The Utility of Template Analysis in Qualitative Psychology Research

From "It Has Stopped Our Lives" to "Spending More Time Together Has Strengthened Bonds": The Varied Experiences of Australian Families During COVID-19

The present study uses a qualitative approach to understand the impact of COVID-19 on family life. Australian parents of children aged 0-18 years were recruited via social media between April 8 and April 28, 2020, when Australians were experiencing social distancing/isolation measures for the first time. As part of a larger survey, participants were asked to respond via an open-ended question about how COVID-19 had impacted their family. A total of 2,130 parents were included and represented a diverse range of family backgrounds. Inductive template thematic analysis was used to understand patterns of meaning across the texts. Six themes were derived from the data, including "Boredom, depression and suicide: A spectrum of emotion," "Families are missing the things that keep them healthy," "Changing family relationships: The push pull of intimacy," "The unprecedented demands of parenthood," "The unequal burden of COVID-19," and "Holding on to positivity." Overall, the findings demonstrated a breadth of responses. Messages around loss and challenge were predominant, with many families reporting mental health difficulties and strained family relationships. However, not all families were negatively impacted by the restrictions, with some families reporting positive benefits and meaning, including opportunities for strengthening relationships, finding new hobbies, and developing positive characteristics such as appreciation, gratitude, and tolerance.

Self-determination theory in acute child and adolescent mental health inpatient care. A qualitative exploratory study

Introduction

There is a dearth of research to guide acute adolescent mental health inpatient care. Self-determination Theory provides evidence that meeting needs for relatedness, autonomy and competence is likely to increase wellbeing and intrinsic motivation. These needs may be able to be met in the inpatient environment.

Method

This qualitative study aimed to explore young people’s experience of acute mental health inpatient care with particular attention to meeting of these three needs. Fifteen young people were interviewed. The importance of relatedness with staff, other young people and families was identified.

Results

Relatedness with staff and peers were valued parts of admission. Some young people describe enhanced relatedness with family. They described loss of autonomy as a negative experience but appreciated opportunities to be involved in choices around their care and having more freedom. Coming into hospital was associated with loss of competence but they described building competence during the admission. Engaging in activities was experienced positively and appeared to enhance meeting of all three needs. Meeting of the three needs was associated with an experience of increased safety.

Conclusions

Engaging young people in activities with a focus on relatedness, autonomy and competence may have specific therapeutic potential. Autonomy, experience of competence and connection with staff may enhance safety more effectively than physical containment. Peer contact may have untapped therapeutic value we understand little of. This study supports the value of Self-determination Theory as a guide day to day inpatient care to meet the needs of adolescents for relatedness, autonomy and competence.

What Sexual and Gender Minority People Want Researchers to Know About Sexual Orientation and Gender Identity Questions: A Qualitative Study

Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation. We conducted a qualitative study to answer the question, "For SGM people, what are the major limitations with current SOGI questions?" Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Questions were refined and presented in semi-structured cognitive interviews. Template analysis using a priori themes guided analysis. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. We present recommendations for future development and use of SOGI measures. Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities.

A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT

BACKGROUND

Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (BRiMS), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility.

OBJECTIVE

This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial.

DESIGN

Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework.

SETTING

Four sites across the UK.

PARTICIPANTS

Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months.

INTERVENTIONS

Intervention - manualised 13-week education and exercise programme (BRiMS) plus usual care. Comparator - usual care alone.

MAIN OUTCOME MEASURES

Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the BRiMS programme (via process evaluation) and economic data.

RESULTS

A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0-6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 -7.7 [95% confidence interval (CI) -17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI -7.8 to 9) and MSIS-29vs2 psychological -0.4 (95% CI -9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0-93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking BRiMS. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of BRiMS were highlighted.

CONCLUSIONS

The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries.

FUTURE WORK

Further development of BRiMS is required to address logistical issues and enhance user-satisfaction and adherence. Following this, a definitive trial to assess the clinical effectiveness and cost-effectiveness of the BRiMS intervention is warranted.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN13587999.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 27. See the NIHR Journals Library website for further project information.

Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis

BACKGROUND

Vaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination.

OBJECTIVE

This study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa.

METHODS

The 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa.

RESULTS

Ethical review submission is planned for October 2020. Data collection is expected to be underway in January 2021.

CONCLUSIONS

The extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/16672.

Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol

BACKGROUND

Use of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism. However, incorrect dosing of these medications is common and puts patients at risk of adverse drug events. One way to improve safe prescribing is the use of population health tools, including interactive dashboards built into the electronic health record (EHR). As such tools become more common, exploring ways to understand which aspects are effective in specific settings and how to effectively adapt and implement in existing anticoagulation clinics across different health systems is vital.

METHODS

This three-phase project will evaluate a current nation-wide implementation effort of the DOAC Dashboard in the Veterans Health Administration (VHA) using both quantitative and qualitative methods. Informed by this evaluation, the DOAC Dashboard will be implemented in four new health systems using an implementation strategy derived from the VHA experience and interviews with providers in those new health systems. Quantitative evaluation of the VHA and non-VHA implementation will follow the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Qualitative interviews with stakeholders will be analyzed using the Consolidated Framework for Implementation Research and Technology Acceptance Models to identify key determinants of implementation success.

DISCUSSION

This study will (1) evaluate the implementation of an EHR-based population health tool for medication management within a large, nation-wide, highly integrated health system; (2) guide the adoption in a set of four different health systems; and (3) evaluation that multi-center implementation effort. These findings will help to inform future EHR-based implementation efforts in a wide variety of health care settings.

Regulatory inspection of registered private drug shops in East-Central Uganda-what it is versus what it should be: a qualitative study

Background

Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers.

Methods

Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done.

Results

Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection.

Conclusion

The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.

'More extraordinary than mundane … ' A phenomenological analysis of the experiences of individuals living with CLE and their taking care in the sun

Introduction

CLE is a chronic inflammatory autoimmune condition of which photosensitivity is a major symptom. Individuals living with CLE are advised to practice photoprotection. Despite the benefits for disease control, many individuals living with CLE do not practice optimal photoprotection. The aim of this study was to gain a deep insight into the lived experiences of individuals with CLE and their photoprotective practices.

Methods

A qualitative study approach was conducted, using Hermeneutic phenomenology. Individuals living with CLE were recruited and interviewed. Rich pictures were used to enrich the interviews. Interviews were transcribed and analysed using Template Analysis.

Results

Analysis revealed four themes: ‘Much more than just a photosensitive skin condition’, ‘The impact of sun on CLE and social dynamics’, ‘Drifting to the sun: personal transitions and social norms’ and ‘Taking care in the sun: easier said than done’.

Discussion and conclusion

This study provides a nuanced insight into the lived experiences of individuals with CLE and their photoprotective practices. Taking care in the sun is not a simplistic process. Beyond the biomedical model of illness, the social impact that CLE has on individuals has a dominant influence on their photoprotective behaviours. Such insights could help healthcare professionals tailor photoprotective advice.

