Using semi-structured interviews, with questions tailored to each group, we explored patients’ and providers’ perspectives of their experiences and challenges during the transition of care of Hispanic/Latino adult patients with diabetes from the hospital to the community. Results: Overlapping themes emerged from both patient and provider interviews identifying common barriers regarding the transition of care, including discordance due to language/communication barriers, perceived burden/nuisance, lack/unawareness of available resources, and lack of patient education. Conclusions: Findings in this study provide a frame of reference that can be used to address challenges facing Hispanic/Latino patients with diabetes. The uniqueness of this study is its exploration of the perspectives of patients and healthcare providers and the overlapping themes that emerged. Additionally, timely outpatient follow-up care, education, and reducing communication discordance can help with lowering readmission rates for patients with diabetes, especially those who are medically disadvantaged and have language barriers. Citation: Hispanic Health Care International PubDate: 2024-08-06T10:22:30Z DOI: 10.1177/15404153241269473
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Authors:Maria V. Hughes Abstract: Hispanic Health Care International, Ahead of Print. Introduction: This service-learning, health promotion project used Leininger's Culture Care Theory to engage Baccalaureate Nursing students in a health promotion initiative specific to Hispanic community members. Methods: Thirty-seven students examined population health data, surveyed Hispanic community members to identify health priorities, and developed a population-specific intervention on diet and risk factors for diabetes. Students created a 5-min script focused on healthy eating plans with recognition of traditional foods associated with the Hispanic culture. Students delivered the script to community members attending an annual Hispanic Heritage Festival. Results: Seventy-six percent of the 488 community participants reported increased knowledge about diabetes risk factors and healthy eating habits. Each student completed a self-reflection on how the project impacted their transcultural skills and reported increased confidence related to engagement and communication with the Hispanic community. Discussion/Significance: Incorporating community-based service-learning into the undergraduate curricula is a powerful educational approach that can enhance students’ ability to provide culturally congruent nursing care. Citation: Hispanic Health Care International PubDate: 2024-08-02T10:29:00Z DOI: 10.1177/15404153241266571
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Abstract: Hispanic Health Care International, Ahead of Print.
Citation: Hispanic Health Care International PubDate: 2024-08-02T10:28:01Z DOI: 10.1177/15404153241266644
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Authors:Nadia Laniado, Parth Shah, Linda Gallo, Martha Daviglus, Carmen Isasi Abstract: Hispanic Health Care International, Ahead of Print. Aims: The aims of this study were to examine the association of social network size with severe tooth loss and the number of missing teeth among Hispanic adults with diabetes in the United States and to assess whether the association varied by glycemic control. Methods: Data obtained from 1,007 adults who participated in the Hispanic Community Health Study were analyzed. Structural social support was measured with the Social Network Index (SNI), which assessed network size and frequency of social contacts. Tooth loss was measured by a count of the number of missing teeth and categorically as severe tooth loss ( Citation: Hispanic Health Care International PubDate: 2024-07-21T12:58:03Z DOI: 10.1177/15404153241264770
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Authors:Juliana Muñoz Bohorquez, Amara Channell Doig, Sarah Goldring, Esmeralda Campos, Kiarra Burton, Jennifer Lynne Delacey, Lisa H. McCoy, Catherine Sorenson, Gina Crist, Crystal Terhune, Jinhee Kim Abstract: Hispanic Health Care International, Ahead of Print. Background: Although COVID-19 has disproportionately impacted immigrant agricultural workers, vaccination efforts have been challenging. Barriers to immunization include language, visa status, and access to medical care. Additionally, vaccine hesitancy, mistrust, and misinformation contributed to low uptake. Methods: A community needs assessment was conducted with immigrant agricultural workers (n = 9) and community stakeholders (n = 15) in rural areas of Maryland and Delaware. In-depth interviews were recorded, transcribed verbatim, and analyzed using template analysis. Results: The participants named trusted and untrusted sources, sources of misinformation, and barriers to accessing information and physical locations to receive the vaccine as reasons for not getting the vaccine. Trusted sources included known community leaders and television programs. Some barriers mentioned were fear of deportation, lack of paid time off, language barriers, and difficulty navigating the U.S. healthcare system. Discussion: There is a need for culturally-tailored programs that address misinformation and barriers and use community-based programming. Citation: Hispanic Health Care International PubDate: 2024-06-17T07:15:40Z DOI: 10.1177/15404153241262050
