The Utility of Template Analysis in Qualitative Psychology Research

"You Really Do Have to Know the Local Context": IRB Administrators and Researchers on the Implications of the NIH Single IRB Mandate for Multisite Genomic Studies

In 2016, the U.S. National Institutes of Health (NIH) announced a new policy requiring single institutional review board (sIRB) review for multisite studies. However, adherence to the new policy requires the separation of regulatory institutional review board (IRB) work per Federal guidance from site-specific local compliance concerns. In particular, genomic research is subject to a wide range of state laws, institutional requirements, and local population preferences. In this qualitative study, we explored the anticipated needs of genomics researchers and IRB administrators around implementing the policy. We observed multiple uncertainties, particularly about intersite communication processes, sIRB selection processes, and roles of the reviewing IRB and local sites regarding local context information relevant to genomics. Optimal implementation of the NIH policy may require additional guidance for researchers and IRB administrators.

Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.

Workflow Requirements for Cost-of-Care Conversations in Outpatient Settings Providing Oncology or Primary Care: A Qualitative, Human-Centered Design Study

BACKGROUND

Patients prefer to discuss costs in the clinical setting, but physicians and teams may be unprepared to incorporate cost discussions into existing workflows.

OBJECTIVE

To understand and improve clinical workflows related to cost-of-care conversations.

DESIGN

Qualitative human-centered design study.

SETTING

2 integrated health systems in the U.S. Pacific Northwest: a system-wide oncology service line and a system-wide primary care service line.

PARTICIPANTS

Clinicians, clinical team members, operations staff, and patients.

MEASUREMENTS

Ethnographic observations were made at the integrated health systems, assessing barriers to and facilitators of discussing costs with patients. Three unique patient experiences of having financial concerns addressed in the clinic were designed. These experiences were refined after in-person interviews with patients (n = 20). Data were synthesized into a set of clinical workflow requirements.

RESULTS

Most patient cost concerns take 1 of 3 pathways: informing clinical care decision making, planning and budgeting concerns, and addressing immediate financial hardship. Workflow requirements include organizational recognition of the need for clinic-based cost-of-care conversations; access to cost and health plan benefit data to support each conversation pathway; clear team member roles and responsibilities for addressing cost-of-care concerns; a patient experience where cost questions are normal and each patient's preferences and privacy are respected; patients know who to go to with cost questions; patients' concerns are documented to minimize repetition to multiple team members; and patients learn their expected out-of-pocket costs before treatment begins.

LIMITATION

Results may have limited generalizability to other health care settings, and the study did not test the effectiveness of the workflows developed.

CONCLUSION

Clinic-based workflows for cost-of-care conversations that optimize patients' care experience require organizational commitment to addressing cost concerns, clear roles and responsibilities, appropriate and complete data access, and a team-based approach.

PRIMARY FUNDING SOURCE

Robert Wood Johnson Foundation.

Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Patient-Centered Approach

OBJECTIVE

To promote patient-centered oncology care through an in-depth analysis of the patient experience of body image disturbance (BID) following surgery for head and neck cancer (HNC).

STUDY DESIGN

Qualitative methods approach using semistructured key informant interviews.

SETTING

Academic medical center.

SUBJECTS AND METHODS

Participants with surgically treated HNC underwent semistructured key informant interviews and completed a sociodemographic survey. Recorded interviews were transcribed, coded, and analyzed using template analysis to inform creation of a conceptual model.

RESULTS

Twenty-two participants with surgically treated HNC were included, of whom 16 had advanced stage disease and 15 underwent free tissue transfer. Five key themes emerged characterizing the participants' lived experiences with BID following HNC treatment: personal dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance. The participant's perceived BID severity was modified by preoperative patient expectations, social support, and positive rational acceptance. These 5 key themes and 3 experiential modifiers form the basis of a novel, patient-centered conceptual model for understanding BID in HNC survivors.

CONCLUSION

A patient-centered approach to HNC care reveals that dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance are key conceptual domains characterizing HNC-related BID. Recognition of these psychosocial dimensions of BID in HNC patients can inform development of HNC-specific BID patient-reported outcome measures to facilitate quantitative assessment of BID as well as the development of novel preventative and therapeutic strategies for those at risk for, or suffering from, BID.

"It would be so much easier": health system-led genetic risk notification-feasibility and acceptability of cascade screening in an integrated system

Assess the feasibility and acceptability of health system-led genetic risk notification in a US integrated health system. We conducted semi-structured phone interviews with individuals age 40-64 years who had undergone genetic sequencing, but had not yet received their results, assessing attitudes to direct outreach to relatives. During each interview, we collected contact information for adult relatives identified as members of the same system and attempted to identify each relative in administrative data. We conducted 20 interviews. Most participants expressed support for Kaiser Permanente Washington involvement in familial risk notification. Direct outreach to relatives received the most unqualified support; outreach to the relatives' physician or interaction with the relatives' electronic medical record received more tempered support. Support was motivated by the desire to have risk communicated accurately and quickly. The most common caveat was a desire to alert relatives before the health system contacted them. Of 57 named relatives who were members of the same health system, we retrieved a single match for 40 (70.2%) based on name or birthdate. Health system involvement in familial risk notification received support in a sample of patients in a US integrated health system, and identification of relatives is feasible.