Development and validation of a postgraduate anaesthesiology core curriculum based on Entrustable Professional Activities: a Delphi study

Background: Postgraduate training curricula should not be based on time-spans or predefined numbers of performed procedures. One approach to link competencies to clinical tasks is the concept of Entrustable Professional Activities (EPA). The goal of this study was the definition, ranking and validation of EPAs for anaesthesiology postgraduate training and the creation of an anaesthesiologic core curriculum. Methods: Anaesthesiologists of different levels of training participated in the study (single-center, cross-sectional) . First, an expert group defined a preliminary list of EPAs. Then a first Delphi round (n= 47 participants) was applied to identify daily anaesthesiology tasks with the goal to define EPAs. From the first Delphi round a new set of EPAs was defined, using the template and mapping method. Through an alignment process, conducted by the expert group, the preliminary EPAs and the new set of EPAs from the first Delphi round were summarised into a new list of EPAs. This list was presented to the study participants in a second Delphi round (n=80 participants), with the goal to validate and rank each EPA and to define the year of entrustment. For this purpose, participants were asked in the second Delphi round if each EPA should be included into an anaesthesiology core curriculum and in which year of training entrustment should take place. Furthermore, they were asked to rank each EPA on a numeric scale, defining its importance. From this numeric scale, the content validity index (CVI) for each EPA was calculated. Consensus of the results from the second Delphi round was calculated, using the one-way random effects model to calculate Intra-Class-Correlations (ICC). Percentages of agreement among the whole set of EPAs of this study and a previously published set of EPAs were computed. Results: A core-curriculum comprising of 39 EPAs was developed. The EPAs were subdivided into superior/high and inferior/low scoring EPAs, reflecting their importance and were mapped to the year of entrustment. The results reached high consensus among the different participating anaesthesiologist groups (overall agreement was 0.96 for the CVI of each EPA and 0.83 for the year in which the EPAs should be entrusted). Agreement with the previously defined set of EPAs was 73.3%. Conclusion: This study provides a further step in transforming postgraduate anaesthesiology training into a more contemporary approach. Other studies are necessary to complete and amend the presented core curriculum of EPA based postgraduate anaesthesiology training.

Feasibility and acceptability of a telephone and web-based stroke caregiver intervention: a pilot randomized controlled trial of the RESCUE intervention

OBJECTIVE

Assess the feasibility and acceptability of an Internet and telephone support and problem-solving intervention for stroke caregivers.

DESIGN

Randomized controlled pilot trial with four arms: four-week intervention (n = 13), eight-week intervention (n = 13), eight-week attention control (n = 13), and standard care (n = 14).

SETTING

Southeastern U.S. Veterans Health System.

PARTICIPANTS

Informal caregivers of Veterans who suffered a stroke in the preceding 2.5 years were enrolled over an 18-month period.

INTERVENTIONS

Intervention participants received RESCUE, a support and problem-solving intervention delivered via telephone and Internet by registered nurses. Attention control participants received active listening with no advice delivered by nurses via telephone.

MAIN MEASURES

Feasibility of a larger trial was assessed via recruitment and retention. Acceptability was assessed using an adapted enactment tool and qualitative interviews. Changes in caregiver depressive symptoms and burden were measured by the Center for Epidemiologic Studies Depression Scale and Zarit Burden Interview. The study was not powered for significance testing.

RESULTS

Of 340 eligible caregivers, 53 (16%) agreed to participate. Among those enrolled, 51 (96%) completed the study. Caregiver mean age was 60.3 (10.1), 49 (93%) were female and 36 (68%) were white. At baseline, 21 (39%) caregivers had high risk of depression and 18 (33%) had significant burden. Acceptability and enactment tool findings indicated positive participant responses to the intervention. Most rated the amount of sessions the "right amount". Qualitative analysis revealed the intervention was valued by and acceptable to caregivers.

CONCLUSIONS

Findings indicate the RESCUE intervention is feasible and acceptable to caregivers and warrants further testing.

Perspectives on an Acceptance and Commitment Therapy (ACT) based program for patients with inflammatory bowel disease and comorbid anxiety and/or depressive symptoms

Background and aim: Individuals with inflammatory bowel disease (IBD) suffer higher rates of anxiety and depression than the general population, however, few psychological interventions are designed for this population. Acceptance and Commitment Therapy (ACT), aimed to increase psychological flexibility, may be useful to address the unique concerns of IBD sufferers. This study aimed to explore stakeholder perspectives on an ACT-based intervention prototype tailored to people with IBD and comorbid anxiety and/or depressive symptoms.Methods: An Intervention Mapping methodology guided intervention design. A qualitative exploratory design was used to investigate the perspectives of stakeholders. Focus groups or interviews obtained feedback from IBD patients of a major regional hospital, and health providers to IBD patients Australia-wide.Results: Findings were analysed using template analysis. Data saturation was reached at 19 participants (11 patients and 8 health professionals). Participants' perspectives on the ACT-based intervention were distributed across four themes: (1) Barriers to access and participation; (2) Timing in the illness trajectory; (3) ACT is useful for IBD; and (4) The more support, the better.Conclusion: The findings suggest that an ACT modality and blended delivery design is well received by patients and health professionals, providing recommendations to future researchers and clinicians on intervention design.

Determinants of Evidence-based Practice Uptake in Rural Intensive Care Units. A Mixed Methods Study

Rationale: Evidence-based practices promote quality care for intensive care unit patients but chronic evidence-to-practice gaps limit their reach.Objectives: To characterize key determinants of evidence-based practice uptake in the rural intensive care setting.Methods: A parallel convergent mixed methods design was used with six hospitals receiving a quality improvement intervention. Guided by implementation science principles, we identified barriers and facilitators to uptake using clinician surveys (N = 90), key informant interviews (N = 14), and an implementation tracking log. Uptake was defined as completion of eight practice change steps within 12 months. After completing qualitative and quantitative data analyses for each hospital, site, staff, and program delivery factors were summarized within and across hospitals to identify patterns by uptake status.Results: At the site level, although structural characteristics (hospital size, intensivist staffing) did not vary by uptake status, interviews highlighted variability in staffing patterns and culture that differed by uptake status. At the clinician team level, readiness and self-efficacy were consistently high across sites at baseline with time and financial resources endorsed as primary barriers. However, interviews highlighted that as initiatives progressed, differences across sites in attitudes and ownership of change were key uptake influences. At the program delivery level, mixed methods data highlighted program engagement and leadership variability by uptake status. Higher uptake sites had better training attendance; more program activities completed; and a stable, engaged, collaborative nurse and physician champion team.Conclusions: Results provide an understanding of the multiple dynamic influences on different patterns of evidence-based practice uptake and the importance of implementation support strategies to accelerate uptake in the intensive care setting.

