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South K, Smaldone A, Sadeghi H, Piane V, Kowal R, Wei L, George M. Parent and adolescent perceptions of cystic fibrosis management responsibility: A mixed-methods study. Pediatr Pulmonol 2023; 58:2340-2351. [PMID: 37232332 PMCID: PMC10524381 DOI: 10.1002/ppul.26494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Adolescents with cystic fibrosis (CF) and their parents must navigate changing roles and responsibilities within the family including transfer of disease management responsibilities. AIM/OBJECTIVE The aim of this qualitative study was to explore how families share and transfer CF management responsibility from the perspectives of adolescents with CF and their parents. METHODS Guided by qualitative descriptive methodology, we purposively sampled adolescent/parent dyads. Participants completed two surveys measuring family responsibility (Family Responsibility Questionnaire [FRQ]) and transition readiness (Transition Readiness Assessment Questionnaire [TRAQ]) We conducted semistructured video or phone interviews, used a codebook to guide team coding and analyzed qualitative data using both content analysis and dyadic interview analysis. RESULTS Thirty participants (15 dyads) enrolled (7% Black; 33% Latina/o; 40% female; adolescent age 14.4 ± 2 years; 66% prescribed highly effective modulator therapy; 80% of parents were mothers). Parent FRQ and TRAQ scores were significantly higher than their adolescent indicating differing perceptions of responsibility and transition readiness. We inductively identified four themes: (1) CF management is a delicate balance (CF management is a routine which is easily disrupted), (2) Growing up and parenting under extraordinary circumstances (the burden of CF weighs on families as they navigate adolescence), (3) Differing Perceptions of risk and responsibility (adolescent and parent perceptions of treatment responsibility and the risks of nonadherence do not always align), and (4) Balancing independence and protection (families must weigh the benefits and risks of allowing adolescents increased independence). CONCLUSIONS Adolescents and parents demonstrated differing perceptions of CF management responsibility, which may be related to a lack of communication between family members about this topic. To help facilitate alignment of parent and adolescent expectations, discussion of family roles and responsibility for CF management should begin early during the transition process and be discussed regularly during clinic visits.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Hossein Sadeghi
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Victoria Piane
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Rebecca Kowal
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Leanna Wei
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Maureen George
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
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Wang Q, Lee RLT, Hunter S, Chan SWC. Patients' experiences of using a mobile application-based rehabilitation programme after total hip or knee arthroplasty: a qualitative descriptive study. BMC Nurs 2023; 22:246. [PMID: 37496003 PMCID: PMC10373373 DOI: 10.1186/s12912-023-01409-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND An increasing number of patients are discharged from a total hip or knee arthroplasty with a short length of hospital stay. Technologies, such as mobile applications, are used to provide remote support to patients' postoperative rehabilitation. Patients' experiences of receiving mobile application-based rehabilitation after total hip or knee arthroplasty have not been investigated extensively. METHODS This was a qualitative descriptive study. Twenty-five participants who had completed a mobile application-based rehabilitation programme for total hip or knee arthroplasty were recruited. Semi-structured interviews were conducted via telephone between July 2021 and January 2022 regarding the participants' experiences using the programme. All interviews were audio-recorded and verbatim transcribed. Data were analysed using inductive content analysis. The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research. RESULTS Data analysis revealed five categories: (a) improved access to health care, (b) encouraged postoperative recovery, (c) established supportive relationships, (d) facilitated learning, and (e) future directions. CONCLUSION The theory-underpinned mobile application-based rehabilitation programme demonstrated potential value in supporting patients' rehabilitation after arthroplasty. Nurses can consider using mobile technologies to expand their role in arthroplasty rehabilitation and improve the quality of rehabilitation care.
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Affiliation(s)
- Qingling Wang
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, China.
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Newcastle, NSW, Australia.
| | - Regina Lai-Tong Lee
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Newcastle, NSW, Australia
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Sharyn Hunter
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Newcastle, NSW, Australia
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Currie G, Materula D, Gall N, Lachuk G, Richard C, Yohemas M, Dewan T, Gibbard WB, Zwicker J. Care coordination of children with neurodevelopmental disabilities and medical complexity during the COVID-19 pandemic: Caregiver experiences. Child Care Health Dev 2023. [PMID: 37407028 DOI: 10.1111/cch.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/19/2023] [Accepted: 03/04/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic and subsequent public health restrictions created significant challenges for children with neurodevelopmental disabilities with medical complexity and their caregivers including restrictions in care coordination for children and their families. Care coordination enhances families' skills in accessing and coordinating medical, education and disability care across sectors and systems. OBJECTIVE This study examined the implications of pandemic restrictions on care coordination from caregiver perspectives. These experiences can inform emergency preparedness planning and recovery strategies. METHOD A qualitative descriptive design was utilized to explore and describe the experience of caregivers of children with neurodevelopmental disabilities and medical complexity. Nineteen caregivers were interviewed about their experience with care coordination during the pandemic. FINDINGS Caregiver experiences of care coordination during the pandemic highlighted the importance of care coordination during a public health emergency. Two themes emerged: (1) disruptions to care coordination from initial COVID-19 restrictions leading to lack of access to supports and services, increasing level of need, and impacts of disruption for caregivers and children; and (2) adaptation and responsiveness to COVID-19 restrictions by advocating for families and managing uncertainties. RECOMMENDATIONS Recommendations include recognition of care coordination as a protective factor, designation as an essential service and sustained or increased funding for care coordination during emergencies. Families should be engaged in identifying care needs during care coordination, including during public health emergencies.
