Women in Africa may have experienced conflicting pressures during the COVID-19 pandemic. While the unpredictable nature of the pandemic was prompting some women to delay pregnancies, the pandemic was potentially limiting access to reproductive health services due to supply shortages, fears of virus exposure, and mobility restrictions. In this study, we used longitudinal data from Kenya and Burkina Faso and applied a multilevel perspective to better understand the factors contributing to change or persistence in contraceptive use during the early months of the pandemic. We found a marginal increase in contraceptive uptake in the early days of the pandemic. Multilevel logistic regression results revealed that interpersonal trust and accurate knowledge of COVID-19 precautions were associated with a greater likelihood of initiating contraception. These factors appeared to have provided women with confidence to navigate the complicated COVID-19 landscape. At the same time, we observed a decrease in contraceptive use in regions with high COVID-19 cases, suggesting the virus was limiting access to contraception in some contexts. These findings highlighted the need for public health officials to ensure that women have the necessary knowledge and ability to safely access contraception during public health crises, when overall demand for contraception may be increasing.

BACKGROUND: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. OBJECTIVE: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. METHODS: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. RESULTS: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. CONCLUSIONS: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation.

Negative health events can cause considerable stress in patients, negatively impacting both physical health and psychological well-being. To cope, many patients turn to socially supportive interactions and social media has become an important tool for accessing social support networks. However, research on the mental and physical health outcomes of social media-enabled social support seeking has produced conflicting results. This inconsistency in research findings has made it difficult for practitioners to make recommendations to patients on how to access online social support following negative health events. In this short commentary, I argue that effective access to stress-buffering social support online is intimately tied up in features of the social media platforms through which that support is transmitted. I propose three theory-backed distinctions between social media platforms with the goal of directing users toward effective, helpful social media engagement following negative health events.

BACKGROUND Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver's burden by simplifying ADRD health care management. OBJECTIVE This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach. METHODS Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants' characteristics as well as PHR-ADRD use and experiences based on overall favorability status. RESULTS Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants. CONCLUSIONS Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system.

Migration has long been used as a strategy for livelihood diversification in rural, subsistence communities. Yet in order for migration to effectively serve as a livelihood diversification strategy, it should meet certain conditions: migration should ease financial burdens, should confer access to economically valuable resources and information, and should broaden social networks. Using qualitative data gathered in 25 interviews with rural migrants to Oua-gadougou, Burkina Faso, we examine how mobile phone technology has impacted migration as a livelihood diversification strategy. Our results show that while mobile phones facilitate migration, the advantages conferred may benefit migrants at the expense of the home communities. Mobile phones alleviate financial constraints, enable access to broader networks, and facilitate informational and resource support among migrants. Our results show limited evidence of migrants using mobile phone technology to provide resources or information to the home community. Our results highlight the need to reconsider the ways in which migration can be used as a livelihood diversification strategy in light of changing communication technologies to promote the economic success of both migrants and their home communities.

Adolescent and young adult (AYA) childhood cancer survivors (CCS) should be empowered to continue their survivor-focused care as they transition into adult medicine. However, the majority of AYA-aged survivors become lost to follow up around the age of typical transition to adulthood. The purpose of this study was to identify, from the patient’s perspective, key factors that facilitate successful transitions to adult-centered survivorship care. A qualitative study was conducted with AYA CCS (n = 29) from the survivorship clinic of a single institution as key informants. Data were collected through a series of structured phone interviews and subjected to thematic content analysis. Four major themes with multiple subthemes were identified: (1) transition practices need to be flexible and individually tailored; (2) effective communication is critical to a successful transition; (3) continuity in providers is needed during the transition; and (4) comprehensive care means care that also addresses psycho-social well-being. From the perspective of AYA CCS, the ideal model of transitional survivorship care could include a patient navigator who promotes provider flexibility, consistent communication, and pro-active comprehensive care that encompasses both medical and psycho-social well-being. Models of care for CCS should be built to provide, or seamlessly facilitate, continuous survivor-focused care across the age continuum. A longitudinal relationship with a survivor-focused provider can help promote the values that CCS’ report as important in transitioning care from pediatric- to adult-centered care.

Poor women who live in peri-urban communities are often faced with food insecurity due to seasonal variations in food availability and accessibility. Additionally, in these communities, fertility levels are often elevated despite geographic proximity to urban areas with low cost contraception. We conducted five focus group interviews to investigate the lived experiences of childbearing in peri-urban Ouagadougou, Burkina Faso to understand the behavioral and biological determinants of fertility outcomes. In the analysis of the interviews we pay particular attention to seasonal food insecurity experiences and the biological and behavioral determinants of childbearing. Our results suggest that there are less optimal times of year for childbearing and that poor, peri-urban women adjust their behavior accordingly. The results also suggest that there remain important barriers to contraceptive use even in cases where individuals associate pregnancy and childbearing with physical and psychological risk. This paper provides greater depth in understanding the determinants of fertility in resource-poor, peri-urban communities and points to some barriers for lowering fertility in similar areas.