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Authors:Enrique Moncada-Mapelli, Luz Angela Roman, Maryorie Katteryne Galeas-Torre,
Victor Roman-Lazarte Abstract: Hispanic Health Care International, Ahead of Print. Introduction: The emigration of Venezuelans has seen a significant increase in recent years. The aim of this study was to identify factors associated with access to contraceptives in migrant women from Venezuela residing in Peru. Methods: An exploratory cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru. Access to contraceptives (yes/no) was established as the dependent variable. A Poisson regression model was performed for complex samples, and crude (PRc) and adjusted (PRa) prevalence ratios were reported. Results: A total of 3617 migrant women were analyzed, with 50.12% reporting access to contraceptives. Factors associated with greater access to contraceptives included being between 20 to 29 years old, having a university education, the entry period after the declaration of COVID-19 quarantine was associated with lower access to contraceptives. Conclusions: Access to contraceptives for Venezuelan migrants should be provided to all, as it is a free service in Peru. Additionally, education and family planning should be provided from the basic or middle school level to prevent unintended pregnancies in the future. Complete coverage should be provided regardless of the time of entry into Peru. Citation: Hispanic Health Care International PubDate: 2024-05-29T06:37:06Z DOI: 10.1177/15404153241258158
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Authors:Evelyn Iriarte, Maria J. Baeza, Natalia Villegas, Rosina Cianelli, Samantha Stonbraker, Paul Cook, Catherine Jankowski Abstract: Hispanic Health Care International, Ahead of Print. Introduction: The use of telenovelas shows promise as a mode of education that could enhance Latino people's ability to prevent or manage different health conditions. This scoping review examined the available evidence about telenovela interventions on Latino health. Methods: A scoping review was conducted by searching five peer-reviewed databases for articles published on any date in English or Spanish. The methods of this review were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews recommendations. Results: A total of 431 articles were identified, and 22 articles published between 1999 and 2022 were included in the final scoping review. Nineteen telenovela interventions were described in the literature. Most studies included telenovela interventions without other elements (n = 15; 68%), and 91% were conducted in the U.S. (n = 20). Studies were qualitative (n = 8; 36%), quantitative (n = 8; 36%), and mixed methods (n = 6; 27%), and most telenovela interventions were developed and/or tested in Spanish (n = 10; 53%). The most common topics for the telenovela interventions were substance use/risky sexual health behaviors, cardiovascular disease, and mental health. Conclusions: This scoping review may serve to continue empirical and theoretical work on telenovela-style entertainment interventions on Latino health and future implementation in real-life settings. Citation: Hispanic Health Care International PubDate: 2024-05-27T06:50:02Z DOI: 10.1177/15404153241257929
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Authors:Maryory Guevara-Lozano, Beatriz Pérez-Giraldo, Ligia Patricia Arroyo-Marlés, Mónica Andrea Nonsoque-Cholo, Beatriz Sánchez-Herrera Abstract: Hispanic Health Care International, Ahead of Print. Precedents: The transfer between nursing shifts must guarantee the quality of care for patients and their families in the hospital. This study aimed to transform the handover between nursing shifts to strengthen the care capacity of patients and their family caregivers, and improve the care capacity of nursing staff, in a Latin American university hospital. Methods: This is a Nursing Methodology Research developed in the following phases: (a) identification of the best handover practices between nursing shifts to apply them within the institutional culture; (2) diagnosis of the transfer between shifts in the hospital; (3) design and validation of the transformation proposal; (4) measurement of transfer indicators; and (5) definition of a path to improve this transfer. Results: The proposal developed focuses on the patient and their family caregiver. The proposed protocol considered the perspective of the care recipients, the nursing staff, and the best available evidence. The overall transfer rating over 10 months went from 65% to 84%. Conclusions: The adjustment to the transfer process made it possible to strengthen the care capacity of patients and their family caregivers and improve the care capacity of the nursing staff. Citation: Hispanic Health Care International PubDate: 2024-05-07T05:32:35Z DOI: 10.1177/15404153241246804