Veterans' assignment to single-site versus scattered-site permanent supportive housing

To address homelessness among Veterans, a growing proportion of permanent supportive housing units supported by the U.S. Departments of Housing and Urban Development and Veterans Affairs Supportive Housing (HUD-VASH) program are allocated to programs where multiple Veterans with a history of homelessness live in a particular building, referred to as single-site housing. This mixed-methods study-including administrative data from Veterans who moved into HUD-VASH housing and qualitative data from focus groups with services providers at 10 single-site programs-describes the characteristics and needs of Veterans who moved into single-site HUD-VASH programs, the rationale for developing single-site HUD-VASH programs, and the services provided in single-site programs that are responsive to Veterans' needs. Based on quantitative analyses, Veterans who were older and had chronic medical and mental health conditions and sought related care were at increased odds of receiving single-site housing. Qualitatively, we found that HUD-VASH programs developed single-site programs for two reasons: to ensure that the most vulnerable Veterans remained housed through the provision of supportive services and to increase housing options for hard-to-house Veterans, including those who require more support because of medical, mental health, or substance use disorders; physical disabilities; or lack of ability to live independently for other reasons. Due to the high needs of Veterans served by single-site programs, development of these programs should consider both space and staffing needs. Future research should assess the relationship between assignment to housing type and health and housing outcomes for participants as well as service enhancements to address Veterans' needs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Perceptions of Local Environmental Issues and the Relevance of Climate Change in Nepal's Terai: Perspectives From Two Communities

The direct and indirect impacts of global climate change entail serious consequences for global biophysical and social systems, including the health, well-being and sustainability of communities. These impacts are especially serious for vulnerable groups in economically developing societies. While climate change is a global phenomenon, it is at the local level that impacts are most felt, and from where responses to climate change are enacted. It is increasingly urgent that communities possess the capacity to respond to climate change, now and in the future. Community representations of climate-relevant issues are critical to underpinning responses. Environmental representations do not directly reflect actual physical conditions but are interpreted through social and cultural layers of understanding that shape environmental issues. This paper investigates environmental and climate-relevant perceptions within two communities in the Terai region of Nepal; the city of Bharatpur and the village of Kumroj in Chitwan Province. Following mixed findings on levels of climate change awareness in Nepal, we set out to explore perspectives on the environment and climate change awareness by conducting 30 qualitative interviews with local people. The study found that issues linked to sanitation and cleanliness were most important in both communities, while reports of temperature and weather changes were less common and typically linked to local causes rather than climate change. Imagined futures were also closely related to current environmental issues affecting communities and did not discuss climate change, though temperature and weather changes were anticipated. However, when talk of climate change was deliberately elicited, participants displayed their awareness, though this was rarely linked to local conditions. We conclude that, in light of other pressing local issues, climate change is yet to penetrate the environmental representations of some communities and there is a need to address the disconnect between local issues and global climate change. Making climate change relevant at the local level by connecting to salient local issues and co-benefits comprises an important step in bridging the gap between more global awareness and its relevance more locally, particularly for communities at risk.

The intersection of interpersonal violence and housing instability: Perspectives from women veterans

Women veterans in the United States face a disproportionate risk of housing instability (HI) and interpersonal violence (IV), largely perpetrated by intimate partners or involving nonpartner sexual violence, compared to both male veterans and nonveteran women. To explore the ways in which IV and HI intersect in the experiences of women veterans, we analyzed transcripts of in-depth qualitative interviews with 20 women veterans who had screened positive for HI at a Veterans Affairs Medical Center. Three broad themes emerged related to the intersection of IV (specifically intimate partner violence or nonpartner sexual violence) and HI among women veterans: (1) HI can be precipitated by and increase vulnerability to IV, (2) experiences of IV impact women's definitions of housing safety and security, and (3) IV can pose a barrier to accessing housing services and other support systems. Findings indicate areas for improvement to screening processes and service provision to more effectively address the co-occurring and interacting safety and housing needs of women veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Developing shared leadership in a public organisation: Processes, paradoxes and consequences

Much organisational decision-making is embedded in hierarchical structures and leadership, even though hierarchies are limited in how they deal with increasingly complex issues. This paper explores links between identity formation, and the subsequent development of shared leadership. It explores how a programme to develop shared leadership changed a public science organisation, from one dependent on hierarchical leadership, to one that also used shared leadership to better address the complex public context. Using Day and Harrison’s levels of leadership identity framework, this study first examines the processes of a development programme at individual, relational, and collective levels. Results reveal cascading growth in leadership identities through processes such as job crafting and contagion. Despite the resulting positive processes, inherent paradoxes of power, goals, and attitude underlying shared leadership development are also identified. Within these paradoxes, tensions between vertical hierarchy versus dispersed networks, task performance versus job crafting, fatigue versus revitalisation, and cynicism versus evangelism were found.

Understanding mothers' experiences of positive changes after neonatal death

Background: The death of a neonatal baby has the potential for parents to experience many negative outcomes. Post traumatic growth describes positive personal change from the struggle with a traumatic event. This has not been explored in this context. Objective: This study sought to understand the experiences of mothers whose neonatal baby had died; in particular, whether mothers were able to experience any positive changes in their lives since the death of their baby. The study also sought to explore what factors may have facilitated or prevented these changes. Method: Ten mothers were recruited, whose baby had died in the neonatal period between two and 10 years previously. Mothers completed semi-structured, one-to-one interviews. Interview transcripts were analysed using Template Analysis. Results: Despite ongoing sadness, mothers recognized positive personal changes in their self-perception, relationships and life philosophy which were consistent with the post-traumatic growth model. Mothers also identified facilitators and barriers to these changes which were categorized into five themes: 'Person-centred care', 'making sense', 'personal coping strategies', 'learning to live with it' and 'identity'. Conclusions: This study identified that the mothers made a conscious personal decision to cope with their experience. This is a unique finding which requires further exploration. Facilitators and barriers of growth both occurred as elements within the same five themes, indicating that all identified domains before and after the death have the potential to facilitate or to prevent personal growth. Importantly, these findings indicate that person-centred services, which are responsive to individual needs at all stages, are vital when providing maternity care in the context of loss.

Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study

OBJECTIVES

To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not.

DESIGN

Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism.

SETTING

In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study.

PARTICIPANTS

181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure.

RESULTS

Five main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days.

CONCLUSIONS

Implementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.

Creating allegiance: leading transformational change within the NHS

Background

Within the UK National Health Service (NHS) the move to Sustainable Transformation Plans/Partnerships and Integrated Care Systems reflect the increasing need and expectation for transformational change at a system level across both health and social care boundaries. Transformational change is complex, emergent and dynamic requiring new, non-traditional forms of leadership which are highly relational and persuasive.

Aim of the study

The current study aimed to explore a small number of NHS senior leaders’ experiences of undertaking transformational change within their localities over a period of a year following participation in a national transformational change programme designed to enhance personal capabilities.

Method

Four pairs of leaders working on different change programmes took part in the study and were interviewed at three time points about their approach to their change work. The data were analysed qualitatively using template analysis.

Results

A core theme of Creating Allegiance to an Emergent Future World was developed. The senior leaders created allegiance to the transformational change through a process of Connecting on three levels: relational, with purpose and vision and through practice. Allegiance creation was attempted even if the transformational change work at the year-end was deemed successful or not.

Conclusions

The study highlights the types of leadership behaviours employed by the participants reflecting the complexity and social construction of their transformational work. The findings provide further evidence to the existing system leadership literature as well as emphasising the importance of creating stakeholder, multilevel buy-in to healthcare transformation.

A Mobile App-Based Intervention for Depression: End-User and Expert Usability Testing Study

BACKGROUND

Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance.

OBJECTIVE

The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression.

METHODS

Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research.

RESULTS

The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns.

CONCLUSIONS

Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects.

Preventing Conflicts in Sharing Communities as a Means of Promoting Sustainability

The sharing economy is a new promising trend with many positive outcomes on society and the environment, as it provides potential for sustainable solutions due to the reduction of resource consumption and less waste. However, research and practice show that sharing comes with its own share of problems. People often act selfishly, and in worst-case scenarios try to take advantage of others without contributing to the shared good. To achieve the higher goal of sustainability, it is important that conflicts in the sharing economy are prevented, and a setting is achieved that allows people to easily behave in a cooperative and sustainable way. The present research examines which conflicts emerge in sharing communities (study 1) and community gardens in particular (study 2), and whether regulation can prevent conflicts in large groups. Two exploratory studies were conducted. First, a qualitative study with consumers and non-consumers of the sharing economy revealed that regulatory systems are perceived as important for preventing the exploitation of other community members, but also that cooperation should not be enforced with strict controls and punishment. Rather, problems should be discussed in a democratic group setting, rules and goals should be set up together, and trust should be built. Second, a questionnaire study with community gardeners in Austria confirmed these results, and showed that trust is related to less conflict in community gardens, while harsh forms of regulation are related to a potential for greater conflict. Additionally, the results indicate that soft forms of regulation are related to fewer relationship and task conflicts, better conflict resolutions, a high sense of community, and greater trust in the community. We then discuss how these findings can be used to regulate sharing economy activities and give limitations and directions for future studies.

Towards a clinical and empirical definition of burn scarring: A template analysis using qualitative data

OBJECTIVE

This study aimed to describe the nature, scope or meaning of the concept 'burn scar', from the perspective of adults and children with burn scarring, caregivers of children with burn scarring and health professionals who were considered experts in the treatment of burn scarring. The impact of the identified characteristics on burn scar health-related quality of life (HRQOL) was also examined.

METHOD

Using a phenomenological qualitative approach, 43 transcripts from semi-structured interviews with people with burn scars (n=10 adults and n=11 children), their caregivers (n=9) and health professionals (n=13) were analyzed using template analysis.

RESULTS

Ten characteristics of burn scars were identified by health professionals: 'stretchability', 'hardness', 'raised', 'thickness', 'surface area', 'scar sensitivity', 'scar surface appearance', 'hydration', 'fragility', and 'color'. However, 'thickness', 'scar surface area' and 'hydration' were not described by children with burn scars and 'scar surface area' was not described by adults with burn scars or caregivers. All groups (adults, children, caregivers and health professional) perceived that the burn scar characteristics of 'stretchability' and 'scar sensitivity' impacted upon all indicators of burn scar HRQOL. The burn scar characteristics of 'fragility', 'scar surface appearance' and 'color' were largely perceived by all groups to impact upon the emotional and physical indicators of burn scar HRQOL alone.

CONCLUSIONS

This study identified there are differences in the burn scar characteristics considered important by health professionals and those characteristics that adult/child/caregivers perceived to impact on indicators of burn scar HRQOL. It is recommended that outcome measures of burn scarring include the burn scar characteristics of 'stretchability' and 'scar sensitivity' at a minimum. The inclusion of 'fragility', 'scar surface appearance' and 'color' should also be considered.