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Affiliation(s)
- Genevieve Currie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada
| | - Dercia Materula
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Gall
- Alberta Health Services, Calgary, Alberta, Canada
| | - Gina Lachuk
- Alberta Health Services, Calgary, Alberta, Canada
| | | | | | - Tammie Dewan
- Alberta Health Services, Calgary, Alberta, Canada
| | | | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Alberta, Canada
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Gupta A, Prasad R, Abraham S, Nedungalaparambil NM, Landes M, Steele Gray C, Sridharan S, Bhattacharyya O. Pioneering family physicians and the mechanisms for strengthening primary health care in India-A qualitative descriptive study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001972. [PMID: 37289670 DOI: 10.1371/journal.pgph.0001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023]
Abstract
India has one of the most unequal healthcare systems globally, lagging behind its economic development. Improved primary care and primary health care play an integral role in overcoming health disparities. Family medicine is a subset of primary care-delivered by family physicians, characterized by comprehensive, continuous, coordinated, collaborative, personal, family and community-oriented services-and may be able to fill these gaps. This research aims to understand the potential mechanisms by which family physicians can strengthen primary health care. In this qualitative descriptive study, we interviewed twenty family physicians, identified by purposeful and snowball sampling, who are among the first family physicians in India who received accredited certification in FM and were identified as pioneers of family medicine. We used the Contribution of Family Medicine to Strengthening Primary Health Care Framework to understand the potential mechanisms by which family medicine strengthens primary health care. Iterative inductive techniques were used for analysis. This research identifies multiple ways family physicians can strengthen primary health care in India. They are skilled primary care providers and support mid and low-level health care providers' ongoing training and capacity building. They develop relationships with specialists, ensure appropriate referral systems are in place, and, when necessary, work with governments and organizations to access the essential resources needed to deliver care. They motivate the workforce and change how care is delivered by ensuring providers' skills match the needs of communities and engage communities as partners in healthcare delivery. These findings highlight multiple mechanisms by which family physicians strengthen primary health care. Investments in postgraduate training in family medicine and integrating family physicians into the primary care sector, particularly the public sector, could address health disparities.
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Affiliation(s)
- Archna Gupta
- Department of Family and Community Medicine, St. Michaels Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Ramakrishna Prasad
- PMCH Restore Health, Bangalore, Karnataka, India
- National Centre for Primary Care Research & Policy, Academy of Family Physicians of India (AFPI), New Delhi, India
| | - Sunil Abraham
- Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Megan Landes
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Carolyn Steele Gray
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Sanjeev Sridharan
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Health Policy Evaluation, Social Science Research Institute, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Onil Bhattacharyya
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Teicher J, Moore C, Esser K, Weiser N, Arje D, Cohen E, Orkin J. The Experience of Parental Caregiving for Children With Medical Complexity. Clin Pediatr (Phila) 2023; 62:633-644. [PMID: 36475307 PMCID: PMC10676025 DOI: 10.1177/00099228221142102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Children with medical complexity (CMC) have complex chronic conditions with significant functional impairment, contributing to high caregiving demand. This study seeks to explore impacts of parental caregiving for CMC. Fifteen caregivers of CMC followed at a tertiary care hospital participated in semi-structured interviews. Interviews were concurrently analyzed using a qualitative description framework until thematic saturation was reached. Codes were grouped by shared concepts to clarify emergent findings. Four affected domains of parental caregiver experience with associated subthemes (in parentheses) were identified: personal (identity, physical health, mental health), family (marriage, siblings, family quality of life), social (time limitations, isolating lived experience), and financial (employment, medical costs, accessibility costs). Despite substantial challenges, caregivers identified two core determinants of personal resilience: others' support (hands-on, interpersonal, informational, material) and a positive outlook (self-efficacy, self-compassion, reframing expectations). Further research is needed to understand the unique needs and strengths of caregivers for this vulnerable population.
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Affiliation(s)
- Jessica Teicher
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clara Moore
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Danielle Arje
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, ON, Canada
| | - Julia Orkin
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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Isaacs A, Mitchell EKL, Sutton K, Naughton M, Hine R, Bullock S, Azar D, Maybery D. Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105870. [PMID: 37239597 DOI: 10.3390/ijerph20105870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | | | - Keith Sutton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Michael Naughton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Rochelle Hine
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Shane Bullock
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Denise Azar
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
- Gippsland Primary Health Network, Traralgon, VIC 3844, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
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Haynes A, Howard K, Johnson L, Williams G, Clanchy K, Tweedy S, Scheinberg A, Chagpar S, Wang B, Vassallo G, Ashpole R, Sherrington C, Hassett L. Physical Activity Preferences of People Living with Brain Injury: Formative Qualitative Research to Develop a Discrete Choice Experiment. THE PATIENT 2023:10.1007/s40271-023-00628-9. [PMID: 37204699 DOI: 10.1007/s40271-023-00628-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND OBJECTIVE The World Health Organization physical activity guidelines for people living with disability do not consider the needs of people living with moderate-to-severe traumatic brain injury. This paper describes the qualitative co-development of a discrete choice experiment survey to inform the adaption of these guidelines by identifying the physical activity preferences of people living with moderate-to-severe traumatic brain injury in Australia. METHODS The research team comprised researchers, people with lived experience of traumatic brain injury and health professionals with expertise in traumatic brain injury. We followed a four-stage process: (1) identification of key constructs and initial expression of attributes, (2) critique and refinement of attributes, (3) prioritisation of attributes and refinement of levels and (4) testing and refining language, format and comprehensibility. Data collection included deliberative dialogue, focus groups and think-aloud interviews with 22 purposively sampled people living with moderate-to-severe traumatic brain injury. Strategies were used to support inclusive participation. Analysis employed qualitative description and framework methods. RESULTS This formative process resulted in discarding, merging, renaming and reconceptualising attributes and levels. Attributes were reduced from an initial list of 17 to six: (1) Type of activity, (2) Out-of-pocket cost, (3) Travel time, (4) Who with, (5) Facilitated by and (6) Accessibility of setting. Confusing terminology and cumbersome features of the survey instrument were also revised. Challenges included purposive recruitment, reducing diverse stakeholder views to a few attributes, finding the right language and navigating the complexity of discrete choice experiment scenarios. CONCLUSIONS This formative co-development process significantly improved the relevance and comprehensibility of the discrete choice experiment survey tool. This process may be applicable in other discrete choice experiment studies.
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Affiliation(s)
- Abby Haynes
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia.
- Sydney Musculoskeletal Health, Level 10 KGV Building, Missenden Road, Camperdown (Gadigal land), NSW, 2050, Australia.