The Integration of Resource Patients in Collaborative Research: A Mixed Method Assessment of the Nesting Dolls Design

OBJECTIVES

This is a quality assessment of a research design developed for a collaborative study on adolescents and young adults who survived a brain tumor.

METHODS

A descriptive and critical mixed methods approach was used to assess the design itself, the quality and information power of the database and the integration of collaborators. Project documentation, field notes and transcripts from focus groups interviews(n = 19) were used for the evaluation, which was based on the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

The design proved to be pertinent to resolve methodological stakes in a "fragile field". The mobilisation of collaborators as members of a "Sherpa team" in all phases of the project helped the team create a progressive focus approach well-adapted for data gathering and analysis as well as produce a high-quality database.

CONCLUSION

The Nesting Dolls Design including the didactic approach developed along the deployment of the project helped researchers, clinicians and resource patients/parents understand the research procedures and the roles of all collaborators. This fostered a meaningful engagement in the project.

PRACTICE IMPLICATIONS

Resources and time for training, communication and supervision are necessary to reach the objectives of collaborative research involving novices and are worth the time and efforts.

Factors influencing patient education in shared medical appointments: Integrative literature review

OBJECTIVE

This integrative literature review investigates the factors influencing patient education in Shared Medical Appointments.

METHODS

Following template analysis method, we used key concepts of the Social Cognitive Theory (SCT) and Social Constructivism as a priori themes. After detailed analysis of the included studies, we deduced subthemes, forming a final template. Based on this final template, we analysed our data again as a final check.

RESULTS

We included 22 studies. We found that the factors feeling of bonding, humour, feeling of safety, access to information, time, relationship participants-staff, modelling and self-regulation influence the education of SMA participants. Furthermore, we found that health care providers function both as leaders and peers.

CONCLUSION

We found eight factors that influence the education of SMA participants. Health care providers exert influence on these factors, but in turn, they are also influenced by them in their transfer of knowledge.

PRACTICE IMPLICATIONS

In order to create a climate of learning and to promote transfer of knowledge, these eight factors should be considered. Health care providers should be aware of their roles and they might need some extra skills for their leadership roles. This can also lead to practical implications for the curriculum in medical schools.

‘Sorry doctor….I didn’t hear that….’: phenomenological analysis of medical students’ experiences of simulated hearing impairment through virtual reality

Introduction

Hearing impairment is a common condition that can have a significant impact on an individual. Ineffective communication between such individuals and doctors remains an important barrier. There is a need to provide medical students with a deeper understanding of such challenges. Increasingly, simulation is being used to develop empathy skills. In this study, we aimed to seek a deep understanding of medical students’ experiences of being placed in the role of a hearing-impaired patient by means of a virtual reality (VR) simulation.

Methods

A multidisciplinary group developed a 360° VR video-learning experience. This experience portrayed a consultation with a doctor from a hearing-impaired individual’s perspective. A qualitative study approach, using hermeneutic phenomenology, was conducted. Following the VR experience, students were interviewed, and transcripts of interviews were analysed using a Template Analysis approach.

Results

Analysis yielded four main themes: (1) ‘much more than just watching a video’: a VR experience of hearing impairment; (2) ‘hearing through their ears’: experiencing a person’s world with hearing impairment; (3) ‘not just what you can’t hear…but how it makes you feel’: reactions evoked by a VR hearing impairment experience and (4) redirecting my future professional self?

Discussion

This study provides an insight into medical students’ experiences of a novel VR hearing impairment simulation. VR simulation has the potential to provide a novel complementary training method for medical students. By providing an immersive learning experience, VR can offer an empathic stepping into the ears of those that live with hearing impairment.

Implementing Mental Health Promotion Initiatives-Process Evaluation of the ABCs of Mental Health in Denmark

Treatment and prevention alone are unlikely to make a significant difference in reducing the burden of poor mental health and mental illness. Therefore, mental health promotion (MHP) initiatives are advocated. In 2014, the ABCs of mental health (ABCs) partnership was established in Denmark; in the partnership, partner organisations, e.g., municipalities and NGOs, use a research-based framework for MHP, the ABC-framework, to develop and implement MHP initiatives. This paper has two aims: (1) to outline the overall characteristics of these MHP initiatives; and (2) to explore local coordinator and stakeholder perceptions of the implementation processes and the impact of the MHP initiatives. Questionnaire surveys, individual interviews and group interviews were conducted during 2017-2020. The MHP initiatives were grouped according to three strategies: building MHP capacity, campaign activities to promote mental health awareness and knowledge and establishing and promoting opportunities to engage in mentally healthy activities. The ABC-framework was positively received and viewed as providing relevant knowledge for working with MHP as well as fostering intersectoral and interprofessional collaborations. However, using a bottom-up approach to develop and implement MHP initiatives can be time-consuming and resource demanding, and it requires a deliberate balancing of local adaptability and concrete guidance when engaging stakeholders and implementers. Overall, using the ABC-framework to develop and implement MHP initiatives holds great promise for advancing and promoting MHP practice.

"Tomorrow, I'll Be Fine": Impacts and coping mechanisms in adolescents and young adults with primary dysmenorrhoea

AIMS

To understand the experiences of adolescents and young adults with primary dysmenorrhoea through the lens of structured frameworks extant in contemporary pain literature.

DESIGN

Descriptive qualitative study.

METHODS

Thirty-nine adolescents and young adults (ages 16-24 years) with primary dysmenorrhoea participated in semi-structured in-person interviews. Transcripts of the interviews were analysed using deductive thematic analysis from November 2018 to April 2019.

RESULTS

Two overarching themes, each with subthemes, were identified. The first theme, primary dysmenorrhoea impacts the whole person, contained the following subthemes: biological, social, and psychological. The second theme, coping mechanisms of women with primary dysmenorrhoea, contained the following subthemes: primary, secondary, and passive coping.

CONCLUSION

Women experience several primary dysmenorrhoea-related impacts on their biological, social, and psychological functioning. Women employ a variety of coping mechanisms to manage their primary dysmenorrhoea pain.

IMPACT

This study emphasizes the significant effects of primary dysmenorrhoea on nearly every aspect of women's lives and contributes to an understanding of the ways women cope with this pain. The findings of this study underscore the need for continued consideration of primary dysmenorrhoea as a debilitating pain process as well as the need for additional interventions to help women manage this condition.

Participants’ Perspectives on Healthcare Service Quality in Multispecialty Hospitals: A Qualitative Approach

Professional services like healthcare operate with high degree of information asymmetry, where usually the seeker of service lacks knowledge and skills, and as a result, they cannot evaluate the benefits. Alternative indicators in the service delivery are sought by the seekers to bring evenness in their evaluation, which might not be reflective of providers’ perspectives of care. This study attempts to explore perspectives of both the participants in healthcare service delivery in multispecialty hospital settings. Semi-structured interviews were conducted using snowball sampling with doctors, paramedical staff and managers in multispecialty hospitals and patients and their attendants who have visited the same set of hospitals during past one year. The narratives of the respondents based on a priori interview themes were converted into textual data. Template analysis technique was used to thematically analyse and present the results. Differing accounts of two participants emerged out of the analysis and a gap between providers’ and seekers’ perspectives of each other’s expectations and perceptions of performance was observed. This study is a novel attempt to simultaneously account for both the participants’ perspectives to present a holistic picture rather than a one-sided view of healthcare service quality.