Understanding women's uptake and adherence in Option B+ for prevention of mother-to-child HIV transmission in Papua, Indonesia: A qualitative study

Background

Despite a more proactive approach to reducing new HIV infections in infants through lifelong treatment (Option B+ policy) for infected pregnant women, prevention of mother-to-child transmission of HIV (PMTCT) has not been fully effective in Papua, Indonesia. Mother-to-child transmission (MTCT) is the second greatest risk factor for HIV infection in the community, and an elimination target of <1% MTCT has not yet been achieved. The purpose of this study was to improve understanding of the implementation of Option B+ for PMTCT in Papua through investigation of facilitators and barriers to women’s uptake and adherence to antiretroviral therapy (ART) in the program. This information is vital for improving program outcomes and success of program scale up in similar settings in Papua.

Methods

In-depth interviews were conducted with 20 women and 20 PMTCT health workers at two main referral hospitals for PMTCT in Papua. Development of interview guides was informed by the socio-ecological framework. Qualitative data were managed with NVivo11 software and themes were analysed using template analysis. Factors influencing women’s uptake and adherence in Option B+ for PMTCT were identified through final analysis of key themes.

Results

Factors that motivated PMTCT uptake and adherence were good quality post-test HIV counselling, belief in the efficacy of antiretroviral (ARV) attained through personal or peer experiences, and a partner who did not prevent women from seeking PMTCT care. Key barriers for PMTCT participation included doubts about ARV efficacy, particularly for asymptomatic women, unsupportive partners who actively prevented women from seeking treatment, and women’s concerns about community stigma and discrimination.

Conclusions

Results suggest that PMTCT program success is determined by facilitators and barriers from across the spectrum of the socio-ecological model. While roll out of Option B+ as current national policy for pregnant women in Papua has improved detection and enrolment of HIV-positive women, health facilities need to address various existing and potential issues to ensure long-term adherence of women beyond the current PMTCT program, including during pregnancy, childbirth and breastfeeding.

Text Classification for Organizational Researchers: A Tutorial

Organizations are increasingly interested in classifying texts or parts thereof into categories, as this enables more effective use of their information. Manual procedures for text classification work well for up to a few hundred documents. However, when the number of documents is larger, manual procedures become laborious, time-consuming, and potentially unreliable. Techniques from text mining facilitate the automatic assignment of text strings to categories, making classification expedient, fast, and reliable, which creates potential for its application in organizational research. The purpose of this article is to familiarize organizational researchers with text mining techniques from machine learning and statistics. We describe the text classification process in several roughly sequential steps, namely training data preparation, preprocessing, transformation, application of classification techniques, and validation, and provide concrete recommendations at each step. To help researchers develop their own text classifiers, the R code associated with each step is presented in a tutorial. The tutorial draws from our own work on job vacancy mining. We end the article by discussing how researchers can validate a text classification model and the associated output.

Stand More AT Work (SMArT Work): using the behaviour change wheel to develop an intervention to reduce sitting time in the workplace

BACKGROUND

Sitting (sedentary behaviour) is widespread among desk-based office workers and a high level of sedentary behaviour is a risk factor for poor health. Reducing workplace sitting time is therefore an important prevention strategy. Interventions are more likely to be effective if they are theory and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. This article describes the development of the Stand More AT Work (SMArT Work) intervention, which aims to reduce sitting time among National Health Service (NHS) office-based workers in Leicester, UK.

METHODS

We followed the BCW guide and used the Capability, Opportunity and Motivation Behaviour (COM-B) model to conduct focus group discussions with 39 NHS office workers. With these data we used the taxonomy of Behaviour Change Techniques (BCTv1) to identify the most appropriate strategies for facilitating behaviour change in our intervention. To identify the best method for participants to self-monitor their sitting time, a sub-group of participants (n = 31) tested a number of electronic self-monitoring devices.

RESULTS

From our BCW steps and the BCT-Taxonomy we identified 10 behaviour change strategies addressing environmental (e.g. provision of height adjustable desks,), organisational (e.g. senior management support, seminar), and individual level (e.g. face-to-face coaching session) barriers. The Darma cushion scored the highest for practicality and acceptability for self-monitoring sitting.

CONCLUSION

The BCW guide, COM-B model and BCT-Taxonomy can be applied successfully in the context of designing a workplace intervention for reducing sitting time through standing and moving more. The intervention was developed in collaboration with office workers (a participatory approach) to ensure relevance for them and their work situation. The effectiveness of this intervention is currently being evaluated in a randomised controlled trial.

TRIAL REGISTRATION

ISRCTN10967042 . Registered on 2 February 2015.

'It's a silver lining': A template analysis of satisfaction and quality of life following post-mastectomy breast reconstruction

OBJECTIVE

In the United Kingdom, the number of women undergoing post-mastectomy breast reconstruction is increasing. Consequently, exploring patient-reported outcomes in breast surgery has become increasingly important. This study investigated satisfaction and quality of life following post-mastectomy breast reconstruction.

DESIGN

Qualitative research design.

METHODS

In-depth, semi-structured telephone interviews were conducted with 25 women (age, M = 53.08, SD = 8.41) following breast reconstruction in the United Kingdom. Data were analysed using template analysis which produced three-first-level, 13 second-level, and 19 third-level themes.