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | - Liam Johnson
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Gavin Williams
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Physiotherapy Department, Epworth HealthCare, Melbourne, VIC, Australia
| | - Kelly Clanchy
- School of Health Sciences and Social Work, Griffith Health, Griffith University, Gold Coast, QLD, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Sean Tweedy
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sakina Chagpar
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | - Belinda Wang
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | | | - Rhys Ashpole
- Insurance and Care (icare) NSW, Sydney, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | - Leanne Hassett
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Implementation Science Academy, Sydney Health Partners, Sydney, NSW, Australia
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Bird M, Neely KC, Montemurro G, Mellon P, MacNeil M, Brown C, Sulz L, Storey K. Parental Perspectives of Sleep in the Home: Shaping Home-School Partnerships in School-Based Sleep Promotion Initiatives. Prev Chronic Dis 2023; 20:E38. [PMID: 37167552 DOI: 10.5888/pcd20.220395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Sleep is a critical component of child health and the prevention of chronic disease. Children may benefit from school-based sleep promotion; however, parents need to be involved for healthy sleep strategies learned at school to be translated to the home. The objective of this study was to explore parental perspectives on sleep behaviors and responsiveness to school-based sleep promotion. METHODS Twenty-five parents of school-aged children were purposively sampled for interviews from July 2019 through April 2020 in Alberta, Canada. Descriptive qualitative methodology was used, and data were generated through semistructured interviews and researcher field notes. Interviews were transcribed and themes were identified by using latent content analysis. RESULTS Three themes emerged from analysis: 1) sleep is valued and supported, 2) barriers to healthy sleep exist, and 3) schools are allies in promoting sleep. Parents perceived that sleep was essential for their child's health, facilitated healthy sleep practices in the home, and highlighted barriers (busy schedules and poor parental role models) that affected sleep. Parents supported and expressed value in school-based sleep promotion and noted factors that affected the success of school-based sleep promotion. CONCLUSION Parents are responsive to school-based sleep promotion. Promotion efforts should include resources that engage and involve parents in the school community. Throughout the development of resources to support school-based sleep promotion, additional consideration of parent-reported barriers to promoting healthy sleep in the home should be included.
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Affiliation(s)
- Melissa Bird
- Alberta Health Services, Calgary, Alberta, Canada
| | - Kacey C Neely
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | | | - Pamela Mellon
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Megan MacNeil
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Cary Brown
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren Sulz
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, 3-300 ECHA, 11405-87 Ave, Edmonton, AB Canada T6G 1C9
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Ries NM, Johnston B. Making an Advance Research Directive: An Interview Study with Adults Aged 55 and Older with Interests in Dementia Research. Ethics Hum Res 2023; 45:2-17. [PMID: 37167476 DOI: 10.1002/eahr.500171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Many people with dementia are interested in taking part in research, including when they no longer have capacity to provide informed consent. Advance research directives (ARD) enable people to document their wishes about research participation prior to becoming decisionally incapacitated. However, there are few available ARD resources. This Australian interview study elicited the views of people aged 55 years and older about the content of an ARD form and guidance booklet and processes to support research planning. Participants (n = 25; 55 to 83 years) had interests in dementia research. All participants described the ARD materials as easy to understand, and all expressed willingness to take part in future research. Nearly half believed that an ARD should be legally enforceable, while others saw it as a nonbinding document to guide decisions about their participation in research. Close family members were preferred as proxy decision-makers. The ARD form and guidance booklet may be adapted for use elsewhere.
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Affiliation(s)
- Nola M Ries
- Professor in the Faculty of Law at University of Technology Sydney
| | - Briony Johnston
- PhD candidate at the Faculty of Law at University of Technology Sydney
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Maheu C, Parkinson M, Wong C, Yashmin F, Longpré C. Self-Employed Canadians' Experiences with Cancer and Work: A Qualitative Study. Curr Oncol 2023; 30:4586-4602. [PMID: 37232805 DOI: 10.3390/curroncol30050347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Self-employed individuals with cancer face unique challenges that have not been fully explored in previous research. For example, while some studies conducted in Europe have suggested that self-employed workers with cancer experience more adverse health and work-related outcomes compared to salaried workers, the specific manners in which cancer affects the health, work, and businesses of self-employed individuals remain inadequately understood. This lack of understanding represents a crucial gap in the literature, as self-employed individuals make up a significant portion of the workforce in many countries, including Canada. To address this gap, a qualitative interpretive description study was undertaken to explore the experiences of 23 self-employed Canadians diagnosed with cancer from six provinces, with the aim of generating insights into the unique challenges faced by this population. The interviews were conducted in the language chosen by the participants from the two official languages of Canada, namely English and French. Using reflexive thematic analysis, four major themes and twelve subthemes were generated from the participants' shared accounts that reflected the impact of cancer on self-employed Canadians' physical, cognitive, and psychological function, affecting their work ability and their ability to maintain their business and financial well-being. Participants in the study also shared strategies they used to continue working and maintain their business during their cancer experience. This study sheds light on the impact of cancer on self-employed individuals and provides insight into the experiences of self-employed individuals with cancer that can inform the development of interventions to support this population.
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Affiliation(s)
- Christine Maheu
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada
| | - Maureen Parkinson
- BC Cancer Agency, Patient & Family Counseling, Vancouver, BC V5Z 1G1, Canada
| | - Caitlin Wong
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada
| | - Fatima Yashmin
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada
| | - Caroline Longpré
- Nursing Sciences Department, Université du Québec en Outaouais (UQO), St-Jérôme, QC J7Z 0B7, Canada
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Duran-Kiraç G, Uysal-Bozkir Ö, Uittenbroek R, van Hout H, Broese van Groenou MI. Informal caregiver and nurse perceptions of access to culturally appropriate health care for ethnic minority persons with dementia: A qualitative study. J Adv Nurs 2023. [PMID: 37113024 DOI: 10.1111/jan.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
AIMS This study explored what informal caregivers of ethnic minority (EM) persons with dementia in the Netherlands perceive as culturally accessible health care and nurses' perceptions of how cultural competence can be improved to facilitate access to health care for EM persons with dementia and their informal caregivers. DESIGN Qualitative description research with semi-structured individual interviews and focus group discussions (FGDs). METHODS Semi-structured interviews with 15 nurses and 6 informal caregivers provided input for two FGDs with nurses about the need to strengthen their cultural competence to improve access to health care for EM persons with dementia and their informal caregivers. Interview data were collected between September 2020 and April 2021 in the Netherlands. Focus group discussion data were collected between June and September 2021 in the Netherlands. RESULTS Nurses and informal caregivers experienced difficulty building and maintaining a relationship. Contrary to informal caregivers' experiences, nurses felt a shared cultural background with the persons with dementia and informal caregiver is necessary. Although nurses acknowledged the importance of cultural knowledge, cultural skills, in particular, were mentioned as needing improvement. Examples are mapping involved family members and their roles, asking the right questions and letting go of personal judgements. Nurses frequently mentioned stereotypical thinking and seeing 'the other' as different, and collaboration with(in) family proved difficult for informal caregivers and nurses. CONCLUSION Strengthening cultural skills will contribute to facilitating better access to cultural appropriate health care for EM persons with dementia and their informal caregivers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT This study explores what is perceived as culturally accessible health care and what nurses need to improve their cultural competence. We show that strengthening nurses' cultural competence by addressing which skills should be improved can improve access to health care for EM persons with dementia and their informal caregivers.
