Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons

Open Access. Powered by Scholars. Published by Universities.®

Community Health and Preventive Medicine

Depression

Institution
Publication Year
Publication
Publication Type
File Type

Articles 1 - 30 of 38

Full-Text Articles in Medicine and Health Sciences

The Impact Of Stress During Adolescence And The Prevalence Of Pediatric Obesity, Olatunbosun Olakunri, Venkat Venkataraman May 2024

The Impact Of Stress During Adolescence And The Prevalence Of Pediatric Obesity, Olatunbosun Olakunri, Venkat Venkataraman

Rowan-Virtua Research Day

Obesity is a chronic condition that can be attributed to myriad factors including socioeconomic status, biological risk factors, and various environmental factors. These factors can be considered stress factors, and exposure to various levels of stress can impact the development of stress within the pediatric patients. The purpose of this study is to assess the association between the environmental, mental, social, physical, and psychological stress adolescents are exposed to and how they contribute to the prevalence of pediatric obesity throughout the United States. Understanding these risk factors can help us as a community and most importantly as clinicians develop better …


Gut Feelings: A Literature Review On The Gut-Brain Axis And Its Potential Influence On Mood, Grace Johnson Mar 2024

Gut Feelings: A Literature Review On The Gut-Brain Axis And Its Potential Influence On Mood, Grace Johnson

University Honors Theses

In recent decades, research on the gut-brain axis has evolved due to an increasing interest in the connection between gut health and mental health. The gut-brain axis presents a new frontier of health for both medical professionals and psychologists as there is expanding evidence illustrating the comorbidity of gut disorders and mood disorders. Due to the complex nature of studying the gut-brain axis and the myriad of influences on mood disorders such as depression, research has yet to find significant results definitively tying the two together. Nonetheless, the current body of literature on the topic provides a promising outlook on …


The Eyes Beyond The Screen: Digital Media Policy And Child Health, Yahia Al-Qudah Sep 2023

The Eyes Beyond The Screen: Digital Media Policy And Child Health, Yahia Al-Qudah

Research Symposium

Background: Modern communication technology and digital media have provided society with a foundation for instant messaging. Pictures, videos, and texts connect individuals with families, friends, and the world. Consequently, digital media has accelerated exposure to risk in which children and adolescents are most vulnerable. This project’s objective is to 1) congregate and highlight current knowledge about the impact of digital media on child health, and 2) underline deficiencies in related laws and regulations as well as offer solutions in digital media policy.

Methods: A systematic literature review was conducted through the JAMA Pediatrics database with keywords such as “digital media,” …


Mixed Method Approach Towards The Life Of University Students During The Covid-19 Pandemic, Raihan Khan, Andrew White, Tony Jehi Sep 2023

Mixed Method Approach Towards The Life Of University Students During The Covid-19 Pandemic, Raihan Khan, Andrew White, Tony Jehi

Department of Health Sciences - Faculty Scholarship

Background

The COVID-19 pandemic negatively impacted the higher education system. This mixed-methods study aimed to assess COVID-19 fear, anxiety, and stress among Shenandoah Valley college students.

Methods

An online survey was fielded and completed by n=680 students. Qualitative semi-structured interviews were conducted with 20 students.

Results

The mean participant age was 22.14±5.48 years, and primarily White (81.9%), women (80.4%), and undergraduate (78.0%) students. Approximately 41% were enrolled in health-related majors (41.4%). Women students had significantly higher anxiety, depression, and fear of contracting COVID-19 than men. Undergraduate students had significantly higher depression than graduate students. Qualitative analysis revealed several major themes: …


Worse Postoperative Outcomes And Higher Reoperation In Smokers Compared To Nonsmokers For Arthroscopic Rotator Cuff Repair, Susan G. Wager, Spencer Brown, Michael Gaudiani, Joshua P. Castle, Eric Jiang, Vasilios Moutzouros, Eric Makhni, Stephanie J. Muh Mar 2023

Worse Postoperative Outcomes And Higher Reoperation In Smokers Compared To Nonsmokers For Arthroscopic Rotator Cuff Repair, Susan G. Wager, Spencer Brown, Michael Gaudiani, Joshua P. Castle, Eric Jiang, Vasilios Moutzouros, Eric Makhni, Stephanie J. Muh

Medical Student Research Symposium

Introduction: Smoking impairs healing potential and is a significant risk factor for complications following orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmokers.