RESULTS

Following reconstruction, women reported improved emotional functioning, although this was often accompanied by deterioration in physical, sexual, and/or social functioning. Women positively appraised their breast appearance, although some reported a decline in satisfaction over time, attributing this decline to their chosen reconstructive technique. Many women accepted the inevitability of scarring and most perceived their scars as a representation of their journey, signifying survival. Generally, women were satisfied with the outcome of their reconstruction, although on reflection some would not have opted for reconstruction. Following breast reconstruction, women were increasingly likely to experience the fear of recurrence, attributed to no longer being able to have a mammogram on the affected breast(s).

CONCLUSIONS

This study provides new insights into post-mastectomy breast reconstruction and is a novel application of template analysis. The analysis demonstrates only slight variation in some categories of experience among women, despite a heterogeneous sample. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life to support the needs of women following reconstruction. Statement of contribution What is already known on this subject? Patient satisfaction and quality of life are key patient-reported outcomes of breast reconstruction, although relatively few studies distinguish between types of satisfaction. The number of women electing to undergo reconstructive surgery is steadily increasing. As a consequence, exploring patient-reported outcomes in reconstructive breast surgery has become increasingly important for research and clinical practice. It is often suggested that breast reconstruction offers psychosocial benefits, although within the literature some mixed findings have been reported. Therefore, a qualitative exploration has the potential to add some clarity to the experiences of women following post-mastectomy breast reconstruction. What does this study add? To our knowledge, this is the first study to employ template analysis to explore the experiences of women following post-mastectomy breast reconstruction. Template analysis demonstrated that there was only slight variation in some categories of experience among women, despite a heterogeneous sample. This study distinguishes between the patient-reported outcomes breast satisfaction and outcome satisfaction to identify the key factors that are involved in determining satisfaction. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life which require improvement to support the unmet needs of women following breast reconstruction. The study presents two novel findings. Women attributed the fear of cancer recurrence to no longer being able to have a mammogram on the affected breast(s). Women also reported a decline in appearance-related satisfaction over time due to either the ptotic nature of autologous-based reconstruction or the fuller projected breast implant-based reconstruction affords.

Current opinions and recommendations of paediatric healthcare professionals - The importance of tablets: Emerging orally disintegrating versus traditional tablets

The appropriate prescribing of paediatric dosage forms is paramount in providing the desired therapeutic effect alongside successful medication adherence with the paediatric population. Often it is the opinion of the healthcare practitioner that dictates which type of dosage form would be most appropriate for the paediatric patient, with liquids being both the most commonly available and most commonly used. Orally disintegrating tablets (ODTs) are an emerging dosage form which provide many benefits over traditional dosage forms for paediatric patients, such as rapid disintegration within the oral cavity, and the reduction in the risk of choking. However the opinion and professional use of healthcare practitioners regarding ODT's is not known. This study was designed to assess the opinions of several types of healthcare professionals (n = 41) regarding ODTs, using a survey across two hospital sites. Results reaffirmed the popularity of liquids for prescribing in paediatrics, with 58.0% of participants preferring this dosage form. ODTs emerged as the second most popular dosage form (30.0%), with healthcare practitioners indicating an increasing popularity amongst patients in the hospital setting, belief with 63.0% of practitioners agreeing that many liquid formulations could be substituted with a suitable ODT. The desired properties of an ideal ODT were also identified by healthcare practitioners preferring a small, fast disintegrating tablet (90.2% and 95.1% respectively), with the taste, disintegration time and flavour being the three most important attributes identified (29.5%, 28.7% and 21.7% respectively). This study provided a pragmatic approach in assessing healthcare professional's opinions on ODTs, highlighting the ideas and thoughts of practitioners who are on the frontline of paediatric prescribing and treatment and gave an indication to their preference for ODT properties.

Older Adults' Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA)

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults' experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults' sexual rights.

Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence: Pilot randomized trial and qualitative interviews

BACKGROUND

A large proportion of hospital outpatients are alcohol dependent (AD) but few are engaged in treatment for their drinking. Brief intervention, designed to raise patients' awareness of their drinking, might encourage uptake of referral to specialty treatment. We assessed the feasibility of conducting a randomized trial evaluating the effectiveness of electronic brief intervention on the uptake of specialty treatment in hospital outpatients with likely AD.

METHODS

This study was conducted in the outpatient department of a large public hospital in Newcastle, Australia. We randomly assigned adults who scored ≥10 on the AUDIT-C and were not currently receiving treatment for their drinking to electronic brief intervention (comprising an assessment of their drinking and personalized feedback) and referral (n = 59), or to referral alone (n = 64). We pre-specified two co-primary outcomes as the proportions of patients who (1) accepted and (2) attended a Drug and Alcohol outpatient clinic appointment. We interviewed 15 study participants to investigate why they had declined the appointment and what sort of help they might prefer to receive.

RESULTS

Ten patients (five in each group) accepted an appointment, and one patient (control) attended. Most interviewees' did not see their drinking as a problem or were confident they could manage it by themselves. Those who identified a preferred source of help expressed a preference for treatment by a GP.

CONCLUSION

Uptake of specialty treatment in hospital outpatients with likely AD was low regardless of whether they received brief intervention. Accordingly, a large randomized trial does not appear to be feasible.

Longitudinal impact of interprofessional education on attitudes, skills and career trajectories: a protocol for a quasi-experimental study in New Zealand

INTRODUCTION

Interprofessional practice is recognised as an important element of safe and effective healthcare. However, few studies exist that evaluate how preregistration education contributes to interprofessional competencies, and how these competencies develop throughout the early years of a health professional's career. This quasiexperimental study will gather longitudinal data during students' last year of preregistration training and their first 3 years of professional practice to evaluate the ongoing development of interprofessional competencies and the influence that preregistration education including an explicit interprofessional education (IPE) programme may have on these.