Hospitalist and Intensivist Experiences of the "Open" Intensive Care Unit Environment: a Qualitative Exploration

BACKGROUND

Most U.S. academic medical centers employ "closed" intensive care units (ICUs), where critically ill patients are admitted under the supervision of intensivists managing dedicated ICU teams. Some centers utilize a unique "open" ICU structure, where primary services longitudinally follow patients who become critically ill into the ICU with intensivist comanagement. The impact of open ICUs on patient care and education of trainees has not been well-characterized.

OBJECTIVE

The objective of this study is to characterize affordances and barriers to education and patient care, from the perspectives of hospitalists and intensivists teaching in the ICU.

DESIGN

We conducted semi-structured interviews with hospitalist and intensivist faculty at a large academic medical center with an open ICU structure. We coded deidentified interview transcripts to inductively analyze the data for themes and subthemes.

PARTICIPANTS

We recruited hospitalist and intensivist faculty members who attend on teaching services in the open ICU system.

APPROACH

Given the complexity of multiple teachers and learners in the ICU environment, we selected shared mental models as our primary theoretical lens through which we analyzed and interpreted our data.

KEY RESULTS

We identified three main themes regarding education in the open ICU system: (1) communication challenges, (2) educational barriers and affordances, and (3) structural barriers and affordances. Hospitalists and intensivists agreed on some barriers and facilitators to education, such as continuity of care, yet they disagreed on others. Specifically, hospitalists and intensivists had a shared mental model regarding barriers to patient care and education in the open ICU structure, but had divergent opinions regarding the affordances of the structure, such as continuity and availability of ICU expertise.

CONCLUSIONS

The open ICU environment presents facilitators and barriers to trainee education and patient care. Our findings can be leveraged to improve communication, education, and patient care on both hospitalist and ICU teams.

Acceptability and usability of smartphone-based brainwave entrainment technology used by individuals with chronic pain in a home setting

BACKGROUND

Brainwave entrainment (BWE) using rhythmic visual or auditory stimulation has many potential clinical applications, including the management of chronic pain, where there is a pressing need for novel, safe and effective treatments. The aim of this study was to gain qualitative feedback on the acceptability and usability of a novel BWE smartphone application, to ensure it meets the needs and wishes of end users.

METHODS

Fifteen participants with chronic pain used the application at home for 4 weeks. Semi-structured telephone interviews were then carried out. A template analysis approach was used to interpret the findings, with an initial coding template structured around the constructs of a theoretical framework for assessing acceptability of healthcare interventions. Structured data analysis generated a final modified coding structure, capturing themes generated across participants' accounts.

RESULTS

The four main themes were 'approach to trying out the app: affective attitude and ethicality', 'perceived effectiveness', 'opportunity costs and burden' and 'intervention coherence and self-efficacy'. All participants were willing to engage with the technology and welcomed it as an alternative approach to medications. Participants appreciated the simplicity of design and the ability to choose between visual or auditory stimulation. All the participants felt confident in using the application.

CONCLUSION

The findings demonstrate preliminary support for the acceptability and usability of the BWE application. This is the first qualitative study of BWE to systematically assess these issues.

How Teachers Meet in Interdisciplinary Teams: Hangouts, Distribution Centers, and Melting Pots

PURPOSE

To explore team learning processes among interdisciplinary teacher teams in the development of integrated health professions education and to investigate students' perspectives on the quality of the educational courses.

METHOD

Using an exploratory, sequential mixed-methods design, the first author conducted 17 vignette-guided, semistructured interviews with teachers originating from diverse disciplines. These teachers worked in different courses of integrated, undergraduate health professions programs at the Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. The interview guide and vignettes were based on team learning research. The interviews sought to establish how interdisciplinary teacher team members work together on integrated curricula. The vignettes reflected constructs of team learning processes: sharing, co-construction, and constructive conflict. Data were collected between November 2017 and March 2018 and analyzed using template analysis. Sequentially, course evaluation data were used to provide a descriptive analysis of students' perspectives on educational quality (course organization, structure, learning effect, and alignment).

RESULTS

Three team approaches were identified. In fragmented teams or "hangouts," teachers individually worked on tasks that they were interested in, leaving their disciplinary mark. Framework-guided teams or "distribution centers" aimed to work within the given frameworks and organizational expectations, striving for disciplinary balance. Integrated teacher teams or "melting pots" used an interdisciplinary approach on all topics and put students at the center. Integrated teams reflected high-level team learning processes and were most satisfied with their (team)work. In contrast, fragmented and framework-guided teams mainly reflected low-level team learning processes. Students evaluated courses of integrated teacher teams highest on all investigated quality items (course organization, structure, learning effect, and alignment).

CONCLUSIONS

Successful interdisciplinary teacher teams are represented by an integrated approach with high-level team learning behavior and the best course evaluations. Therefore, health professions education management should actively encourage and facilitate integrated teacher teamwork.

Implementation of an Academic-to-Community Hospital Intensive Care Unit Quality Improvement Program. Qualitative Analysis of Multilevel Facilitators and Barriers

Rationale: Implementation of evidence-based best practices is influenced by a variety of contextual factors. It is vital to characterize such factors to maintain high-quality care. Patients in the intensive care unit (ICU) are critically ill and require complex, interdisciplinary, evidence-based care to enable high-quality outcomes. Objectives: To identify facilitators and barriers to implementation of an academic-to-community hospital ICU interprofessional quality improvement program, "ICU Innovations." Methods: ICU Innovations is a multimodal quality improvement program implemented between 2014 and 2017 in six community ICUs in rural settings serving underserved patients in South Carolina. ICU Innovations includes quarterly on-site seminars and extensive behind the scenes facilitation to catalyze the implementation of evidence-based best practices. We use qualitative analysis to identify contextual factors related to program implementation processes. Guided by an implementation science framework, the Exploration, Adoption/Preparation, Implementation, Sustainment framework, we conducted semistructured key informant interviews with clinician champions at six community ICUs and six parallel interviews with ICU Innovations' leadership. We developed a qualitative coding template based on the framework and identified contextual factors associated with implementation. Standard data on hospital and ICU structure and processes of care were also collected. Results: Outer and inner factors interconnected dynamically to influence implementation of ICU Innovations. Collaborative engagement between the program developers and partner sites (outer context factor) and site program champion leadership and staff readiness for change (inner context factors) were key influences of implementation. Conclusions: This research focused on rural hospital ICUs with limited or nonexistent intensivist leadership. Although enthusiasm for the ICU Innovations program was initially high, implementation was challenging because of multiple contextual factors. Critical steps for implementation of evidence-based practice in rural hospitals include optimizing engagement with external collaborators, maximizing the role of a committed site champion, and conducting thorough site assessments to ensure staff and organizational readiness for change. Identifying barriers and facilitators to program implementation is an on-going process to tailor and improve program initiatives.