Methods: A retrospective review of patients who underwent rotator cuff repair was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 …


Affective Depression Mediates Ptsd To Suicide In A Sample Of Treatment-Seeking First Responders, James Whitworth, Jeanine Galusha, Jose Carbajal, Warren Ponder, Donna Schuman Mar 2023

Affective Depression Mediates Ptsd To Suicide In A Sample Of Treatment-Seeking First Responders, James Whitworth, Jeanine Galusha, Jose Carbajal, Warren Ponder, Donna Schuman

Faculty Publications

Objective: The aim of this study was to examine the associations of comorbid

posttraumatic stress disorder (PTSD), affective or somatic depression, and

suicide among first responders (FRs). Method: We used baseline data from

FRs (N = 232) who sought services at a nonprofit mental health agency specializing

in treating trauma exposed FRs. We conducted two PROCESS simple

mediation models with PTSD as the predictor, affective depression and somatic

depression as the mediators, and suicidality as the dependent variable.

Results: Affective depression significantly mediated the relationship between

PTSD and suicidality, whereas somatic depression did not. The direct effect …


Resilience And Prenatal Mental Health In Pakistan: A Qualitative Inquiry, Shireen Shehzad, David Arthur, An-Sofie Van Parys, Nicole Letourneau, Gail Wagnild, Shahirose Sadrudin Premji, Nargis Asad, Olivier Degomme Nov 2022

Resilience And Prenatal Mental Health In Pakistan: A Qualitative Inquiry, Shireen Shehzad, David Arthur, An-Sofie Van Parys, Nicole Letourneau, Gail Wagnild, Shahirose Sadrudin Premji, Nargis Asad, Olivier Degomme

School of Nursing & Midwifery

Background: Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention.
Methods: The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A …


The Impact Of Interruptions In Gender-Affirming Medical Care During Covid-19 On Anxiety And Depression Among Trans And Non-Binary People In Canada: A Longitudinal Study, Sara Todorovic Oct 2021

The Impact Of Interruptions In Gender-Affirming Medical Care During Covid-19 On Anxiety And Depression Among Trans And Non-Binary People In Canada: A Longitudinal Study, Sara Todorovic

Electronic Thesis and Dissertation Repository

Background. Transgender and non-binary (TGNB) populations experience disproportionally high levels of anxiety and depression; it is imperative we investigate how the COVID-19 pandemic may have impacted the mental health of TGNB communities. Methods. Among a Canadian sample of TGNB persons aged >=15 years, we used multiple linear regression to examine whether interruptions in gender-affirming care were associated with anxiety and depression, and whether that effect was modified by pre-pandemic mental health. Results. Anxiety and depression levels were high both pre-pandemic and during the pandemic. Approximately a quarter of TGNB persons experienced interruptions in hormonal care. After adjusting for confounders, there …


Examining The Impact Of Stressors, Depressive Symptoms, And The Moderating Role Of Traditional Latino Gender Norms In Miami Dade County, Gabriella Marie Wuyke Jun 2021

Examining The Impact Of Stressors, Depressive Symptoms, And The Moderating Role Of Traditional Latino Gender Norms In Miami Dade County, Gabriella Marie Wuyke

FIU Electronic Theses and Dissertations

Latino men experience disproportionate rates of depressive symptoms, compared to their non-Hispanic White counterparts. Factors related to immigration, culture, and the endorsement of traditional Latino gender norms can have deleterious effects on the mental health of Latino men. The aims of this research study were to examine the moderating role of traditional Latino gender norms among immigration and cultural stressors on depressive symptoms among Latino immigrant men in Miami-Dade County using three distinct data sets.