Campuses across the United States continue to welcome a record number of Chinese students coming in pursuit of both academic and cultural goals. Yet, high levels of acculturative stress coupled with difficulties integrating into life abroad jeopardize accomplishing these goals. In this study, we examine Chinese students’ Internet use both prior to and during study abroad, and its effects on stress, integration, and learning while abroad. In-depth interviews were conducted with 18 undergraduate and graduate students from China currently studying in the United States. Findings indicate that although online media and resources provide valuable information to Chinese students, they may also set the stage for entry into established, cohesive co-national peer groups, thereby discouraging integration.

Post-migration stressors represent significant obstacle to refugee adjustment, and continued exposure to post-migration stressors can negatively affect mental and physical health. Communities of support maintained over the Internet may provide a sense of constancy and reliability that may insulate against the negative effects of stress. We conducted five focus group interviews with Iraqi and Sudanese refugees to understand how refugees use the Internet to access support in their daily lives. Four trends were observed: (a) Internet use was related to culture of origin, (b) refugees were reluctant to explore online, (c) children served as brokers of online knowledge, and (d) limited Internet access is associated with increased time and financial obligations. This study aims to contribute to theory on Internet-mediated social support and to refugee health by creating smoother pathways to self-sufficiency and allowing refugees to exhibit agency in constructing and maintaining online networks of support.

This study analyzes images and associated commentary from an online image-sharing community (www.imgur.com). We hypothesize that, in the presence of overt communication of social rules, site content will reflect a somewhat consistent, content convergence irrespective of who comments, given that an individual’s social identity, rather than their individual identity, will dominate their online interactions. We began with a random sample of 5000 images, and we grouped those images into six categories. We then randomly selected 10 images from each category, and conducted a close qualitative analysis of the micro-comments submitted in response to those images. Our results suggest that there is an overt communication of behavioral standards through explicit behavior correction by other site members. Content convergence can also be observed both in responses to a single image, and more broadly in comment similarity across images and even categories. Cultural norms and resulting content convergence suggests that individuals may come to see themselves as representatives of the site when they post – and may modify their behavior accordingly. This may lead to the perception that a common voice appears throughout the site, which may have implications for the communication of social support over the Internet, and for more quantitative analyses.

This review of literature from multiple disciplines argues that the Internet is useful both in communicating support, and in the rapid reestablishment of socially supportive peer networks, when an individual’s support needs change following a transition. We extend prior typologies of transition by identifying common features and outcomes of transition. We subsequently describe how transition involves a loss of social support networks and social capital, leading to increased stress and decreased wellbeing. Finally, we examine the features of computer mediated social support, and how those align with support needs following a transition. This paper provides a theoretical underpinning and a common language for the study of transition and its associated stress. The paper also suggests that computer-mediated social support may in some instances be superior to available face-to-face support options for managing the transitional factors affecting stress.

As the old model of study abroad welcomes a new generation of student, administrators are forced to grapple with how and whether to adapt the old model to new communication technologies. Assumed in the traditional model of study abroad, and in the cultural and language learning theories around which those programs were constructed, is that learning takes place in face-to-face (FTF) encounters with the host culture. Under these assumptions, the Internet is merely a distraction and ought to be avoided during study abroad. However, more recent research on Internet-mediated communication no longer situates Internet-mediated communication as diametrically opposed to FTF communication. Study abroad participants and administrators have long grappled with how to decrease stress and increase integration during study abroad. Literature on Internet-mediated social support, and computer-mediated communication, suggests that the Internet may be an effective means through which to access socially supportive peer networ...

F r o n t i e r s : T h e I n t e r d i s c i p l i n a r y J o u r n a l o f S t u d y A b r o a d

Following COVID-19, the CDC asked individuals to social distance and state and local authorities nationwide began issuing curfews and recommendations to "shelter-in-place." Known to be more susceptible to the negative effects of COVID-19 and often coping with higher levels of social isolation, many worried that older adults' mental health would suffer. While computer-mediated communication (CMC) is on the rise among older adults, whether and how older adults leverage the social benefits of CMC remains underexplored. This study assesses older adults' CMC use after COVID and the impact of CMC engagement on access to connection, information, and resources. We follow 22 older adults over 6 weeks, using longitudinal qualitative surveys to study CMC use patterns and mental health outcomes. Results revealed that while older adults exhibited purpose-driven CMC engagement, limited integration into larger online communities restricted access to up-to-the-minute information, notably early in the pandemic. Longitudinal findings show progressively less engagement with online news and information, withdrawal from online social engagement, and a progressive relaxing of social distancing. This study sheds light on how best to reach older adults following disaster, and where older adults may be disadvantaged as social media becomes a modern "emergency broadcast system."

Mobile Health (mHealth) interventions have received a mix of praise and excitement, as well as caution and even opposition over recent decades. While the rapid adoption of mHealth solutions due to the COVID-19 pandemic has weakened resistance to integrating these digital approaches into practice and generated renewed interest, the increased reliance on mHealth signals a need for optimizing development and implementation. Despite an historically innovation resistant medical ethos, mHealth is becoming a normalized supplement to clinical practice , highlighting increased demand. Reaching the full potential of mHealth requires new thinking and investment. The current challenge to broaden mHealth adoption and to ensure equity in access may be overcoming a "design purgatory," where innovation fails to connect to practice. We recommend leveraging the opportunity presented by the COVID-19 pandemic to disrupt routine practice and with a new focus on theory-driven replicability of mHealth tools and strategies aimed at medical education and professional organizations.