'We all have the same right to have health services': a case study of Namati's legal empowerment program in Mozambique

BACKGROUND

Legal empowerment and social accountability are two strategies that are increasingly used to address gaps in healthcare in low- and middle-income countries, including failure to provide services that should be available and poor clinical and interpersonal quality of care. This paper is an explanatory case study of a legal empowerment effort that employs community paralegals and trains Village Health Committees (VHCs) in Mozambique. The research objective was to explore how community paralegals solved cases, the impact paralegals had on health services, and how their work affected the relationship between the community and the health sector at the local level.

METHODS

The case study had two components: (1) a retrospective review of 24 cases of patient/community grievances about the health system, and (2) qualitative investigation of the program and program context. The case reviews were accomplished by conducting structured in-depth interviews (IDIs) with those directly involved in the case. The qualitative investigation entailed semi-structured Key Informant Interviews (KIIs) with district, provincial, and national health managers and Namati staff. In addition, focus group discussions (FGDs) were held with Health Advocates and VHC members.

RESULTS

Case resolution conferred a sense of empowerment to clients, brought immediate, concrete improvements in health service quality at the health facilities concerned, and seemingly instigated a virtuous circle of rights-claiming. The program also engendered incipient improvements in relations between clients and the health system. We identified three key mechanisms underlying case resolution, including: bolstered administrative capacity within the health sector, reduced transaction and political costs for health providers, and provider fear of administrative sanction.

CONCLUSIONS

This study contributes to the limited literature regarding the mechanisms of legal empowerment case resolution in health systems and the impact of hybrid legal empowerment and social accountability approaches. Future research might assess the sustainability of case resolution; how governance at central, provincial, and district level is affected by similar programs; and to what extent the mix of different cases addressed by legal empowerment influences the success of the program.

Taking over or taking in? A qualitative case study of successful acquisitions

There is a widely held but scarcely challenged belief that most organizational changes fail, especially in mergers and acquisitions (M&A). Failure of M&A is often attributed to factors such as differences in organizational cultures, contested identities, perceived injustice, lack of trust, ineffective leadership and poor communication. A qualitative study was conducted in an acquiring company and two target companies to identify the criteria of a successful change, to explore perceptions of the degree of success of the acquisition(s) they had experienced, and to investigate the factors influencing these perceptions. The findings demonstrated that M&A can be considered successful when attention is paid, not only to integration of practices, but also to socio-cultural factors in managing M&A processes. The overall evaluation of these two acquisitions was that they had been successful. Implications for theory and practice include the possible differences between small- and large-scale M&A experiences.

A Contemporary Analysis of Aircraft Maintenance-Related Accidents and Serious Incidents

Aircraft maintenance has been identified as a key point of concern within many high-risk areas of aviation; still being a casual/contributory factor in a number of accidents and serious incidents in commercial air transport industry. The purpose of this study is to review and analyse the aircraft maintenance-related accidents and serious incidents which occurred between 2003 and 2017, to provide a better understanding of the causal and contributory factors. To achieve this, a dataset of maintenance-related accidents and serious incidents was compiled and then qualitatively analysed by thematic analysis method. Coding these events by using NVivo software enabled the development of a taxonomy, MxFACS. The coded output was then evaluated by subject matter experts, and an inter-rater concordance value determined to demonstrate the rigour of the research process. Subsequently, the events were evaluated in terms of their relationship to known accident categories such as loss of control, runway excursions. The most frequent maintenance event consequences were found to be runway excursions and air turnbacks, with the second level categories being related to failures in engine and landing gear systems. The greatest maintenance factor issues were ‘inadequate maintenance procedures’ and ‘inspections not identifying defects’. In terms of fatalities, ‘collision events’ were the most prominent consequence, ‘engine-related events’ were the most significant event, and ‘inadequate maintenance procedures’ were the most concerning maintenance factor. The study’s findings may be used in conjunction with existing risk analysis methodologies and enable the stakeholders to develop generic or customised bowties. This may identify the existing barriers in the system as well as weaknesses which will enable the development of mitigation strategies on both organisational and industry-wide levels.

Surgery for women with endometrioma prior to in vitro fertilisation: proposal for a feasible multicentre randomised clinical trial in the UK

STUDY QUESTION

Is it feasible to undertake a randomised controlled trial to establish whether surgical removal of endometrioma or not, improves live birth rates from IVF?

SUMMARY ANSWER

A randomised controlled trial (RCT) comparing surgery versus no surgery to endometrioma prior to IVF is only feasible in UK if an adaptive rather than traditional study design is used; this would minimise resource wastage and complete the trial in an acceptable time frame.

WHAT IS KNOWN ALREADY

There is wide variation in the management of endometriomas prior to IVF, with decisions about treatment being influenced by personal preferences.

STUDY DESIGN, SIZE, AND DURATION

This was a mixed-methods study consisting of an online survey of clinicians, a focus group and individual interviews with potential trial participants.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Endometriosis and fertility experts across the UK were invited to participate in an online anonymised questionnaire. Potential future trial participants were recruited from a tertiary care fertility centre and invited to participate in either individual interviews or focus groups.

MAIN RESULTS AND THE ROLE OF CHANCE

Clinicians and potential trial participants confirmed the need for an RCT to inform the management of an endometrioma prior to IVF. There were 126 clinicians who completed the survey, and the majority (70%) were willing to recruit to a trial. Half of those who responded indicated that they see at least 10 eligible women each year. The main barriers to recruitment were waiting lists for surgery and access to public funding for IVF. One focus group (n = 7) and five interviews were conducted with potential trial participants (n = 3) and their partners (n = 2). The findings from these discussions highlighted that recruitment and retention in a potential RCT could be improved by coordination between IVF and surgical services such that an operation does not delay IVF or affect access to public funding. Live birth was considered the most important outcome with an improvement of at least 10% considered the minimum acceptable by both patients and clinicians.

LIMITATIONS, REASONS FOR CAUTION

This feasibility study captured views of clinicians across the UK, but as patients were from a single Scottish centre, their views may not be representative of other areas with limited public funding for IVF.