The first study (N= 279) examined the moderating role of machismo and caballerismo between negative context of reception (NCR) and depressive symptoms. Moderation analysis revealed …


Mindfulness-Based Interventions For Prenatal Stress, Anxiety, And Depression, Fiona Kate Rice May 2021

Mindfulness-Based Interventions For Prenatal Stress, Anxiety, And Depression, Fiona Kate Rice

Expressive Therapies Capstone Theses

Pregnant people in the United States (US) face myriad barriers to resource accessibility when seeking support, including financial gatekeeping, discrimination, and cis-gendering of the process. Commodification of prenatal support is exhaustive and contributes to a growing exclusivity of traditionally accessible interventions designed to reduce stress, anxiety, and depression, and to promote positive fetal outcomes and parent-child bond. Mindfulness-based interventions are particularly appropriate for reducing stress, anxiety, and depression in pregnancy. Mindfulness-based interventions are intersectional, accessible means of pregnancy and childbirth support with evidence-based outcomes of positive birth experiences and results. Mindfulness is defined as nonjudgmental awareness of the present moment. …


Adverse Childhood Experiences As Predictors Of Perceived Health: Assessing The Ace Pyramid Model Using Multiple-Mediation, Phillip Hughes, Tabitha L. Ostrout Oct 2020

Adverse Childhood Experiences As Predictors Of Perceived Health: Assessing The Ace Pyramid Model Using Multiple-Mediation, Phillip Hughes, Tabitha L. Ostrout

HCA Healthcare Journal of Medicine

Background: Adverse Childhood Experiences (ACEs) have been shown to contribute to a litany of mental and physical health problems, including several chronic diseases and death, via a model known as the ACE pyramid. Many of the results of ACEs in the ACE pyramid are known contributors to poor perceived health, which has significant health implications. Despite these results, a possible link between ACEs and perceived health has not been examined to date. Based on the temporal order of the ACE pyramid, we believe any relationship between ACEs and perceived health will be mediated by other components of the model.

Methods: …


Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden May 2020

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine …


Analytic Hierarchy Process: An Innovative Technique For Culturally Tailoring Evidence-Based Interventions To Reduce Health Disparities, Jaime A. Corvin, Isabella Chan, Claudia X. Aguado, Ian Dollman, Junius Gonzales Jan 2020

Analytic Hierarchy Process: An Innovative Technique For Culturally Tailoring Evidence-Based Interventions To Reduce Health Disparities, Jaime A. Corvin, Isabella Chan, Claudia X. Aguado, Ian Dollman, Junius Gonzales

Publications from Provost Junius J. Gonzales

Latinos in the United States represent a disproportionate burden of illness and disease and face barriers to accessing health care and related resources. Culturally tailored, evidence-based interventions hold promise in addressing many of these challenges. Yet, ensuring patient voice is vital in the successful development and implementation of such interventions. Thus, this paper examines the application of analytic hierarchy process (AHP) to inform the augmentation and implementation of an evidence-based chronic disease self-management programme for underserved Latinos living with both minor depression and chronic illness. The process of AHP allows for direct input from the individuals that would utilize such …


Addressing Adolescent And Young Adult Mental Health During The Covid-19 Pandemic, Megan Boyer Jan 2020

Addressing Adolescent And Young Adult Mental Health During The Covid-19 Pandemic, Megan Boyer

Family Medicine Clerkship Student Projects

This quality improvement project at South Burlington Family Medicine aimed to investigate the mental health of individuals ages 13-25 in our practice during the COVID-19 pandemic. Eligible patients received a PHQ-9 questionnaire with two additional questions related to COVID-19. Recommendations for future interventions to serve this population were made based on these preliminary findings, with the goal of doing a full PDSA cycle in the near future.