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Affiliation(s)
- Gözde Duran-Kiraç
- Research Group Living Well with Dementia, Department of Health and Well-being, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Özgül Uysal-Bozkir
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Ronald Uittenbroek
- Department of Health and Well-being, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Hein van Hout
- Departments of General Practice and Medicine of Older People, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
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Dakic JG, Hay-Smith J, Lin KY, Cook J, Frawley HC. Experience of Playing Sport or Exercising for Women with Pelvic Floor Symptoms: A Qualitative Study. SPORTS MEDICINE - OPEN 2023; 9:25. [PMID: 37097457 PMCID: PMC10127961 DOI: 10.1186/s40798-023-00565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/09/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Women participate in sport at lower rates than men, and face unique challenges to participation. One in three women across all sports experience pelvic floor (PF) symptoms such as urinary incontinence during training/competition. There is a dearth of qualitative literature on women's experiences of playing sport/exercising with PF symptoms. The purpose of this study was to explore the lived experience of symptomatic women within sports/exercise settings and the impact of PF symptoms on sports/exercise participation using in-depth semi-structured interviews. RESULTS Twenty-three women (age 26-61 years) who had experienced a breadth of PF symptom type, severity and bother during sport/exercise participated in one-one interviews. Women played a variety of sports and levels of participation. Qualitative content analysis was applied leading to identification of four main themes: (1) I can't exercise the way I would like to (2) it affects my emotional and social well-being, (3) where I exercise affects my experience and (4) there is so much planning to be able to exercise. Women reported extensive impact on their ability to participate in their preferred type, intensity and frequency of exercise. Women experienced judgement from others, anger, fear of symptoms becoming known and isolation from teams/group exercise settings as a consequence of symptoms. Meticulous and restrictive coping strategies were needed to limit symptom provocation during exercise, including limiting fluid intake and careful consideration of clothing/containment options. CONCLUSION Experiencing PF symptoms during sport/exercise caused considerable limitation to participation. Generation of negative emotions and pain-staking coping strategies to avoid symptoms, limited the social and mental health benefits typically associated with sport/exercise in symptomatic women. The culture of the sporting environment influenced whether women continued or ceased exercising. In order to promote women's participation in sport, co-designed strategies for (1) screening and management of PF symptoms and (2) promotion of a supportive and inclusive culture within sports/exercise settings are needed.
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Affiliation(s)
- Jodie G Dakic
- Department of Physiotherapy, Monash University, 47 - 49 Moorooduc Highway Frankston, Victoria, 3199, Australia.
- Department of Physiotherapy, The University of Melbourne, 161 Barry St, Parkville, 3010, Australia.
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Kuan-Yin Lin
- Department of Physical Therapy, National Cheng Kung University, No. 1, Ta-Hsueh Road, Tainan, 701, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1, Ta-Hsueh Road, Tainan, 701, Taiwan
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Plenty Rd &, Kingsbury Dr, Bundoora, VIC, 3086, Australia
| | - Helena C Frawley
- Melbourne School of Health Sciences, The University of Melbourne, 161 Barry St., Parkville 3010, VIC, Australia
- Allied Health Research, The Royal Women's Hospital, Parkville, VIC, 3052, Australia
- Allied Health Research, Mercy Hospital for Women, Studley Rd, Heidelberg, VIC, 3084, Australia
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63
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Bian W, Cheng J, Dong Y, Xue Y, Zhang Q, Zheng Q, Song R, Yang H. Experience of pediatric nurses in nursing dying children - a qualitative study. BMC Nurs 2023; 22:126. [PMID: 37072761 PMCID: PMC10111798 DOI: 10.1186/s12912-023-01274-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
PURPOSE To explore pediatric nurses' challenges and effective coping strategies in caring for dying children. METHODS A descriptive qualitative study was adopted. Data were collected using a semi-structured interview with ten nurses from the pediatric, pediatric emergency, and neonatology departments. RESULTS Three themes were generated: stressors, consequences, and coping strategies. Ten sub-themes were generalized: negative emotions; helplessness; questioning rescue behavior; fear of communication; lack of workforce for night rescue; compassion fatigue; burnout; changes in life attitudes; self-regulation; leadership approval and no accountability. CONCLUSIONS Through qualitative research, nurses' challenges and effective coping strategies in caring for dying children were found, which provides information for nurses' career development and related policy formulation in China. CLINICAL RELEVANCE While there are many articles in China on hospice care, there is little research on the nurses' experience of caring for dying children. Many studies have mentioned the adverse consequences of caring for dying children in foreign countries, leading to post-traumatic stress disorder (PTSD). However, domestic discussion of such problems is rare, and no corresponding coping strategies exist. This study explores pediatric nurses' challenges and effective coping strategies in caring for dying children.
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Affiliation(s)
- Weina Bian
- Department of Nursing, Hanzhong Central Hospital, Shaanxi, 723000, China
| | - Junxiang Cheng
- Department of Psychiatry, the First Hospital of Shanxi Medical University, Shanxi, 030000, China
| | - Yue Dong
- Department of ICU, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, 222000, China
| | - Ying Xue
- Department of Nursing, Hanzhong Central Hospital, Shaanxi, 723000, China
| | - Qian Zhang
- Department of Nursing, Hanzhong Central Hospital, Shaanxi, 723000, China
| | - Qinghua Zheng
- Department of Nursing, Hanzhong Central Hospital, Shaanxi, 723000, China
| | - Rui Song
- Department of Nursing, Hanzhong Central Hospital, Shaanxi, 723000, China
| | - Hongwei Yang
- Department of Statistics, Hanzhong Central Hospital, Shaanxi, 723000, China.