WIDER IMPLICATIONS OF THE FINDINGS

There is a need for an appropriately powered RCT to establish whether or not surgical treatment of endometrioma prior to IVF improves live birth rates. There are logistical issues to be considered due to limited number of participants, funding of IVF and waiting times. These could be overcome in a RCT by using an adaptive design which would include a prospectively planned opportunity for modification of specified aspects of the study design based on interim analysis of the data, coordination of IVF treatments and endometriosis surgeries and international collaboration. Similar principles could be used for other questions in fertility where a traditional approach for randomised trials is not feasible.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was received from the NHS Grampian R&D pump priming fund (RG14437-12). S.B. is Editor-in-Chief of HROPEN, and A.W.H. is Deputy Editor of HROPEN. Neither was involved in the review of this manuscript. L.S. reports grants from CSO and NIHR to do endometriosis research, outside the submitted work. K.C. reports grants from NIHR/HTA and CSO during the conduct of the study. J.H.e., A.W.H., J.D., S.B.r., K.B., G.B., J.H.u. and K.G. report no conflict of interest.

The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study

BACKGROUND

The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change.

METHODS

A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis.

RESULTS

Barriers and facilitators were analysed according the COM-B domains. "Capability" factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff "motivation" included skilled facilitation of training, trainees' desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). "Opportunity" factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential.

CONCLUSIONS

A wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.

Telegram as a Tool to Supplement Online Medical Education During COVID-19 Crisis

INTRODUCTION

Instant Messaging Applications are known for their potential to enhance learning. However, to date, there has been little investigation into the implications of the 'Telegram' application for online medical education and training.

AIM

This study explores the potential benefits and disadvantages of integrating Telegram into undergraduate medical education during the COVID-19 pandemic.

METHODS

An exploratory study was conducted between March and May 2020, with 203 undergraduate medical students recruited through purposive sampling. Data was collected through seven open-ended questions, followed by thematic analysis using Atlas.ti.

RESULTS

Most students participating in this study reported multiple utilities of the application, including easy access to educational resources and the ability to add unlimited members, as well as files in all formats and sizes. Additionally, the application assisted students to engage with collaborative learning, maintain their wellbeing, and ensure their security. However, they also reported some drawbacks, i.e., a complex interface, information overload, and a tendency to distract them, causing time wastage.

CONCLUSION

This study concludes that Telegram provides an effective mobile learning platform for medical students during the current crisis, in particular. Moreover, it offers considerably more functionalities and fewer potential drawbacks than alternative applications.

Causal item of Brief Illness Perception Questionnaire (BIPQ) scale: The main categories

The causal item of illness perception from Brief Illness Perception Questionnaire (BIPQ) has no clearly defined response categories. It restricts the comparison of findings across studies on illness perception. Therefore, this study analyzed the causal item responses and proposed a categorization structure. The cohort study measurements were conducted at early cardiac rehabilitation and six months later. Illness perception was assessed using BIPQ scale with qualitative responses of causal item being independently coded by two researchers who assigned the responses to categories using template analysis approach. The study identified seven main causal categories of illness perception: lifestyle, psychological causes, natural causes, working conditions, body changes, environmental factors, and other causes. The perception that acute coronary syndrome is mainly due to lifestyle factors associates with better health-related outcomes compared to other causal perceptions. The proposed categorization of BIPQ causal item could be tested in the future research among different samples accounting only the main cause.

Anatomy of an effective workplace health intervention: a comprehensive new model

Purpose

This study proposes a new model, called the Integrated Human Health Model (IHHM), to improve the design and effectiveness of Workplace Health Promotion (WHP) interventions.

Design/methodology/approach

Eighteen participants were purposefully selected from 44 participants in a 2.5-day WHP intervention targeting multiple health behaviours (MHB). The intervention has shown to improve quality of life and health-related behaviours in rigorous studies. Qualitative data collection methods were observations, repeat semi-structured interviews and weekly e-journals collected over three months. Template analysis was used to develop the IHHM describing participants' experiences.

Findings

The IHHM describes the health behaviour change process using eight themes: facilitation, assessment, desired life, barriers, knowledge and skills, insights, action planning, and monitor and support.

Practical implications

With the paucity of evidence informing WHP intervention effectiveness, this study provides a preliminary model serving practitioners to design more effective interventions and scholars to improve evidence.

Originality/value

This study proposes a practical comprehensive model for practitioners and leaders to more effectively design and evaluate successful MHB WHP interventions compared to existing models.

Learning Challenges, Teaching Strategies, and Cognitive Load: Insights From the Experience of Seasoned Endoscopy Teachers

PURPOSE

Learners of medical procedures must develop, refine, and apply schemas for both cognitive and psychomotor constructs, which may strain working memory capacity. Procedures with limitations in visual and tactile information may add risk of cognitive overload. The authors sought to elucidate how experienced procedural teachers perceived learners' challenges and their own teaching strategies in the exemplar setting of gastrointestinal endoscopy.

METHOD

The authors interviewed 22 experienced endoscopy teachers in the United States, Canada, and the Netherlands between May 2016 and March 2019 and performed thematic analysis using template analysis method. Interviews addressed learner challenges and teaching strategies from the teacher participants' perspectives. Cognitive load theory informed data interpretation and analysis.

RESULTS

Participants described taking steps to "diagnose" trainee ability and identify struggling trainees. They described learning challenges related to trainees (performance over mastery goal orientation, low self-efficacy, lack of awareness), tasks (psychomotor challenges, mental model development, tactile understanding), teachers (teacher-trainee relationship, inadequate teaching, teaching variability), and settings (internal/external distractions, systems issues). Participants described employing strategies that could match intrinsic load to learners' levels (teaching along developmental continuum, motor instruction, technical assistance/takeover), minimize extraneous load (optimize environment, systems solutions, emotional support, define expectations), and optimize germane load (promote mastery, teach schemas, stop and focus).

CONCLUSIONS

Participants provided insight into possible challenges while learning complex medical procedures with limitations in sensory channels, as well as teaching strategies that may address these challenges at individual and systems levels. Using cognitive load theory, the authors provide recommendations for procedural teachers.

They ask for protection: An exploratory study into experiences with violence among unaccompanied refugee children in Dutch reception facilities

BACKGROUND

Children placed under governmental supervision and staying in residential or foster care are more vulnerable to violence than children who live with their own families. One specific group of children staying in reception facilities under governmental supervision comprises unaccompanied refugee children who have fled to a host country without their parents.

OBJECTIVE

This qualitative study explores the experiences of unaccompanied children with regard to violence in reception facilities in the Netherlands from the perspective of the children.

PARTICIPANTS AND SETTING

183 unaccompanied children (N = 183) sheltered in a variety of reception facilities in the Netherlands.

METHOD

Semi-structured interviews were conducted focusing on several topics related to their perceived quality of life. The transcripts of the interviews were analyzed for experiences with violence occurring inside the reception facilities. The codebook that was used was based on the categorization of maltreatment in the fourth United States National Incidence Study (NIS-4) and the interpretation of violence by the Committee on the Rights of the Child in General Comment No. 13 (GC 13).

RESULTS

A large share (66 %) of the unaccompanied children had experienced violence in various reception facilities. Most of the experiences reported had to do with either physical and emotional abuse and neglect or institutional violence.