Integrative Pharmacotherapeutic Approaches To Treating Depression, Charlotte Tse Oct 2019

Integrative Pharmacotherapeutic Approaches To Treating Depression, Charlotte Tse

Independent Study Project (ISP) Collection

Traditional Chinese Medicine (TCM), based in the philosophy-religions of Buddhism, Confucianism, and Daoism, is more than a purely prescriptive medical system; it is a way of life focused primarily on the principles of prevention rather than the more reactionary direction that pharmacotherapy in the US has taken. Mental illness is expected to account for a quarter of China’s overall health burden by 2020, with depression affecting around 100 million people and nearly 30 percent of young Chinese adults. Conventional antidepressants have a delayed onset and unpredictable therapeutic efficacy in this condition, especially in mild to moderate cases of depression. In …


A Letter To My Departed Niece, * Anonymous * Jul 2019

A Letter To My Departed Niece, * Anonymous *

Journal of Patient-Centered Research and Reviews

The following piece was written in the weeks following the death of the author’s niece. It is an attempt to explore how we as a society handle health crises differently for medical versus mental health diagnoses.


Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr May 2019

Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr

Doctor of Nursing Practice Final Manuscripts

Purpose: Evaluation of an evidence-based protocol that measures the effectiveness of universal depression screening at an integrated healthcare center. At risk patients are those who complete a patient health questionnaire (phq-9) and score ≥ 10 when presenting for a primary care visit. A score of ≥ 10 prompts further evaluation by the primary care provider (PCP) prior to behavioral health care management (BHCM) referral.

Background: In 2016, 16.2 million adults aged 18 or older in the U.S. experienced a major depressive episode (MDE). 65.3% of those received some form of treatment from a healthcare professional (therapy and/or medication). Early identification …


Stress Reduction: Mindful Mandalas, Olivia Parrott, Carolyn Gillespie, Krystal Klag, Eleke Bonsi, Jenn Smith Apr 2019

Stress Reduction: Mindful Mandalas, Olivia Parrott, Carolyn Gillespie, Krystal Klag, Eleke Bonsi, Jenn Smith

Scholar Week 2016 - present

Mental Health is an ever-increasing topic of discussion in several sectors of today’s society. One career, law enforcement, seems to correlate job-related responsibilities with rising numbers in post-traumatic stress disorder, depression, and anxiety. A group of nursing students from Olivet Nazarene University sought to incorporate their understanding of stressors associated with the helping profession of law enforcement while researching cost-effective, evidence-based, self-care methods that have a proven ability to reduce signs of depression and anxiety. One such method is the practice of mindfulness.

Mindfulness must be understood fundamentally before it may be useful in practice in reducing the effects of …


Feeling Green: The Benefits Of Green Space On Urbanites' Mental Health, Kathryn A. Hoagland Mar 2019

Feeling Green: The Benefits Of Green Space On Urbanites' Mental Health, Kathryn A. Hoagland

Liberal Arts and Engineering Studies

This investigation intends to determine the best methods for incorporating public green space into dense urban areas, for the betterment of residents' mental health. Data from studies showing differences in the prevalence of anxiety and depression in urban and rural areas are discussed alongside data from studies looking at the effect that certain types of green space might have on mental health. While there is no exact consensus on the extent to which nature has positive effects on mental health there is enough of a correlation to argue for the implementation of public green spaces in urban design, in order …


The Contributing Factors To Adolescent Depression, Josie H. Lee Apr 2018

The Contributing Factors To Adolescent Depression, Josie H. Lee

Independent Study Project (ISP) Collection

Objective: This paper reviews individual, familial, peer, and societal factors influencing adolescent depression in developed countries. Background: Depression usually onsets at adolescence and contributes to high DALYs. Since depression is treatable, efforts should be made to reduce its prevalence and effect. Methods: The research consisted of looking at literature relevant to the topic and age group and conducting interviews with experts who know about and have worked with adolescent depression. Discussion: Adolescents begins at the onset of puberty, allowing different biological factors such as genetics, stress of puberty, and cognitive changes to increase vulnerability to depression. Adolescents who had substance …


