Publications

The novel coronavirus disease (COVID-19) pandemic that has swept our country has led to significant community-wide disruptions in all sectors of public and private life. In the weeks and months following the pandemic, many communities faced inadequate access to essential supplies such as food and diapers, reduced access to health care, and a widening digital divide (Peretz et al., 2020). To date, Texas has had over 2.9 million cases of infections and 52,000 deaths from COVID-19 (Texas Department of State Health Services, 2021). The devastations of the pandemic in Texas have intensified the longstanding structural drivers of health inequities such as adverse working conditions, growing economic disparities, and limited resources and access to essential goods and healthcare services (Logan & Castañeda, 2020).

Recto, P., Lesser, J., Zapata, J., Jr, Moreno-Vasquez, A., Gandara, E., Zavala Idar, A., & Castilla, M. (2022). The Development and Implementation of a COVID-19 Project ECHO: A Program for Community Health Workers Serving Populations from Rural and Medically Underserved Areas in South Texas. Issues in mental health nursing, 43(2), 184–188. https://doi.org/10.1080/01612840.2021.1954449

As part of a new directive, the Human Resources Services Administration (HRSA) mandated Area Health Education Center (AHEC) Programs across the nation to implement an interprofessional education (IPE) program for health professional students, with the goal of fostering collaborative practice among health profession students and motivating students to work in medically underserved areas post-graduation. The South Texas AHEC Program collaboratively developed and implemented a co-curricular IPE initiative, the AHEC Scholars Program, including didactic and practicum components, focused on the needs of communities in our area. A pre-post quasi-experimental design was used to evaluate the student outcomes related to IPEC Competencies and knowledge and preparation for the practice of core topic areas mandated by HRSA. Student outcomes showed statistically significant improvement in all measures. In order to obtain more detailed accounts of students' practicum experiences, students were asked to complete reflective journals after each practicum. The AHEC Scholars Program provides students with opportunities to work with underserved populations and enables students to explore the benefits of team-based care. This article summarizes the collaborative process of the development and implementation of the AHEC Scholars Program; secondly, it details student outcomes from a 3-month pilot study.

Moreno-Vasquez, A., Gandara, E., Idar, A. Z., Recto, P., Zapata, J., Jr, & Lesser, J. (2021). Developing and implementing a co-curricular IPE program: AHEC Scholars Program. Public health nursing (Boston, Mass.), 38(6), 1080–1087.

The purpose of this secondary analysis of qualitative data was to understand the multifactorial influences that impact the health and health behaviors of Hispanic adolescent fathers DESIGN & METHODS: Qualitative description was the method used for this secondary analysis. The theoretical domains of the Vulnerable Populations Conceptual Framework were used to guide this study. The semi-structured interviews of 17 participants were analyzed using qualitative content analysis. Participants were Hispanic adolescent fathers, between the ages of 16 and 23 years, who were attending a fatherhood program. Most participants came from socioeconomically disadvantaged backgrounds and unstable families. Additionally, their exposure to widespread neighborhood and domestic violence resulted in gang involvement and illegal activities. The cumulative impact of adverse childhood events resulted in substance use and psychological distress. However, becoming a father was transformative, motivating adolescents to stop engaging in destructive, unhealthy behaviors. Adolescent fathers' well-being is an important component of perinatal health because it affects family functioning and health outcomes in their children. The perinatal period presents a "golden" opportunity to promote health and should be leveraged by nurses to allow adolescent fathers to become involved during the perinatal period. A family-centered approach is critical in addressing the complex needs of this population. An assessment of their psychosocial environment, including childhood trauma, is necessary to help nurses identify at-risk fathers. Additionally, trauma informed care is a valuable tool that nurses can utilize to foster trust in Hispanic adolescent fathers.

Recto, P., & Lesser, J. (2021). Adolescent Fathers’ Perceptions and Experiences of Fatherhood: A Qualitative Exploration with Hispanic Adolescent Fathers. Journal of pediatric nursing, 58, 82–87.

This study examined how the effects of the COVID-19 crisis has impacted young Hispanic fathers. Using qualitative description, in-depth interviews were conducted among Hispanic fathers between the ages of 18 and 24 years, from community-based fatherhood program. The interviews of seven young Hispanic fathers were analyzed using qualitative content analysis. The participants’ initial and ongoing fears about COVID-19 resulted from not having adequate information about the severity of the disease and how easily one can contract and transmit it to others. They also expressed concerns about the threat of the pandemic on their family's well-being, finances, and employment status. Providing for their families was their main priority, with some continuing to work, despite the risks of becoming infected with COVID-19. Despite their many hardships, fathers found strength in their families and remained hopeful in overcoming the challenges during the pandemic. The pandemic has presented difficulties and loss for many. Nurses in the community are well positioned to serve young Hispanic fathers to ensure their needs are met. A family-centered approach is ideal for young fathers to provide them equal opportunity to be actively involved in promoting health for themselves and their families during the pandemic.