METHODS AND ANALYSIS

Participants are students and graduates from the disciplines of dentistry, dietetics, medicine, nursing, occupational therapy, oral health, pharmacy and physiotherapy recruited before their final year of study. A subset of these students attended a 5-week IPE immersion programme during their final year of training. All data will be collected via five written or electronic surveys completed at 12-month intervals. Each survey will contain the Attitudes Towards Health Care Teams Scale and the Team Skills Scale, as well as quantitative and free-text items to explore vocational satisfaction, career trajectories and influences on these. Students who attend the IPE programme will complete additional free-text items to explore the effects of this programme on their careers. Quantitative analysis will compare scores at each time point, adjusted for baseline scores, for graduates who did and did not participate in the IPE programme. Associations between satisfaction data and discipline, professional setting, location and IPE participation will also be examined. Template analysis will explore free-text themes related to influences on career choices including participation in preregistration IPE.

ETHICS AND DISSEMINATION

This study has received approval from the University of Otago Ethics Committee (D13/019). Results will be disseminated through peer-reviewed publications, conferences and stakeholder reports. Findings will inform future IPE developments and health workforce planning.

Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study

BACKGROUND

The Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery.

OBJECTIVE

To evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS.

DESIGN

Qualitative descriptive study design.

METHODS

Healthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers.

RESULTS

Template analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS.

CONCLUSION

This study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service.

Team Sport in the Workplace? A RE-AIM Process Evaluation of 'Changing the Game'

Background

The workplace is a priority setting to promote health. Team sports can be an effective way to promote both physical and social health. This study evaluated the potential enablers and barriers for outcomes of a workplace team sports intervention programme ‘Changing the Game’ (CTG). This study was conducted in a FTSE 100 services organisation. This process evaluation was conducted using the RE-AIM framework.

Methods

A mixed methods approach was used. Data were collected from the participants in the intervention group prior to, during and at the end of the intervention using interviews (n = 12), a focus group (n = 5), and questionnaires (n = 17). Organisational documentation was collected, and a research diary was recorded by the lead author. The evidence collected was triangulated to examine the reach, efficacy, adoption, implementation and maintenance of the programme. Data was assessed through template analysis, and questionnaire data were analysed using multiple regression and a series of univariate ANOVAs.

Results

CTG improved VO₂ Max, interpersonal communication, and physical activity behaviour (efficacy) over 12-weeks. This may be attributed to the supportive approach adopted within the design and delivery of the programme (implementation). Individual and organisational factors challenged the adoption and maintenance of the intervention. The recruitment and communication strategy limited the number of employees the programme could reach.

Conclusion

The process evaluation suggests addressing the culture within workplaces may better support the reach, adoption and maintenance of workplace team sport programmes. Future research should consider investigating and applying these findings across a range of industries and sectors.

Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial

Background

Little is known about how to discourage clinicians from ordering low-value services. Our objective was to test whether clinicians committing their future selves (ie, precommitting) to follow Choosing Wisely recommendations with decision supports could decrease potentially low-value orders.

Methods

We conducted a 12-month stepped wedge cluster randomised trial among 45 primary care physicians and advanced practice providers in six adult primary care clinics of a US community group practice.Clinicians were invited to precommit to Choosing Wisely recommendations against imaging for uncomplicated low back pain, imaging for uncomplicated headaches and unnecessary antibiotics for acute sinusitis. Clinicians who precommitted received 1–6 months of point-of-care precommitment reminders as well as patient education handouts and weekly emails with resources to support communication about low-value services.The primary outcome was the difference between control and intervention period percentages of visits with potentially low-value orders. Secondary outcomes were differences between control and intervention period percentages of visits with possible alternate orders, and differences between control and 3-month postintervention follow-up period percentages of visits with potentially low-value orders.

Results

The intervention was not associated with a change in the percentage of visits with potentially low-value orders overall, for headaches or for acute sinusitis, but was associated with a 1.7% overall increase in alternate orders (p=0.01). For low back pain, the intervention was associated with a 1.2% decrease in the percentage of visits with potentially low-value orders (p=0.001) and a 1.9% increase in the percentage of visits with alternate orders (p=0.007). No changes were sustained in follow-up.

Conclusion

Clinician precommitment to follow Choosing Wisely recommendations was associated with a small, unsustained decrease in potentially low-value orders for only one of three targeted conditions and may have increased alternate orders.

Trial registration number

NCT02247050; Pre-results.

The development and validation of measures to assess cooking skills and food skills

BACKGROUND

With the increase use of convenience food and eating outside the home environment being linked to the obesity epidemic, the need to assess and monitor individuals cooking and food skills is key to help intervene where necessary to promote the usage of these skills. Therefore, this research aimed to develop and validate a measure for cooking skills and one for food skills, that are clearly described, relatable, user-friendly, suitable for different types of studies, and applicable across all sociodemographic levels.

METHODS

Two measures were developed in light of the literature and expert opinion and piloted for clarity and ease of use. Following this, four studies were undertaken across different cohorts (including a sample of students, both 'Food preparation novices' and 'Experienced food preparers', and a nationally representative sample) to assess temporal stability, psychometrics, internal consistency reliability and construct validity of both measures. Analysis included T-tests, Pearson's correlations, factor analysis, and Cronbach's alphas, with a significance level of 0.05.