Tipsheet: Student Mental Health And Resources, Unl Office Of The Executive Vice Chancellor Apr 2018

Tipsheet: Student Mental Health And Resources, Unl Office Of The Executive Vice Chancellor

Public Health Resources

Stress, depression, anxiety, alcohol abuse, eating disorders, and other mental health challenges affect at least 1 in 5 college students*. Faculty can be an important source of support for UNL students. Here are some strategies for supporting student mental health:

1. Communicate the importance of mental health. Mental health is just as important as physical health. When someone breaks a leg they go to the hospital. Mental illness is the same thing. If someone is feeling depressed they should seek treatment. Normalize mental health by talking about getting support if you notice your students struggling with stress, depression, anxiety, etc. …


Determining The Knowledge, Attitudes And Beliefs Of Healthcare Providers In Treating Non-Specific Acute And Chronic Back Pain, Stacey L. Kale May 2017

Determining The Knowledge, Attitudes And Beliefs Of Healthcare Providers In Treating Non-Specific Acute And Chronic Back Pain, Stacey L. Kale

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Stacey Kale

Managing back pain has become a public health and clinical challenge (Krein et al., 2016). Incidence of back pain related complaints requiring treatment in the US is estimated at 11.2% of the adult population (Dowell, Haegerich, & Chou, 2016). New research suggests that it is the most common pain problem (Pauline, 2016). It is the third most expensive health disorder and is exceeded only by cancer and heart disease. Many health care providers lack formal pain management education and training thus leaving them at risk for failing to properly manage patients …


Burnout Or Depression: Both Individual And Social Issue, Bianchi Renzo, Irvin Sam Schonfeld, Eric Laurent Jan 2017

Burnout Or Depression: Both Individual And Social Issue, Bianchi Renzo, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

In view of the profound problems attached to the construct of burnout, we recommended that occupational health specialists focus on (job-related) depression rather than burnout to help workers more effectively. Epstein and Privitera (April 8, 1398) rejected our recommendation on the grounds that burnout is not a “purely individual syndrome”. Problematically, Epstein and Privitera attributed to us an idea that is not ours. In these authors’ view, equating burnout with depression is synonymous with mistakenly individualising a social problem. For two reasons, the argument that depression cannot replace burnout because burnout is a social problem whereas depression is an individual …


What Are The Most Commonly Used Tools To Screen Depression In Hiv-Infected Gay And Bisexual Men?, Michael Isner Jan 2017

What Are The Most Commonly Used Tools To Screen Depression In Hiv-Infected Gay And Bisexual Men?, Michael Isner

Honors Undergraduate Theses

Gay and bisexual men infected with human immunodeficiency virus (HIV) comprise a sizable, medically vulnerable population. Depression is the most commonly experienced mental health disorder affecting this group of people, lending itself to a host of risks associated with depression. As screening of depression in this population can be challenging, it is vital that clinicians have the best available tools and guidelines to detect depressive symptomology. This focused, comprehensive review of the literature examined current data describing the clinical instruments used to detect depressive symptoms in HIV-infected gay and bisexual men. The aim of this analysis was to seek out …


Community Health News, Georgia Southern University Feb 2016

Community Health News, Georgia Southern University

Community Health Department News (2011-2018)

  • Georgia Southern Examines Latinos’ views of Co-Morbid Chronic Disease and Minor Depression


Association Between Social Integration And Health Among Internal Migrants In Zhongshan, China, Yanwei Lin, Qi Zhang, Wen Chen, Jingrong Shi, Siqi Han, Xiaolei Song, Yong Xu, Li Ling Jan 2016

Association Between Social Integration And Health Among Internal Migrants In Zhongshan, China, Yanwei Lin, Qi Zhang, Wen Chen, Jingrong Shi, Siqi Han, Xiaolei Song, Yong Xu, Li Ling