Recto, P., & Lesser, J. (2021). Young Hispanic fathers during COVID-19: Balancing parenthood, finding strength, and maintaining hope. Public health nursing (Boston, Mass.), 38(3), 367–373.

Public health crises, such as the coronavirus disease 2019(COVID-19) pandemic, have led to significant community-wide disruptions in all sectors of public and private life. The pandemic also has revealed inequities in certain populations, amplifying social and economic factors that further contribute to poor mental health outcomes (Substance Abuse and mental Health Services Administration [SAMHSA], n.d.).What is commonly seen during national crises and disasters is that those who are impoverished, unemployed, marginalized, and represent ethnic minority groups are disproportionately harmed physically, emotionally, economically, and educationally (Fortuna et al., 2020). One such group that has been impacted by the pandemic is adolescent fathers

Recto, P., Lesser, J., Moreno-Vasquez, A., Zapata, J., Jr, & Zavala Idar, A. (2021). Supporting the Mental Health Needs of Adolescent Fathers during COVID-19: Opportunities for Nursing Practice and Community-Based Partnerships. Issues in mental health nursing, 42(7), 702–705.

Opioid use disorder is a growing public health concern in South Texas. To assist in mitigating the effects of this epidemic, staff produced a program that focused on replicating, modifying, and evaluating the impact of the "Opioid Addiction Treatment ECHO™ (Extension of Community Health Outcomes) for CHWs (community health workers) program" on 26 CHWs practicing in rural and other medically underserved areas through teleconferencing technology. CHWs trained on the topic of substance use disorder concentrated on behavioral health integration with a focus on opioid prescription misuse. The analysis found that knowledge attainment was increased above the pretest means. The ECHO™ model proved to be effective at linking subject matter experts and specialists at an academic "hub" with CHWs in local communities.

Zapata, J., Jr, Colistra, A., Lesser, J., Flores, B., Zavala-Idar, A., & Moreno-Vasquez, A. (2021). Opioid Use Disorder ECHO: A Program Evaluation of a Project That Provides Knowledge and Builds Capacity for Community Health Workers in Medically Underserved Areas of South Texas. Issues in mental health nursing, 42(4), 381–390.

Using a life course theory perspective, this qualitative descriptive study explored how Hispanic adolescent fathers view fatherhood, and how their perception of parenthood is shaped by critical life events. Hispanics are one of the largest ethnic groups, as well as one of the populations that is overrepresented in adolescent births in the United States. Despite this, Hispanic adolescent fathers are understudied and underrepresented in research. Participants were recruited from a community-based fatherhood program. Semi-structured interviews were conducted with Hispanic fathers, ages 16 years to 23 years. Participants conveyed their grief over fragmented family relationships and limited interactions with their own father. Some lived in hostile environments where they frequently experienced racism, discrimination, and neighborhood violence. The cumulative impact of these events resulted in substance use and emotional distress. Becoming a father was a sentinel event that helped resolve negative perceptions about fatherhood. Fatherhood also motivated participants towards a more productive, meaningful life.

Recto, P., & Lesser, J. (2020). The Parenting Experiences of Hispanic Adolescent Fathers: A Life Course Theory Perspective. Western journal of nursing research, 42(11), 918–926.

Recto, P., & Lesser, J. (2021). “Fathers Need Help Too”: Adolescent Fathers and Depression. Issues in mental health nursing, 42(5), 515–518.

Access to diabetes education and resources for diabetes self-management is limited in rural communities, despite higher rates of diabetes in rural populations compared with urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings. This two-phase Stage 1 feasibility study aimed to use a mixed methods design to examine the feasibility and acceptability of an mHealth diabetes education program combining SBIRT and financial incentives to engage rural individuals. In Phase 1, we aimed to develop, adapt, and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from 2 rural communities in South Texas. Study participants were individuals who attended free diabetes screening events in their community. Those with low or medium risk received health education material, whereas those with high risk or those with a previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were determined by the rate of participant recruitment and retention, the fidelity of program delivery and compliance, and the participant's satisfaction with the intervention program. Of the 98 screened rural community members in South Texas, 72 individuals met the study eligibility and 62 individuals agreed to enroll in the study. The sample was predominately female and Hispanic, with an average age of 52.6 years. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the poststudy survey, the participants reported high levels of confidence to continue lifestyle modifications, that is, weight loss, physical activity, and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks regardless of the incentive contract type. Positive changes were observed in weight (mean -2.64, SD 6.01; P<.05) and glycemic control index (-.30; P<.05) in all participants from baseline to follow-up. The finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants' participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Combining mHealth with SBIRT has the potential to reach individuals with need to participate in diabetes education in rural communities

Yin, Z., Lesser, J., Paiva, K. A., Zapata, J., Jr, Moreno-Vasquez, A., Grigsby, T. J., Ryan-Pettes, S. R., Parra-Medina, D., Estrada, V., Li, S., & Wang, J. (2020). Using Mobile Health Tools to Engage Rural Underserved Individuals in a Diabetes Education Program in South Texas: Feasibility Study. JMIR mHealth and uHealth, 8(3), e16683.