RESULTS

Both measures were found to have a significant level of temporal stability (P < 0.001). Factor analysis revealed three factors with eigenvalues over 1, with two items in a third factor outside the two suggested measures. The internal consistency reliability for the cooking skills confidence measure ranged from 0.78 to 0.93 across all cohorts. The food skills confidence measure's Cronbach's alpha's ranged from 0.85 to 0.94. The two measures also showed a high discriminate validity as there were significant differences (P < 0.05 for cooking skills confidence and P < 0.01 for food skills confidence) between Food preparation novices' and 'Experienced food preparers.'

CONCLUSIONS

The cooking skills confidence measure and the food skills confidence measure have been shown to have a very satisfactory reliability, validity and are consistent over time. Their user-friendly applicability make both measures highly suitable for large scale cross-sectional, longitudinal and intervention studies to assess or monitor cooking and food skills levels and confidence.

Early career development in the public sector: Lessons from a social constructionist perspective

This article explores the contribution a social constructionist paradigm can make to the study of career, through a small-scale empirical study of recent graduates employed in New Zealand’s state sector. A social constructionist lens denies the possibility of an individualised, generalised understanding of ‘career’, highlighting instead its local, contingent character as the product of social interaction. Our respondents’ collective construction of career was heavily shaped by a range of context-specific interactions and influences, such as the perception of a distinctive national identity, as well as by their young age and state sector location. It was also shaped by the research process, with us as researchers implicated in these meaning-making processes. Social constructionism shines a light on aspects of the field that are underplayed by mainstream, scientific approaches to the study of career, and therefore has valuable implications for practitioners, as well as scholars.

"Go Make Your Face Known": Collaborative Working through the Lens of Personal Relationships

Background:

Collaborative working between professionals is a key component of integrated care. The academic literature on it largely focuses either on integration between health and social care or on the dynamics of power and identity between doctors and nurses. With the proliferation and extension of nursing roles, there is a need to examine collaborative working amongst different types of nurses.

Method:

This study explored experiences of collaborative working amongst generalist and specialist nurses, in community and acute settings. We carried out semi-structured interviews, incorporating the Pictor technique, with 45 nurses, plus 33 other key stakeholders. Transcripts were analysed using Template Analysis. This article focuses on one major thematic area that emerged from the analysis: the significance of interpersonal relationships amongst nurses, and between them and other professionals, patients and carers.

Results:

Relationship issues were ubiquitous in participants’ accounts of collaborative working. Good personal relationships facilitated collaboration; face-to-face interaction was especially valued. Relationships were recognized as requiring effort, especially in new roles. Organisational changes could disrupt productive personal networks.

Conclusion:

Relationship issues are integral to successful collaborative working. Policy and practice leaders must take this into account in future service developments. Further research into collaborative relationships in different settings is needed.

The central role of the occupational therapist in facilitating housing adaptations/home modifications for disabled children

Introduction

Six reviews/inquiries into housing adaptations/home modifications processes occurred in Wales between 2004 and 2015. One resulted in the removal of the means test for children's Disabled Facilities Grants. This research investigated families' and professionals' experiences of the adaptations/home modification process to gain an understanding of their views and experiences.

Method

Mixed methods of an online questionnaire for professionals, and semi-structured interviews or an online questionnaire for families (depending on their preference), were employed. Forty-eight families participated and an additional 16 families responded to an online questionnaire. Analysis of qualitative data identified emergent themes, which are discussed in this article.

Findings

The themes were: poor information and communication mainly aimed at older adults; negative experience of the process; and the positive impact of the completed adaptation. Additionally, whilst undergoing the process, families felt that they needed a contact to guide them through the process. This contact was often by default the community occupational therapist.

Conclusion

A single contact person should be made available for families; occupational therapists should consider their part in that role; more specific information on children's needs should be provided; families need to recognize the part they can play in adding to delays in the delivery of adaptations.

Quality indicators for learner-centered postgraduate medical e-learning

OBJECTIVES

The objectives of this study were to identify the needs and expectations of learners and educational experts in postgraduate medical e-learning, and to contribute to the current literature.

METHODS

We performed four focus-group discussions with e-learning end-users (learners) and didactic experts. The participants were postgraduate learners with varying levels of experience, educational experts from a Dutch e-learning task group, and commercial experts from a Dutch e-learning company. Verbatim transcribed interview recordings were analyzed using King's template analysis. The initial template was created with reference to recent literature on postgraduate medical e-learning quality indicators. The transcripts were coded, after which the emerging differences in template interpretation were discussed until a consensus was reached within the team.

RESULTS

The final template consisted of three domains of positive e-learning influencers (motivators, learning enhancers, and real-world translation) and three domains of negatively influential parameters (barriers, learning discouragers, and poor preparation). The interpretation of the final template showed three subjects which form the basis of e-learning, namely, Motivate, Learn and Apply.

CONCLUSIONS

This study forms a basis for learning in general and could be applied to many educational instruments. Individual characteristics should be adapted to the target audience. Three subjects form the basis of, and six themes cover all items needed for, good (enough) postgraduate e-learning. Further research should be carried out with learners and real-world e-learning to validate this template.

Military veterans’ experiences of NHS mental health services

Purpose

A significant minority of veterans have poor mental health outcomes but their needs are not always well managed by the NHS. The purpose of this paper is to explore veterans’ experiences of NHS mental healthcare in Norfolk and Suffolk to identify ways of improving services.