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Liddell JL. "Treat Me like Your Family": Positive Factors that Influence Patient-Provider Relationships for Native American Women. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:221-234. [PMID: 36135975 PMCID: PMC11104767 DOI: 10.1080/19371918.2022.2127434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Although extensive documentation of the health disparities experienced by Native American peoples exists, little research explores experiences of members of non-federally recognized tribes who receive health care outside of the Indian Health Services (IHS) system. Additionally, positive factors that influence relationships between health care providers and tribal members are understudied and are needed to promote health care access. A qualitative descriptive methodologic approach was used to conduct semi structured life history interviews with 31 women who identified as members of a state-recognized, Gulf South Native American tribe. Results identified the following important themes: Do Participants Have a Regular Provider, Personal Relationship With Provider, Feel Provider Cares, Provider Addresses Concern, and Respect for Traditional or Holistic Medicine. These findings suggest health care providers play an important role in impacting the health care experiences of Native American tribal members. Implications for trainings for health care providers are discussed.
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65
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Do U, Pook M, Najafi T, Rajabiyazdi F, El-Kefraoui C, Balvardi S, Barone N, Elhaj H, Nguyen-Powanda P, Lee L, Baldini G, Feldman LS, Fiore JF. S110-Opioid-free analgesia after outpatient general surgery: A qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial. Surg Endosc 2023; 37:2269-2280. [PMID: 35918552 DOI: 10.1007/s00464-022-09472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Opioid-free analgesia (OFA) may mitigate opioid-related harms after outpatient general surgery; however, the comparative effectiveness of this approach should be assessed in robust randomized controlled trials (RCTs). Undertaking an RCT on OFA raises important practical concerns, including surgeon and patient hesitation regarding pain management without opioids. We conducted a qualitative study to explore patients' and clinicians' perspectives and experiences with a pilot trial focused on OFA after outpatient general surgery. METHODS Patients undergoing outpatient abdominal and breast procedures were randomized to receive post-discharge opioid analgesia (OA) or OFA. Semi-structured interviews with patients and clinicians involved in the trial were conducted to elicit personal perspectives and experiences. Purposive sampling for maximum variation was used to recruit participants with diverse characteristics. Transcribed interviews were assessed using inductive thematic analysis. RESULTS Ten patients (5 abdominal, 5 breast) and 10 clinicians (6 surgeons, 2 anesthesiologists, 2 nurses) were interviewed. Five major themes emerged: readiness for trial engagement, pre-trial thoughts about the interventions, postoperative pain experiences, intervention acceptability, and trial refinement. Most patients were open to OFA. Clinicians expressed willingness to prescribe OFA, particularly after less invasive procedures and when using peripheral nerve blocks (PNBs). Concerns were raised regarding the adequacy of pain control and side effects of non-opioid drugs (e.g., NSAID-induced bleeding, kidney injury). Overall, participants were enthusiastic about the trial and recognized its relevance; clinicians praised the study design and organization; and patients valued the use of electronic questionnaires. Suggestions for improvements included preventing potential bias arising from the use of PNBs (i.e., via standardization or stratification) and reducing patient burden (i.e., decreasing postoperative questionnaires). CONCLUSION Patients and clinicians who participated in a pilot RCT generally accept the clinical equipoise between OA versus OFA after outpatient general surgery and recognize the need for methodologically robust trials to inform evidence-based analgesia prescribing.
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Affiliation(s)
- Uyen Do
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Makena Pook
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Tahereh Najafi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Charbel El-Kefraoui
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Saba Balvardi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Philip Nguyen-Powanda
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gabriele Baldini
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. .,Division of Experimental Surgery, McGill University, Montreal, QC, Canada. .,Department of Surgery, McGill University, Montreal, QC, Canada. .,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada. .,Montreal General Hospital, 1650 Cedar Ave, R2-104, Montreal, QC, H3G 1A4, Canada.
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Codd Y, Coe Á, Kane D, Mullan RH, Stapleton T. A multidisciplinary-led early arthritis service to manage client-identified participation restrictions in early inflammatory arthritis: A qualitative study of service user and staff perspectives. Musculoskeletal Care 2023; 21:130-142. [PMID: 35933715 DOI: 10.1002/msc.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The impact of inflammatory arthritis (IA) on occupational performance and on participation in meaningful life roles is recognised. However, limited research has explored how clinical services support broader life impact and participation restrictions associated with early disease as part of routine healthcare. This exploratory study was undertaken to describe how a novel multidisciplinary-led early arthritis service approach addresses client-identified participation restrictions in early IA. METHODS Qualitative Description (QD) approaches were used to explore perspectives of staff and clients of these multidisciplinary-led early arthritis services in Ireland. Data were gathered using focus groups with staff, and individual semi-structured interviews with clients. Transcripts were analysed using thematic analysis. RESULTS Fifteen staff working in these services participated in the focus groups and 43 clients with IA participated in interviews (female n = 31); diagnosis duration ranged from 5 to 24 months. Participants described how the multidisciplinary-led service had a clear remit to address participation alongside traditional symptom management and provided automatic, immediate access to interventions focussed on identification and management of participation restrictions experienced in early disease. The service model utilised a delivery approach that allowed for ease of early access to a full multidisciplinary team and prolonged support. The most significant feature of the service approach was 'the centrality of the client' which influenced a person-centred approach to identification of needs and priorities for interventions. CONCLUSION Findings indicate the role and value of this innovative multidisciplinary approach in addressing client-identified participation restrictions in routine clinical practice that is positively regarded by clients and staff.
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Affiliation(s)
- Yvonne Codd
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - Áine Coe
- Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - David Kane
- Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - Ronan H Mullan
- Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - Tadhg Stapleton
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Godziuk K, Prado CM, Quintanilha M, Forhan M. Acceptability and preliminary effectiveness of a single-arm 12-week digital behavioral health intervention in patients with knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:129. [PMID: 36797720 PMCID: PMC9936108 DOI: 10.1186/s12891-023-06238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Digital health interventions may improve osteoarthritis (OA) management. This study evaluated the acceptability and preliminary effectiveness of a multimodal digital nutrition, exercise, and mindfulness intervention in adults with knee OA. METHODS Adults with advanced knee OA and an orthopaedic referral were invited to self-enroll in a pragmatic 12-week single-arm intervention. OA-focused nutrition and exercise resources were delivered weekly by email, and secondary components accessed on-demand (web-platform, webinars, and nutrition consultation). Acceptability was assessed by qualitative interview data and completion rates. Preliminary effectiveness on clinical outcomes was assessed by change in health-related quality of life, well-being, mindfulness, self-efficacy, and interest in total knee arthroplasty (TKA) between baseline and 12-weeks. RESULTS N = 102 patients self-enrolled (73.5% female, age 64 ± 7 years, body mass index 32.9 ± 7.3 kg/m2); n = 53 completed the 12-week intervention (71.7% female, age 65 ± 7 years, body mass index 33.4 ± 6.3 kg/m2). Acceptability was demonstrated by positive perceptions of tailored intervention resources. In study completers, health-related quality of life components of pain and physical functioning domains improved at 12-weeks [change in SF36 4.4 (95%CI 0.2-8.6), p = 0.016, and 6.7 (95%CI 2.7-10.7), p < 0.001, respectively]. Self-efficacy for managing daily activities improved [change in PROMIS T-score 4.4 (95%CI 2.8-6.0), p < 0.001]. CONCLUSION A 12-week digital multimodal intervention for knee OA was acceptable to patients and shows preliminary effectiveness in improving self-efficacy, aspects of quality of life, and decreasing interest in TKA. Digital behavioral interventions for knee OA may be an acceptable approach to improve patient outcomes and OA self-management while potentially reducing utilization of costly health system resources.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB, T6G 2P5, Canada.