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Authors:Lila de Tantillo, Brian E. McCabe, Martin Zdanowicz,
Johis Ortega, Juan M. Gonzalez, Sandra Chaparro Abstract: Hispanic Health Care International, Ahead of Print. Introduction: The increased prevalence, severity, and mortality of heart disease and specifically heart failure among Hispanic and Black populations are a concern for clinicians and researchers. Additionally, patients of poor socioeconomic status also have worse outcomes for cardiovascular disease. To address disparities, it is necessary to address the persistent lack of representation in clinical research of diverse populations, including the Hispanic and Black populations and individuals who are of low socioeconomic status. Method: This study was a pilot randomized trial of a medication adherence intervention for heart failure patients conducted at a safety net hospital and affiliated pharmacy with a diverse patient population. Using an evidence-based multifactorial approach, this investigation implemented and adapted best practices to support the inclusion of Hispanic, Black, and socioeconomically diverse participants. Results: A total of 40 participants were recruited, 58% were Hispanic, 38% Black, and 5% White. A total of 40% reported the need for socioeconomic assistance. At 30 days after discharge, follow-up data were obtained for 37 of 40 (93%) of participants either by interview, electronic record, or both. Conclusion: Findings suggest that a combination of strategies used in this trial can be applied to recruit and retain ethnically and socioeconomically diverse participants. Citation: Hispanic Health Care International PubDate: 2024-04-22T07:52:20Z DOI: 10.1177/15404153241248144
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Authors:Francisco Brenes, Evan V. Goldstein, Ernesto Lázaro Sarduy, Richard Lazarus, Gabriela Fernandez, Federico Henriquez, Dariel Asgarali Abstract: Hispanic Health Care International, Ahead of Print. As the U.S. population becomes more racially/ethnically diverse, the Hispanic American immigrant population has slowly grown in recent years. In the face of anti-immigrant policies, limited access to care, fear of deportation, discrimination, stigmatization, poverty, and other stressors, Hispanic American immigrants seek services from botánicas for religious, spiritual, medical, and psychosocial health reasons, including the accessibility and affordability of services from folk practitioners in these herbal dispensaries. Hispanics are the primary consumers of herbal remedies and complementary and alternative medicines in the United States. The purpose of this article is to emphasize the critical role of botánicas in the health and wellness of Hispanic American immigrants. Recommendations for health professionals are provided in the care of Hispanic Americans who utilize folk, traditional, and herbal medicines for health and healing. Citation: Hispanic Health Care International PubDate: 2024-04-15T01:03:52Z DOI: 10.1177/15404153241247261
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Authors:Christian Arce Guzman, Catherin D. Morocho, Kristen Lentsch, Ashley D. Meagher Abstract: Hispanic Health Care International, Ahead of Print. Introduction: The perspective of hospitalized patients with limited English proficiency (LEP) in US hospitals interacting with language-discordant healthcare providers remains understudied. Our goal is to examine the inpatient experiences of Spanish-speaking patients and offer suggestions to improve patient satisfaction. Methods: A survey was administered to Spanish-speaking patients using interpreters during their admission to medicine at an urban, academic hospital. Qualitative thematic analysis of responses was conducted. Results: Thirty-six patients completed the survey. Despite limited use of interpreters, the majority of patients rated interpretation services as excellent, reported high level of involvement in care and respect of their opinions, and preferred video remote interpreting and in-person interpreters. Language barrier and cost affected patients’ comfort level requesting health care services. The mean patient satisfaction score was 9.64. Patients suggested an increase in bilingual personnel, improved access to interpreters, specifically in-person. Conclusion: Although highly satisfied, patients reported inconsistent use of interpretation services in the inpatient setting and suboptimal access. Hospitals should strive to provide language-concordant care and patient-centered interpretation. Patients’ understanding of their health care rights needs better assessment to ease the inpatient experience. Further research is needed to estimate the regard for autonomy by Spanish-speaking patients in their own care. Citation: Hispanic Health Care International PubDate: 2024-04-13T09:23:53Z DOI: 10.1177/15404153241246803