Design/methodology/approach

Interviews were conducted with 30 veterans. Template analysis was undertaken to explore key themes in the interview transcripts.

Findings

Participants were reluctant to seek help but were more likely to engage with a veteran-specific service. Those whose symptoms were military related reported better experiences when accessing treatment that was military sensitive.

Research limitations/implications

This was a local study and the findings do not necessarily reflect the views of the wider veteran community. Most participants who received military sensitive treatment were referred to the study by NHS providers, which could account for their positive feedback.

Social implications

The development of dedicated mental health services may encourage more veterans to seek support, helping to improve patient outcomes. There is a need for further research to determine the effectiveness of dedicated services and identify how they should be deployed.

Originality/value

Where academic interest has generally centred on the aetiology of mental health conditions within the military, this study focussed upon service user experience. The findings contributed to NHS England’s recent decision to extend its network of dedicated services in 12 areas of the country to cover veterans across England from April 2017.

What are the Facilitators and Obstacles to Participation in Workplace Team Sport? A Qualitative Study

Working age adults are failing to meet physical activity recommendations. Inactive behaviours are increasing costs for diminished individual and organisational health. The workplace is a priority setting to promote physical activity, however there is a lack of evidence about why some employees choose to participate in novel workplace activities, such as team sport, whilst others do not. The aim of this study was to explore the complexity of facilitators and obstacles associated with participation in workplace team sport. Twenty-nine semi-structured face-to-face and telephone interviews were conducted with office workers (58% female) (36 ± 7.71) from manufacturing, public services, and educational services. Data was analysed through template analysis. Five sub-level (i.e., intrapersonal, interpersonal, organisational, community and societal influences) facilitate participation or create obstacles for participants. Participants were challenged by a lack of competence, self-efficacy, negative sporting ideals and amotivation. Unhealthy competition, an unstable work-life balance and unsupportive colleagues created obstacles to participation. An unsupportive organisation and workplace culture placed demands on workplace champions, funding, facilities and communication. Healthy competitions, high perceptions of competence and self-efficacy, and being motivated autonomously enabled participation. Further, relatedness and social support created a physical activity culture where flexible working was encouraged and team sport was promoted in accessible locations within the organisation. Researchers should consider accounting for complexity of these influences. A participatory approach may tailor interventions to individual organisations and the employees that work within them. Interventions whereby autonomy, competence and relatedness are supported are recommended. This may be achieved by adapting sports and training workplace champions.

Rethinking cultural diversity in the UK film sector: Practices in community filmmaking

Academic, policy and industry debates have tended to focus on the mainstream film sector when discussing cultural diversity. One of the persistent challenges for the sector has been how to diversify cultural representation and participation. This article suggests that participatory modes of community filmmaking make an important contribution to cultural diversity. Drawing on an evidence base derived from qualitative research conducted in three English regions, the article shifts the spotlight away from the mainstream and onto the margins of the film sector in order to explore more ‘bottom-up’ approaches to cultural diversity. It examines how community filmmakers interpret and engage with questions of cultural diversity and how this connects to the participatory and business practices that they adopt. The findings highlight the significance of processes of practice in how mediated cultural diversity manifests itself and the value of community filmmaking in contributing to wider cultural diversity debates and practices.

A Template Analysis of Writing Self-Efficacy Measures

Background and Purpose: This investigation reviews the item content of writing self-efficacy (WSE) measures developed for undergraduate students. Bandura’s self-efficacy theory and a writing theory by Flower and Hayes informed the a priori themes used to develop a template of WSE categories critical to the concept. Method: Articles describing WSE measures were identified through Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Education Resources Information Center (ERIC), PubMed, Scopus, and Google Scholar (1984–2015). A template analysis method was used to analyze 182 individual items present on 11 WSE instruments. A nursing perspective was applied. Results: The analysis identified 16 categories influencing WSE as well as gaps in current measurement items. Conclusion: The theoretical examination of WSE is the first step toward the development of a WSE measure specific to the nursing context and contributes to nursing education by advancing the measurement of WSE.

Uncertainty and innovation: Understanding the role of cell-based manufacturing facilities in shaping regulatory and commercialization environments

The purpose of this qualitative study is to elucidate stakeholder perceptions of, and institutional practices related to cell-based therapies and products (CTP) regulation and commercialization in Canada. The development of reproducible, safe and effective CTPs is predicated on regulatory and commercialization environments that enable innovation. Manufacturing processes constitute a critical step for CTP development in this regard. The road from CTP manufacturing to translation in the clinic, however, has yet to be paved. This study aims to fill an empirical gap in the literature by exploring how CTP manufacturing facilities navigate Canadian regulatory and commercialization environments, which together drive the translation of novel CTPs from bench to bedside. Using the multi-level model of practice-driven institutional change proposed by Smets et al., we demonstrate how CTP manufacturing practices are governed by established standards, yet meaningfully shape higher-order regulatory and commercial norms in CTP research and development. We identify four key themes that undergird such processes of innovation: 1) managing regulatory uncertainty, which stems from an inability to classify CTPs within existing regulatory categories for approval and commercialization purposes; 2) building a 'business case' whereby a CTP's market potential is determined in large part by proving its safety and effectiveness; 3) standardizing manufacturing procedures that mobilize CTPs from a research and development phase to a commercialization one; and 4) networking between researchers and regulators to develop responsible commercialization processes that reflect the uniqueness of CTPs as distinct from other biologics and medical devices.