| | - Carla M. Prado
- grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Maira Quintanilha
- grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Mary Forhan
- grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
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Whitaker M, Aguirre MC, Gutierrez Chavez M, Beaulieu E, Arones YB, Gershenoff D, Hinton K, Klein N, Munezerou Uwizeye J, Napia E, Ramos C, Tavake-Pasi OF, Villalta J, Wolfsfeld C, Witte B, Maxfield E, Raphael K, Simmons DL, Clark L, Sher T, Smith TW, Baucom KJ. Couple-based lifestyle intervention to prevent type 2 diabetes: protocol for a randomised pilot trial. BMJ Open 2023; 13:e068623. [PMID: 36797025 PMCID: PMC9936286 DOI: 10.1136/bmjopen-2022-068623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Type 2 diabetes is prevalent among US adults. Lifestyle interventions that modify health behaviours prevent or delay progression to diabetes among individuals at high risk. Despite the well-documented influence of individuals' social context on their health, evidence-based type 2 diabetes prevention interventions do not systematically incorporate participants' romantic partners. Involving partners of individuals at high risk for type 2 diabetes in primary prevention may improve engagement and outcomes of programmes. The randomised pilot trial protocol described in this manuscript will evaluate a couple-based lifestyle intervention to prevent type 2 diabetes. The objective of the trial is to describe the feasibility of the couple-based intervention and the study protocol to guide planning of a definitive randomised clinical trial (RCT). METHODS AND ANALYSIS We used community-based participatory research principles to adapt an individual diabetes prevention curriculum for delivery to couples. This parallel two-arm pilot study will include 12 romantic couples in which at least one partner (ie, 'target individual') is at risk for type 2 diabetes. Couples will be randomised to either the 2021 version of the CDC's PreventT2 curriculum designed for delivery to individuals (six couples), or PreventT2 Together, the adapted couple-based curriculum (six couples). Participants and interventionists will be unblinded, but research nurses collecting data will be blinded to treatment allocation. Feasibility of the couple-based intervention and the study protocol will be assessed using both quantitative and qualitative measures. ETHICS AND DISSEMINATION This study has been approved by the University of Utah IRB (#143079). Findings will be shared with researchers through publications and presentations. We will collaborate with community partners to determine the optimal strategy for communicating findings to community members. Results will inform a subsequent definitive RCT. TRIAL REGISTRATION NUMBER NCT05695170.
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Affiliation(s)
- Madelyn Whitaker
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
| | - Monique C Aguirre
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
| | | | - Elizabeth Beaulieu
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
| | - Yeny B Arones
- Hispanic Health Care Task Force, Salt Lake City, Utah, USA
| | | | - Kristie Hinton
- Urban Indian Center of Salt Lake, Salt Lake City, Utah, USA
| | - Natalie Klein
- Lifestyle Coach and Master Trainer Select, Salt Lake City, Utah, USA
| | | | - Eru Napia
- Department of Health, Office of American Indian and Alaska Native Health Affairs, Salt Lake City, Utah, USA
| | - Carmen Ramos
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Brieanne Witte
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Ellen Maxfield
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Kalani Raphael
- Department of Nephrology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Debra L Simmons
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Salt Lake City Veterans Administration, Salt Lake City, Utah, USA
| | - Lauren Clark
- School of Nursing, University of California, Los Angeles, California, USA
| | - Tamara Sher
- College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Timothy W Smith
- Department of Psychology, The University of Utah, Salt Lake City, Utah, USA
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Gibbs D, Warren IM. Implementing infant and family-centred developmental care: Exploring the impact of an innovative educational initiative. Acta Paediatr 2023; 112:264-272. [PMID: 36415078 DOI: 10.1111/apa.16603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
AIM Evidence-based standards for infant and family-centred developmental care are shaping neonatal care. However, the translation of theory and evidence into practice is challenging. This study aimed at exploring the mechanisms by which a structured learning and mentoring model influences the implementation of infant and family-centred developmental care within neonatal practitioners' own clinical practice. METHODS The study used a descriptive qualitative design. Five neonatal practitioners participated in semistructured interviews. Interviews were audio-recorded and transcribed for thematic analysis. RESULTS The qualitative analysis gave rise to four themes and nine subthemes. The four primary themes were motivation and preparedness for FINE 2; learning experiences during FINE 2; post-training reflections and experiences; and anticipating the future. CONCLUSION Neonatal practitioners reported positive outcomes from their participation in relation to the development of their knowledge and skills, their performance of their clinical role and the influence on their relationships with other neonatal staff. Being adequately prepared for the programme in terms of managing the time demands, enabling peer support, the role of additional reading and ensuring realistic line management support were identified as important mechanisms for successful engagement and are being used to support further enhancements of the FINE 2 programme.
