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Challenges to EBP utilization and fidelity should be monitored as EBPs contribute to the delivery of high-quality care. Collaborations between universities and rural agencies may support an agency's abilities to adopt EBPs, train staff, and systematically assess impact.

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Aim: The aim of this concept analysis was to examine stigma in the context of head lice, illuminating its components and providing insights for the development of appropriate nursing interventions.Background: Stigma associated with the phenomenon of head lice management is pervasive, promulgating fear and influencing policy and treatment practices. Few studies have examined stigma in this context. Method:The method followed was the Rodgers's evolutionary method. Data Sources: Health, education, and social sciences databases were searched and yielded 20 articles spanning 1996-2018 used to create a relevant literature review. Results: Stigma arising from head lice infestation is preceded by an actual or perceived case of head lice, negative perceptions of lice, negative perception of groups or persons with head lice, or being associated with a group or person of lesser status believed to be a carrier of head lice. Defining attributes include marks of infestation, negative and unfair beliefs, and shame. Consequences of stigma are economic costs, social costs, mistreatment, and overtreatment with pediculicides. Conclusion: The concept of stigma in the context of head lice management is multifaceted. Further research is required to understand the magnitude of stigma as well as other factors associated with optimal treatment of children with head lice. K E Y W O R D S concept analysis, head lice, Pediculosis capitus, school and pediatric nursing, stigma AUTHOR BIOGRAPHIES

Background American Indian (AI) and Alaska Native (AN) communities experience disproportionately high rates of tobacco use when compared to the overall U.S. population, especially among rural populations. Methods We implemented a single-blind, randomized clinical trial of a text messaging-based smoking cessation intervention through the tobacco quitlines of five states (Alaska, Minnesota, New Mexico, Oklahoma, and Wisconsin) with high percentages of AI residents. We partnered with state quitlines and Optum, a multi-state entity that manages quitlines. Participants who called the quitlines and identified as AI/AN were given the option to enroll in this trial. Upon consent, they were randomly assigned to either the standard quitline program (control) or a program culturally tailored for AI/ANs (intervention), which used a text messaging intervention to encourage smoking cessation. We adapted the text messages based on key informant and focus group input. Baseline data was analyzed for differences across age, sex, and the Fagerström Test for Nicotine Dependence. Results We recruited n = 487 AIs into the trial. Participants had an average age of 41.9 years (SD = 11.7) and 66% were female. The average Fagerström Test for Nicotine Dependence score was 5.38 (SD = 2.37). The intervention and control arms did not significantly differ across any of the baseline characteristics. Conclusion Implementation of this trial illustrated important lessons in adapting, implementing, and evaluating trials in collaboration with AI communities and local and national organizations. This work will inform future efforts to implement culturally-tailored interventions with AI/ANs and advance our knowledge about adapting and implementing smoking cessation interventions.