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Authors:Deborah Lee, Joshua Fogel, Linda Arce, Mohab Idriss, Madilyn Thomas, Mary Fatehi Abstract: Hispanic Health Care International, Ahead of Print. Introduction: The overturning of Roe v. Wade impacted family planning services in many areas of the United States (US). Our study investigates the association of acculturation with interest in and awareness of family planning hospital services of contraception and elective termination of pregnancy among Hispanic women. Methods: We surveyed 306 Hispanic women at a public hospital in a Long Island suburb of New York City. Predictor variables were acculturation (language, media, ethnic social relations) measured by the Short Acculturation Scale for Hispanics and years lived in the US. Outcome variables were interest in and awareness of hospital services of family planning for elective abortion and non-elective non-abortion family planning methods. Results: For interest in hospital services, both language and ethnic social relations acculturation were significantly positively associated with almost all family planning methods whether abortion or non-abortion. However, media acculturation and years lived in the US were significantly positively associated with abortion but not the non-abortion methods. For awareness of hospital services, only language acculturation was significantly positively associated with abortion and some nonelective non-abortion family planning methods. Conclusion: We recommend that healthcare providers and hospitals should be aware of acculturation levels when providing counseling and information about family planning methods to Hispanic women. Citation: Hispanic Health Care International PubDate: 2024-04-13T09:22:53Z DOI: 10.1177/15404153241246103
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Authors:Julien Brisson, Karena D Volesky-Avellaneda Abstract: Hispanic Health Care International, Ahead of Print. Introduction: Sexual and reproductive health (SRH) is a sensitive subject, and young people may be unfamiliar with how to access SRH services. In this cross-sectional study, we examined young people's internet use to understand how they accessed SRH clinics in Colombia. This study also explored Colombian youth's interest in online material teaching how to access SRH services. Methods: During August 2019–February 2020, patients aged 10–24 years old presenting at two SRH clinics in Colombia were invited to answer a survey. Chi-square tests were performed to assess possible differences in how participants inquired how to access the clinic according to sociodemographic characteristics. Results: Among the 812 patients who participated, 91.4% were female and the median age was 19 years. To inquire how to access the SRH clinic, 30.7% of participants asked their parent(s) and 24.0% used the internet. Participants aged 20–24 years old were more likely to use the internet compared to younger participants (p Citation: Hispanic Health Care International PubDate: 2024-04-13T09:22:34Z DOI: 10.1177/15404153241246102
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Authors:Adrianna Nava Abstract: Hispanic Health Care International, Ahead of Print.
Citation: Hispanic Health Care International PubDate: 2024-04-09T07:09:39Z DOI: 10.1177/15404153241243144
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Authors:Araceli Orozco Abstract: Hispanic Health Care International, Ahead of Print.
Citation: Hispanic Health Care International PubDate: 2024-04-03T07:45:47Z DOI: 10.1177/15404153241244448
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Authors:Robert Andrew Yockey Abstract: Hispanic Health Care International, Ahead of Print.
Citation: Hispanic Health Care International PubDate: 2024-04-03T07:45:28Z DOI: 10.1177/15404153241243151
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Authors:Cindy Rodriguez, Cindy Gil, Gerardo Maupomé Abstract: Hispanic Health Care International, Ahead of Print. Recruiting and retaining Hispanic/Latinx (H/L) participants, specifically undocumented immigrants, is challenging in part because of the mistrust and fear in participating in research studies. Additionally, only a few longitudinal studies describe the recruit and retention strategies among Mexican and Central American immigrants aiming to expand the knowledge base about those underprivileged groups; this was the objective of the 6-year longitudinal VidaSana study. In the present methods report, we specifically omit the presentation of results from the empirical data findings of the VidaSana study: the present report describes the process and offers a subjective appraisal of multiple and complementary approaches in the recruitment and retention strategies for Hispanics living in the Midwest region of the United States, including very recently arrived immigrants. This study was able to effectively recruit and retain (81.7%) a cohort of Mexican and Central American immigrants within a period of 36 months. Our recruitment and retention performance were successful in the context of the hostile environment against immigration that dominated the national landscape at the time of our study. The present methods report of the VidaSana study provides an insightful understanding in recruiting and, in particular, retaining H/Ls and H/L recent immigrants into longitudinal studies. Citation: Hispanic Health Care International PubDate: 2024-03-20T07:38:09Z DOI: 10.1177/15404153241235668