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Affiliation(s)
- Deanna Gibbs
- Director of Clinical Research for Neonates and Children (nursing + AHP), Barts Health NHS Trust, London, UK
| | - Inga Marian Warren
- Co-Director FINE International, London, UK.,Honorary Consultant Neonatal Therapist, University College London Hospitals NHS Foundation Trust, London, UK
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Abstract
Rationale & Objective For patients requiring in-center hemodialysis, suboptimal transportation arrangements are commonly cited as a source of ongoing stress and anxiety and have been associated with a reduced quality of life and increased mortality risk. Transportation-related problems are especially pronounced in Canada given its size, low population density, and long, often snowy winters. We aimed to identify and better understand transportation options for hemodialysis patients in Canada and to describe stakeholder experiences. Study Design We used a qualitative descriptive research design to explore stakeholder experiences and perspectives of transportation to and from dialysis facilities. Setting & Participants We recruited participants from a large urban hemodialysis program in Western Canada and included 11 participants from a project group, 45 participants from an open forum, and a survey of 8 social workers. Data collection occurred at a series of project group meetings and an open forum (n=45). In addition, we asked 8 renal social workers based in major cities across Canada to comment on the provision of transport for patients in their area via email or telephone consult. Analytical Approach We used conventional content analysis to explore stakeholder experiences. Results Traveling to and from dialysis facilities remains a source of stress and anxiety for many patients and their families. Patients described several factors contributing to these feelings including: the challenges of physically getting to the treatment center, particularly in adverse weather conditions; being a burden on family and friends; difficulties accessing the treatment facility; issues with public transport; and financial worries related to high costs. Limitations Findings may not be relevant in low- and middle-income countries and those with a warmer climate. Conclusions Without a concerted and collaborative approach to address the barriers identified here, it is likely that travel to and from in-center hemodialysis will continue to adversely affect patients' quality of life.
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Tutty LM. “Looking Back, the Programs Kept Me Alive”: Women’s Impressions of Counseling for Intimate Partner Violence. WOMEN & THERAPY 2023. [DOI: 10.1080/02703149.2023.2167309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Saalim K, Amu-Adu P, Amoh-Otu RP, Akrong R, Abu-Ba’are GR, Stockton MA, Vormawor R, Torpey K, Nyblade L, Nelson LE. Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana. BMC Public Health 2023; 23:166. [PMID: 36694150 PMCID: PMC9872747 DOI: 10.1186/s12889-023-15087-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.
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Affiliation(s)
| | | | | | | | | | - Melissa A. Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY USA
| | | | | | | | - LaRon E. Nelson
- Yale School of Nursing, New Haven, CT USA
- Yale Institute for Global Health, New Haven, CT USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT USA
- Yale School of Public Health, New Haven, CT USA
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73
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Gaudin A, Jackson R, Quinlan P, George M. Spine Surgery Patients' Perceptions of Postoperative Pulmonary Complications. Clin Nurs Res 2023; 32:797-804. [PMID: 36661230 DOI: 10.1177/10547738221149455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Postoperative pulmonary complications (PPCs) are associated with poor patient outcomes, increased costs and prolonged hospitalizations. Incentive spirometry (IS) reduces PPC incidence, but patient IS adherence is often suboptimal. Thus, the purpose of this study was to explore patients' beliefs about, and knowledge of PPCs and IS. We observed IS technique and conducted interviews guided by qualitative descriptive methodologies and the Health Belief Model. Verbatim transcripts of interviews were analyzed using inductive and deductive content analytic methods. Twenty postoperative spinal surgery patients at a single tertiary hospital were enrolled. Five categories related to PPC and IS beliefs and knowledge were identified: (1) social support, (2) preventing a PPC, (3) learning about PPCs, (4) reminders, and (5) lack of IS knowledge. Understanding why patients do not adhere to IS protocols is crucial for minimizing the risk of iatrogenic PPCs and developing strategies to improve adherence to IS.
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Affiliation(s)
| | | | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
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St Clair S, Dearden S, Clark L, Simonsen SE. Some key questions: Pregnancy intention screening by community health workers. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231213735. [PMID: 38105749 PMCID: PMC10729636 DOI: 10.1177/17455057231213735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Unintended pregnancy contributes to a high burden of maternal and fetal morbidity in the United States, and pregnancy intention screening offers a key strategy to improve preconception health and reproductive health equity. The One Key Question© is a pregnancy intention screening tool that asks a single question, "Would you like to become pregnant in the next year?" to all reproductive-age women. This study explored the perspectives of community health workers on using One Key Question in community-based settings. OBJECTIVES This study aimed to identify barriers and facilitators to the use of the One Key Question pregnancy intention screening tool by community health workers who serve reproductive-age women in Salt Lake City, Utah. DESIGN Using reproductive justice as a guiding conceptual framework, this study employed a qualitative descriptive design. Participants were asked to identify barriers and facilitators to the One Key Question, with open-ended discussion to explore community health workers' knowledge and perceptions about pregnancy intention screening. METHODS We conducted focus groups with 43 community health workers in Salt Lake City, Utah, from December 2017 through January 2018. Participants were trained on the One Key Question algorithm and asked to identify barriers and facilitators to implementation. All focus groups occurred face-to-face in community settings and used a semi-structured facilitation guide developed by the study Principal Investigator with input from community partners. RESULTS Pregnancy intention screening is perceived positively by community health workers. Barriers identified include traditional cultural beliefs about modesty and sex, lack of trust in health care providers, and female bias in the One Key Question algorithm. Facilitators include the simplicity of the One Key Question algorithm and the flexibility of One Key Question responses. CONCLUSION One Key Question is an effective pregnancy intention screening tool in primary care settings but is limited in its capacity to reach those outside the health system. Community-based pregnancy intention screening offers an alternative avenue for implementation of One Key Question that could address many of these barriers and reduce disparities for underserved populations.
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Affiliation(s)
| | - Susan Dearden
- Strategic Marketing Analyst, bioMérieux, Salt Lake City, UT, USA
| | - Lauren Clark
- University of California Los Angeles (UCLA) School of Nursing, Los Angeles, CA, USA
| | - Sara E Simonsen
- University of Utah College of Nursing, Salt Lake City, UT, USA
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75
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Gupta A, Prasad R, Abraham S, Nedungalaparambil NM, Bhattacharyya O, Landes M, Sridharan S, Gray CS. The emergence of family medicine in India-A qualitative descriptive study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001848. [PMID: 37172000 PMCID: PMC10180658 DOI: 10.1371/journal.pgph.0001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/30/2023] [Indexed: 05/14/2023]
Abstract
Countries globally are introducing family medicine to strengthen primary health care; however, for many, that process has been slow. Understanding the implementation of family medicine in a national context is complex but critical to uncovering what worked, the challenges faced, and how the process can be improved. This study explores how family medicine was implemented in India and how early cohort family physicians supported the field's emergence. In this qualitative descriptive study, we interviewed twenty family physicians who were among the first in India and recognized as pioneers. We used Rogers's Diffusion of Innovation Theory to describe and understand the roles of family physicians, as innovators and early adopters, in the process of implementation. Greenhalgh's Model of Diffusion in Service Organizations is applied to identify barriers and enablers to family medicine implementation. This research identifies multiple mechanisms by which pioneering family physicians supported the implementation of family medicine in India. They were innovators who developed the first family medicine training programs. They were early adopters willing to enter a new field and support spread as educators and mentors for future cohorts of family physicians. They were champions who developed professional organizations to bring together family physicians to learn from one another. They were advocates who pushed the medical community, governments, and policymakers to recognize family medicine's role in healthcare. Facilitators for implementation included the supportive environment of academic institutions and the development of family medicine professional organizations. Barriers to implementation included the lack of government support and awareness of the field by society, and tension with subspecialties. In India, the implementation of family medicine has primarily occurred through pioneering family physicians and supportive educational institutions. For family medicine to continue to grow and have the intended impacts on primary care, government and policymaker support are needed.
