Purpose: To obtain rural breast cancer survivors’ perceptions of the quality and usability of CaringGuidance™ After Breast Cancer Diagnosis, a web-based, psychoeducational, distress self-management program; and explore the feasibility of gathering survivors’ perceptions about CaringGuidance™ using online focus groups (OFG)s. Participants and Setting: 23 survivors of early-stage breast cancer, mean 2.5 years post- diagnosis, living in rural Nebraska. Methodological Approach: Participants reviewed the CaringGuidance™ program independently over 12 days (mean) before their designated OFG. Extent of participants’ pre-OFG review of CaringGuidance™ was verified electronically. Four synchronous, moderated OFGs were conducted including 5 to 7 women per group. Demographic and OFG participation data were used to assess feasibility. Transcripts of OFGs were analyzed using directed content analysis. Findings: All enrolled women participated in their designated OFG. In assessing program quality, participants reflected on their past and present self and future women, within the context of their rural identity. Five themes of CaringGuidance™’s quality and usability were identified. Recommendations were used to modify CaringGuidance™ prior to pilot efficacy trial. Implications for Nursing: Findings contribute to nurses’ knowledge and guide assessment and intervention pertaining to psychosocial needs of rural women with breast cancer, OFGs, and qualities rural women seek in web-based psychological interventions.

Women experienced significantly more depressive symptoms than men initially and over time, although most women's symptoms improved. Measurement varies widely based on instrument and the inclusion/exclusion of somatic symptoms. More longitudinal studies beyond 6 months with prevalence data and analysis by sex/gender are needed.

Background: Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development.Methods: A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework.Results: Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was enduser focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. Conclusions:The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.

The concept of depression in women with coronary heart disease has been poorly defined for several reasons: numerous widely variable instruments that operationalize the concept, divergent proposed instrument cutoff scores, and continued lack of female participants and data analysis by gender in coronary heart disease research. In the forty articles from 1990 to 2018 evaluating depression in women with coronary heart disease, the concept is defined by specific somatic and cognitive symptoms, preceded by particular physiological and psychosocial vulnerabilities, and leads to poorer outcomes. Concept clarification is necessary for accurate diagnosis of depression, leading to more timely and appropriate interventions for women.