Community & Environmental Health Faculty Publications

Internal migrants are the individuals who migrate between regions in one country. The number of internal migrants were estimated at 245 million in China in 2013. Results were inconsistent in the literature about the relationship between their health statuses and social integration. The main difference exists on how to measure the social integration and whether health statuses of internal migrants improve with years of residence. To complement the existing literature, this study measured social integration more comprehensively and estimated the internal migrants' health statuses with varying years of residence, and explored the associations between the migrants' social integration and health. …


Maternal Obesity And Incidence Of Depression, Caroline A. Habjan May 2015

Maternal Obesity And Incidence Of Depression, Caroline A. Habjan

Honors Capstone Projects - All

Obesity is a national epidemic in the United States, which both directly and indirectly affects the social productivity of individuals, the American macro economy and individuals’ personal health and well being. Depression often interferes with an individual’s ability to work, sleep, study, eat, and enjoy life. A maternal state of both obesity and depression may cause serious adverse medical conditions in the mother’s child. Taking steps to treat depression and obesity are critical in the construct of modern medicine. This project yields results that have the potential to make treatment options better tailored, more efficient, effective and economically-sound for the …


Barriers To Depression Treatment Among Low-Income, Latino Emergency Department Patients, Anjanette A. Wells, Isabel T. Lagomasino M.D., Lawrence A. Palinkas, Jennifer Green, Diana Gonzalez Msw Aug 2013

Barriers To Depression Treatment Among Low-Income, Latino Emergency Department Patients, Anjanette A. Wells, Isabel T. Lagomasino M.D., Lawrence A. Palinkas, Jennifer Green, Diana Gonzalez Msw

Brown School Faculty Publications

Objectives. Low-income and Latinos use the emergency department (ED) as a primary source of care. Also, the depression prevalence in ED patients is high, making the ED a compelling venue for depression screening and intervention. This study examined barriers and facilitators to depression treatment among low-income, predominantly Latino ED patients. Methods. We conducted telephone interviews with 24 ED patients (18-62 years of age, 79% female) who dropped out of a depression treatment intervention. Using grounded theory, we analyzed perceptions of depression and treatment, and barriers and facilitators to mental health treatment. Results. Although most patients acknowledged signs of depression, there …


Health Effects Associated With Foreclosure: A Secondary Analysis Of Hospital Discharge Data, Nancy Menzel, Sheniz Moonie, Melva V. Thompson-Robinson Jan 2012

Health Effects Associated With Foreclosure: A Secondary Analysis Of Hospital Discharge Data, Nancy Menzel, Sheniz Moonie, Melva V. Thompson-Robinson

Nursing Faculty Publications

Objectives. The purpose of this study was to assess the health effects of high home foreclosure rates in an area of the United States of America and the utility of hospital discharge data for this purpose. Methods. We analyzed hospital discharge data from three postal zip codes using the principal diagnosis for 25 Diagnostic Related Groups associated with stress. Descriptive statistics were used to characterize hospital discharge rates for each condition by year and zip code. To test for differences across time, the Cochran-Armitage trend test was performed. Results. Most conditions did not demonstrate a statistical change between …


Reinvention Of Depression Instruments By Primary Care Clinicians, Seong-Yi Baik, Junius Gonzales, Barbara J. Bowers, Jean S. Anthony, Bas Tidjani, Jeffrey L. Susman May 2010

Reinvention Of Depression Instruments By Primary Care Clinicians, Seong-Yi Baik, Junius Gonzales, Barbara J. Bowers, Jean S. Anthony, Bas Tidjani, Jeffrey L. Susman

Publications from Provost Junius J. Gonzales

PURPOSE Despite the sophisticated development of depression instruments during the past 4 decades, the critical topic of how primary care clinicians actually use those instruments in their day-to-day practice has not been investigated. We wanted to understand how primary care clinicians use depression instruments, for what purposes, and the conditions that influence their use.

METHODS Grounded theory method was used to guide data collection and analysis. We conducted 70 individual interviews and 3 focus groups (n = 24) with a purposeful sample of 70 primary care clinicians (family physicians, general internists, and nurse practitioners) from 52 offices. Investigators’ field notes …