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Authors:Adriana Elena Hernández-Gamboa, Josep Barceló-Prats, Magda Liliana Villamizar Osorio, María-Antonia Martorell-Poveda Abstract: Hispanic Health Care International, Ahead of Print. Introduction: In the world, deaths and injuries caused by traffic collisions have been considered a public health problem. In Colombia, 7.238 fatalities were recorded in 2021, with motorcycle riders representing the largest group of victims at 59.7%. Methods: The aim of this qualitative phenomenological study is to describe the risky experiences and deliberate actions of diverse road users that influence the self-management of the risk of traffic collisions. Results: Data were obtained from 22 participants: motorists, pedestrians and drivers. The content analysis describes various human conditions that affect self-management of the risk of traffic accidents, such as unsafe behaviors, non-compliance with traffic regulations by the different road actors, competitive culture among drivers, eagerness, among others. Additionally, factors related to care were determined: healthy recreational activities, promoting the value of one’s own life and that of others, adequate time management and preventive behaviors by some road users. Conclusion: This research provides information on social and cultural aspects, experiences and risky behaviors of different road actors that influence the incidence of traffic accidents in Colombia. Citation: Hispanic Health Care International PubDate: 2024-03-08T06:28:58Z DOI: 10.1177/15404153241235666
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Authors:Erica E. Fortune, Julie S. Olson,
Kelly Hendershot, Alexandra K. Zaleta Abstract: Hispanic Health Care International, Ahead of Print. Introduction: CancerSupportSource (CSS), a distress screening and referral program, identifies unmet needs of people with cancer and links them to resources and support. We developed and validated a Spanish-language version (CSS-Spanish) to better serve Hispanic and Latino communities and promote health equity. Methods: The 25-item CSS-Spanish was created leveraging rigorous translation methods and cognitive interviews to ensure cultural relevance and topical breadth. A total of 210 Spanish-speaking Hispanic and Latino individuals completed CSS-Spanish and comparison measures. Psychometric analyses examined dimensionality and statistical validation, and determined scoring thresholds for depression and anxiety risk subscales. Results: CSS-Spanish represented key concerns across five factors and exhibited strong internal consistency and test–retest reliability, convergent validity, and known-groups validity. Risk subscales demonstrated adequate sensitivity. Conclusion: CSS-Spanish is a reliable, valid multidimensional distress screener that rapidly assesses needs of Hispanic and Latino individuals. Embedded depression and anxiety risk flags can support staff in identifying those with high-acuity needs. Citation: Hispanic Health Care International PubDate: 2024-02-29T07:44:59Z DOI: 10.1177/15404153241230308
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Authors:Judith Aponte, Kelin Figueroa, Noreen B. Brennan, Lillian Diaz, William Ellery Samuels Abstract: Hispanic Health Care International, Ahead of Print. Introduction: Accurate demographic data are essential to identify and monitor differences, trends, and changes in diabetes-related conditions between Hispanics and non-Hispanic Blacks (NHBs). It also provides pertinent information to reduce health and racial disparities among English- and Spanish-speakers. Method: The study's design was a quantitative cross-sectional one. Electronic medical record (EMR) and survey data of the same sample were compared. Descriptive statistics were computed for ethnicity, preferred language, and physiological data. Frequency and percentages were calculated for each continuous and categorical variable. Chi-square was calculated to compare physiological variables by ethnicity and language. Results: During a 5-month period (September 2021–February 2022), 106 individuals from New York City with diabetes took part in this study. Among Hispanics, most from the EMR identified as Other (82.4%), whereas from the survey, most identified as White (57.1%). More Hispanics (19%) and Spanish speakers (18%) had high triglyceride levels compared to NHBs (2%) and English speakers (3%). Conclusion: Ensuring that demographic data are accurate can better inform programs. Because Hispanics and Spanish speakers had the highest triglyceride levels, diabetes programs need to include information on cardiovascular disease and must be available in Spanish, to further reduce risk factors, improve health outcomes, and promote health equity among these populations. Citation: Hispanic Health Care International PubDate: 2024-02-09T10:33:10Z DOI: 10.1177/15404153241229687