CONCLUSION

The breadth of experiences of violence underlines the responsibility of the Dutch state to invest in the safe reception of unaccompanied children in order to protect their development, while also investing in further research on the prevalence of violence in the reception of unaccompanied children.

Mind the gap: Teachers' conceptions of student-staff partnership and its potential to enhance educational quality

Introduction: Student-staff partnerships as a concept to improve medical education have received a growing amount of attention. Such partnerships are collaborations in which students and teachers seek to improve education by each adding their unique contribution to decision-making and implementation processes. Although previous research has demonstrated that students are favourable to this concept, teachers remain hesitant. The present study investigated teachers' conceptions of student-staff partnerships and of the prerequisites that are necessary to render such partnerships successful and enhance educational quality.Method: We conducted semi-structured interviews with 14 course coordinators who lead course design teams and also teach in 4 bachelor health programmes, using Bovill and Bulley's levels of student participation as sensitising concepts during data analysis.Results: The results pointed to three different conceptions of student-staff partnerships existing among teachers: Teachers teach and students study; teachers teach and value students' feedback; and teachers and students co-create. The prerequisites for effective co-creation teachers identified were: Teachers must be open to involve students and create dialogues; students must be motivated and have good communication skills; the organisation must be supportive; and teachers should have the final say.Conclusion: We conclude that teachers' conceptions are consistent with Bovill and Bulley's levels of student participation. Under certain conditions, teachers are willing to co-create and reach the highest levels of student participation.

Technological Change in the Retirement Transition and the Implications for Cybersecurity Vulnerability in Older Adults

Retirement is a major life transition, which leads to substantial changes across almost all aspects of day-to-day life. Although this transition has previously been seen as the normative marker for entry into older adulthood, its influence on later life has remained relatively unstudied in terms of technology use and cybersecurity behaviours. This is problematic as older adults are at particular risk of becoming victims of cyber-crime. This study aimed to investigate which factors associated with the retirement transition were likely to increase vulnerability to cyber-attack in a sample of 12 United Kingdom based older adults, all of whom had retired within the past 5 years. Semi-structured, one to one interviews were conducted and subsequently analysed using thematic analysis. Six themes were identified referring to areas of loss in: social interaction, finances, day-to-day routine, feelings of competence, sense of purpose, and technology support structures. We discuss the implications of these losses for building cyber-resilience in retirees, with suggestions for future research.

Mental health nurses' understandings and experiences of providing care for the spiritual needs of service users: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Addressing spiritual issues to maintain a sense of hope, meaning and purpose can be an important aspect of mental health care which goes beyond simply providing facilities for religious observance. Expressions of spiritual need from service users can potentially be confused with symptoms of mental ill health. Little is known about how mental health nurses understand or provide this aspect of care for service users. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: An understanding from the mental health nurse perspective of how mental health nurses understand and care for service users' spiritual needs, and what influences their practice in this area. Ideas about how education and opportunities for good practice in this area might be advanced. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need more education and guidance as well as supportive team and management cultures so that they feel comfortable and able to deliver this important aspect of care. Abstract Introduction Mental health nurses have a professional obligation to attend to service users' spiritual needs, but little is known about specific issues related to provision of care for spiritual need faced by mental health nurses or how nurses understand this aspect of care and deliver it in practice. Aim/Question To explore mental health nurses' ́understandings of spiritual need and their experiences of delivering this care for service users. Method A qualitative study was conducted in one NHS mental health service. Interviews were undertaken with seventeen mental health nurses practising in a variety of areas. Results Four themes were generated from thematic analysis of data in the template style: Expressing personal perspectives on spirituality; Expressing perspectives on spirituality as a nursing professional; Nursing spiritually; and Permeating anxiety (integrative). Discussion Participants had complex understandings of spiritual need and evident anxieties in relation to this area of care. Two different approaches to nursing spiritually are characterised as (a) pragmatic (concerned with procedural aspects of care) and (b) spiritually empathetic. Mental health nurses were uncertain about the acceptability of attention to spiritual issues as part of care and anxious about distinguishing between symptoms of mental ill health and spiritual needs. Implications for practice Educational experiences need to emphasise both pragmatic and empathetic approaches, and work needs to be organised to support good practice.

Understanding and improving the experience of claiming social security for mental health problems in the west of Scotland: A participatory social welfare study

A growing body of literature links claimant interactions with the UK social security system and negative psychological consequences. Psychologists for social change developed a framework to outline proposed mechanisms of psychological impact from austerity. This codesigned study aimed to make an informed comment on areas of dis(agreement) between the Austerity Ailments framework and how people claiming for mental health problems describe their own experiences. In line with the participatory social welfare design of the study, qualitative analysis was performed by both claimants and academics. The overall findings indicate that existing framework mostly captured claimant experiences. However, some aspects of the claimant experience (particularly social aspects) were not well captured. Claimants were keen to utilise this study as an opportunity to gather claimant ideas on how to improve the system. Therefore, we report their suggestions that may be useful for those designing and improving social welfare systems.

An intimate connection: Exploring the visual art experiences of persons with dementia

The purpose of this study is to describe and discuss the art experience of persons with dementia taking part in guided museum tours at a Norwegian art museum. The analysis is based on semi-structured open-ended interviews with participants and researcher field notes. The results demonstrate the capacity and willingness of persons with dementia to reach out and connect on a personal level with the artworks. We identified four experiential dimensions: (1) a new way of seeing, (2) being lifted out of everyday life, (3) activating emotional and bodily responses and (4) connecting art and life. Our findings draw attention to the existential dimensions of the art experience and show that dementia-friendly programmes can offer individuals with dementia a way to stay connected both to themselves and to the wider community through active participation in a cultural discourse. This is the first research study conducted in this emerging field in a Norwegian context.

Lived experience in people with inflammatory bowel disease and comorbid anxiety and depression in the United Kingdom and Australia

This study explored the lived experience of people with inflammatory bowel disease and anxiety/depression. It utilised a deductive biopsychosocial framework. Overall, 24 patients and 20 healthcare professionals from two countries participated. In the United Kingdom, the main themes included (1) bidirectional relationship between inflammatory bowel disease and mental health, (2) the need for healthcare integration and (3) lack of awareness about the disease. In Australia, (1) the 'vicious cycle' of inflammatory bowel disease and psychosocial health, (2) the need for biopsychosocial healthcare integration and (3) the stigma of a hidden disease. Better communication around mental illness is essential in improving inflammatory bowel disease healthcare.