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Authors:Madeline Fernandez-Pineda, Carlos R. Melendez, Melanie Fernandez, Rosina Cianelli, Jessica Roman, Natalia Villegas, Yui Matsuda, Nilda Peragallo Montano Abstract: Hispanic Health Care International, Ahead of Print. Introduction: This study explored the influence of the Theory of Planned Behavior constructs on human papillomavirus (HPV) vaccine (HPVV) intentions and uptake among Hispanic parents in South Florida for their children aged 9–21. Method: A descriptive exploratory analysis was conducted using 39 surveys completed by Hispanic parents. These surveys encompassed demographic data and questions about HPVV uptake, intention, attitudes, subjective norms, knowledge, self-efficacy, and awareness. Results: Most participants were uninsured (77%), unemployed (59%), and had low Americanism acculturation (74%). A little over half were aware of the HPVV (54%), yet most had high positive HPVV attitudes (95%) and self-efficacy (85%). HPVV intentions within the year were also high (82%); however, HPVV uptake (45%) and HPVV knowledge (40%) were low at the time of the study. Most parents reported physicians (72%) and nurses/nurse practitioners (59%) as the most influential individuals in their decision-making. A statistically significant relationship between HPVV intention and HPVV attitude (X_Wald^2 (1) = 5.71, p = 0.02., OR = 5.11) and between HPVV uptake and HPVV awareness (X_Wald^2 (1) = 4.63, p = 0.03., OR = 12) were observed. Conclusion: This study recommends further research and targeted interventions to improve HPVV awareness among Hispanic communities. The participants’ highly positive attitudes and self-efficacy provide a hopeful outlook for future vaccination efforts within this demographic. Citation: Hispanic Health Care International PubDate: 2024-02-07T06:34:11Z DOI: 10.1177/15404153241229688
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Authors:Adriana Elena Hernández-Gamboa, Rudval Souza da Silva, María Fernanda Toloza Ardila, Yuly Paola Forero Manosalva, Mariana Isabella Velasco Álvarez, Luz Mery Contreras-Ramos Abstract: Hispanic Health Care International, Ahead of Print. Introduction: Death is a natural phenomenon inherent to the human condition and an inevitable consequence of life. As future professionals, nursing students should face the process of death and recognize their limitations, because emotional aspects can influence the quality of health care, especially in Spanish-speaking countries. This study aimed to quantify the level of fear of death among nursing students in a higher education institution in a region of Colombia. Methods: A quantitative correlational study including 258 university students selected by stratified sampling were administered the Collet–Lester Fear of Death Scale; the results were analyzed for the age, religion, marital status, number of children, and academic level of the respondents. Results: On average, the students were 22.9 years old; 83.3% of them were female, 75.6% were Catholic, 14.1% had at least one child, and 66.7% had experienced bereavement in the family. An association was found between the female gender and the fear of one's own death (p = .025). Conclusion: These findings differ from those reported in other Latin American countries where higher academic level and clinical experience are related to lower fear of death. Citation: Hispanic Health Care International PubDate: 2024-02-07T06:33:41Z DOI: 10.1177/15404153241229686
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Authors:Diana M. Llamas, Joanne C. Langan Abstract: Hispanic Health Care International, Ahead of Print. Introduction: Current disadvantages in accessing healthcare services, particularly mental health resources, result in increased psychological dysfunction among Hispanic women with advanced breast cancer. Little is known about using alternative nonpharmacological therapies for Hispanic women experiencing psychological distress secondary to a breast cancer diagnosis. This state-of-the-science paper synthesizes current culturally appropriate alternative therapies that effectively address depressive symptoms, anxiety, and psychological distress among Hispanic women with breast cancer (HWBC). Methods: The search criteria included published articles that used alternative interventions to address psychological needs among HWBC. Ten studies met the inclusion criteria. Results: Four alternative interventions were identified in the literature that significantly met the cultural mental health needs of HWBC. Mindfulness and technology use were the two interventions most studied in this review. Conclusion: Evidence indicates that alternative therapies for mental health improve overall quality of life. Further research to attenuate psychological distress is needed to meet mental health needs among HWBC. Innovative methods such as the use of technology and mindfulness as well as integrating personalized care are crucial to address the cultural needs of HWBC. Citation: Hispanic Health Care International PubDate: 2024-01-23T07:13:21Z DOI: 10.1177/15404153231226390
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