No Need to Worry? Anxiety and Coping in the Entrepreneurship Process

Understanding experiences of and responses to anxiety is foundational to developing robust theories of entrepreneurial behavior. Using open-ended, vignette and graphical elicitation interviews with 77 entrepreneurs, we inductively investigate the experience of and coping responses to anxiety during the entrepreneurship process. We develop a comprehensive and dynamic goal-striving model to explain experiencing and coping with entrepreneurial anxiety by integrating empirical findings with appraisal and control theories. In doing so, we theorize that entrepreneurial anxiety is endogenous to a cyclical conception of goal-striving, such that various sources of anxiety make sense only in consideration of the goals, standards or values to which they pertain. In this regard, entrepreneurs' coping responses influence four different points of an iterative goal-striving cycle-an insight that moves beyond problematic static and binary coping classifications.

Analyzing the effects of incivility beyond workplaces

Purpose

The purpose of this paper is to peruse a strike enacted by the police force (PF) from a southeast state of Brazil and its consequences to the population through the lens of workplace incivility (WI) theory.

Design/methodology/approach

This study draws on a qualitative research design and social constructivism paradigm. In addition, it uses the template analysis, a peculiar form of thematic analysis, which is grounded on the hierarchical coding. Accordingly, it allows the researcher to yield a broad structure (obviously through the task of analyzing textual data, i.e. published texts) as well as providing enough flexibility to comply with the needs of a study.

Findings

Overall, there was a slightly shift between the initial template and the second one. Rather, the initial thematic assumptions were largely confirmed, namely, antecedents, strike strategy, reactions and consequences; yet, findings also showed other theme, i.e. mitigating decisions. The template analysis used here turned to be a consistent path given that it allowed finding a range of categories related to the themes, which substantiated the results. On the other hand, this investigation shows that even society, as a whole, may be seriously affected by WI.

Research limitations/implications

This investigation has some limitations regarding that it is a qualitative endeavor. Therefore, the outcomes cannot be generalized, and it constitutes the chief limitation of this study.

Practical implications

In terms of practical implications, findings suggest that public managers, mayors and governors must pay strong attention to the task of motivating their workforce. Robust human resource policies and fair salary may avoid job dissatisfaction.

Social implications

Data also indicated that incivility may be related to complex dynamics whose negative impacts may go beyond the workplaces.

Originality/value

This study expands the theory of WI by paying attention to a generally neglected group (police officers). In addition, it focuses on an emergent economy, which is at odds with robust problems of finance and public management nature. In doing so, it provides evidence of other consequences of WI. Broadly speaking, citizens and businesses are consumers of public services, including safety. Finally, it suggests that WI may be associated with two instigators simultaneously. In this case, it was intertwined with governor’s weak human resources policies and the civil servants’ irresponsibility.

Healthcare providers and community perspectives on expedited partner therapy (EPT) for use with gay, bisexual and other men who have sex with men

OBJECTIVES

Expedited partner therapy (EPT) is an effective strategy to reduce rates of chlamydia and gonorrhoea infection and ensure sexual partners are treated. Currently, EPT is provided to heterosexual patients; however, EPT is not routinely recommended for use with gay, bisexual and other men who have sex with men (GBMSM) because of concerns about HIV coinfection. The objective of the qualitative study was to understand provider and community views on the use of EPT with GBMSM.

METHODS

Using convenience sampling methods, we recruited a sample of 18 healthcare providers and 21 GBMSM to participate in in-depth, semistructured interviews. Interviews were conducted over the phone and included questions about knowledge, experiences and potential barriers and facilitators to the use of EPT with GBMSM.

RESULTS

Most providers wanted to provide EPT to GBMSM and believed that the potential barriers and concerns to EPT use were not unique to a patient's sexual orientation. Several providers noted that they were currently providing EPT to GBMSM as part of HIV prevention services. Community members were generally unaware of EPT as a service and most indicated that they would only use EPT if they were in a committed relationship. Barriers included partner allergies and resistance, pharmacy protocols, structural concerns (eg, insurance coverage, pharmacists onsite and transportation) and potential disclosure issues. Facilitators included cultural humility and telemedicine with patients' partners to overcome these barriers.

CONCLUSIONS

Acceptability of EPT use for both chlamydia and gonorrhoea was high among providers and community members. Barriers to EPT use, including concerns about patients' partners' allergies and resistance, disclosure concerns and linkage to HIV prevention services can be overcome through cultural humility trainings and telemedicine. Changing EPT recommendations at the national level to be inclusive of GBMSM is critical to curtail the rising STI and HIV epidemic.

Preparedness for advancing future health: a national qualitative exploration of dietetics graduates' experiences

Effective health workforce preparation is critical to the health of those who stand to benefit from its services. Emerging dietitians can provide important insights on an evolving workforce that is well-placed to advance future global health. This study aimed to explore a national sample of dietetics graduates' experiences of, and challenges faced in, dietetics workforce preparation and preparedness in Australia. An interpretive description methodology guided this study whereby researchers interpreted the meanings that participants attributed to their experiences. Twenty dietitians (graduated within the last 2 years) were purposively sampled from across Australia and detailed insights were obtained through semi-structured interviews. A multi-analyst approach employing thematic and template analysis, enabled five themes to be identified across the data set. These included: (1) being held back; (2) chasing the prize; (3) valuing real learning; (4) easing the transition; and (5) encountering influencers. While graduates appreciated their preparation, they were not empowered or equipped to embrace opportunities in diverse and emerging areas of dietetics practice. Graduates were challenged by the competitive landscape of securing obvious job opportunities and by a lack of support in transitioning into the workforce. Practice exposures and encounters with influential dietitians were highly valued. Research on role-emerging dietetics placements along with enhanced support mechanisms for novice dietitians is urgently required to ensure appropriate alignment between future dietetics preparation and practice. Obtaining insights into health professional graduates' experiences of their education can be used to ensure that emerging health workforces are relevant and responsive to future market needs.

Components of impactful dementia training for general hospital staff: a collective case study

Background and objectives: People with dementia occupy around one quarter of general hospital beds, with concerns consistently raised about care quality. Improving workforce knowledge, skills and attitudes is a mechanism for addressing this. However little is known about effective ways of training healthcare staff about dementia. This study aimed to understand models of dementia training most likely to lead to improved practice and better care experiences for people with dementia, and to understand barriers and facilitators to implementation.Method: A collective case study was conducted in three National Health Service Acute Hospital Trusts in England. Multiple data sources were used including interviews with training leads/facilitators, ward managers and staff who had attended training; satisfaction surveys with patients with dementia and/or carers; and observations of care using Dementia Care Mapping.Results: Interactive face-to-face training designed for general hospital staff was valued. Simulation and experiential learning methods were felt to be beneficial by some staff and stressful and distressing by others. Skilled delivery by an experienced and enthusiastic facilitator was identified as important. Staff identified learning and practice changes made following their training. However, observations revealed not all staff had the knowledge, attitudes and skills needed to deliver good care. Patient and carer satisfaction with care was mixed. A major barrier to training implementation was lack of resources. Supportive managers, organisational culture and strong leadership were key facilitators.Conclusion: Dementia training can lead to improved care practices. There are a range of key barriers and facilitators to implementation that must be considered.