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Affiliation(s)
- Archna Gupta
- Department of Family and Community Medicine, St. Michaels Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Ramakrishna Prasad
- PMCH Restore Health, Bangalore, Karnataka, India
- National Centre for Primary Care Research & Policy, Academy of Family Physicians of India (AFPI), Ghaziabad, India
| | - Sunil Abraham
- Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Onil Bhattacharyya
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Megan Landes
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Sanjeev Sridharan
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Health Policy Evaluation, Social Science Research Institute, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Carolyn Steele Gray
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
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76
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Liddell JL. Birth control access experiences for members of an Indigenous tribe in the Gulf Coast. WOMENS STUDIES INTERNATIONAL FORUM 2023. [DOI: 10.1016/j.wsif.2022.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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77
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Wu MH, Lee TY, Lin MH. The parental experience of participating in surgical decision-making regarding one's child with a congenital heart disease in Taiwan. J Pediatr Nurs 2023; 68:e103-e108. [PMID: 36437130 DOI: 10.1016/j.pedn.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explores how parents experienced the surgical decision-making process for their child with a congenital heart disease (CHD). DESIGN AND METHODS Purposive sampling was used in this qualitative descriptive study at a medical center in Northern Taiwan. Twelve parents whose children had cardiac corrective surgery participated in one-to-one in-depth interviews. The interview content subsequently was transcribed verbatim and analyzed by content analysis. RESULTS Five themes, with 2 to 3 subthemes, were identified: 1) accumulating medical knowledge in a short time, 2) trusting the medical teams but parents needing clear communication, 3) feeling pervasive uncertainty, 4) using self-talk to calm down, and 5) looking for positive energy from various sources. CONCLUSIONS For the parents of these children with CHD, participating in surgical decision-making can be a difficult and stressful experience. When explaining the disease and treatment procedures, it is important for medical professionals to make sure of the individual parent's information needs, to use plain language and encourage parents to ask questions. PRACTICE IMPLICATIONS Although the surgery is imperative and inevitable, understanding the parents' worries and providing adequate support can help them reduce feelings of uncertainty during the decision-making and surgical processes.
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Affiliation(s)
- Mei-Hua Wu
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd, Taipei 10002, Taiwan, ROC.
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Rd. Beitou 11219, Taipei, Taiwan, ROC.
| | - Mei-Hsiang Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Rd. Beitou 11219, Taipei, Taiwan, ROC.
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78
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Heinrich CH, McHugh S, McCarthy S, Donovan MD. Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland. PLoS One 2022; 17:e0274552. [PMID: 36520798 PMCID: PMC9754218 DOI: 10.1371/journal.pone.0274552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/31/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The prevalence of polypharmacy increases with age, increasing the exposure of older adults to potentially inappropriate medications (PIMs). Deprescribing has been shown to reduce PIMs for older residents in long-term care; however, deprescribing is not universally implemented. This study aims to identify the barriers and enablers to deprescribing in Irish long-term care facilities from the healthcare professionals' (HCPs) perspective. METHODS A qualitative descriptive approach was conducted using semi-structured interviews with HCPs working in long-term care (general practitioners, pharmacists and nurses). Purposive sampling with maximum variation was applied to select long-term care sites to identify HCPs, supplemented with convenience sampling of post-graduate HCPs from University College Cork. Data was thematically analysed and mapped to a framework of deprescribing barriers and enablers informed by the Theoretical Domains Framework. RESULTS Twenty-six HCPs participated from 13 long-term care facilities. The main barriers and enablers identified mapped to five domains. Barriers included insufficient resources, lack of co-ordination between healthcare settings and negative social influences. Additional barriers exist in private settings including deprescribing awareness, commitment and the need for incentives. Deprescribing enablers included interprofessional support and patient social influence. To encourage deprescribing, potential enablers include HCP education, pharmacist role expansion and tailored deprescribing guidelines within a structured process. CONCLUSION Interventions to support deprescribing should build on existing systems, involve stakeholders and utilise guidelines within a structured process. Any intervention must account for the nuanced barriers and enablers which exist in both public and private settings.
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Affiliation(s)
- Clara H. Heinrich
- School of Pharmacy, University College Cork, Cork City, Co. Cork, Ireland
- * E-mail:
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork City, Co. Cork, Ireland
| | - Suzanne McCarthy
- School of Pharmacy, University College Cork, Cork City, Co. Cork, Ireland
| | - Maria D. Donovan
- School of Pharmacy, University College Cork, Cork City, Co. Cork, Ireland
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79
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South K, Bakken S, Koleck T, Barcelona V, Elhadad N, Dreisbach C. Women's Experiences of Symptoms of Suspected or Confirmed COVID-19 Illness During the Pandemic. Nurs Womens Health 2022; 26:450-461. [PMID: 36265561 PMCID: PMC9575040 DOI: 10.1016/j.nwh.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/19/2022] [Accepted: 09/22/2022] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To explore experiences of symptoms of suspected or confirmed COVID-19 illness among women using the CovidWatcher mobile citizen science app. DESIGN Convergent parallel mixed-methods design. PARTICIPANTS Twenty-eight self-identified women consented for follow-up after using CovidWatcher. Participants' ages ranged from 18 to 83 years old. METHODS We collected data via semistructured, virtual interviews and surveys: the COVID-19 Exposure and Family Impact Survey and Patient-Reported Outcomes Measurement Information System measures. We used directed content analysis to develop codes, categories, themes, and subthemes from the qualitative data and summarized survey data with descriptive statistics. RESULTS We derived five themes related to symptom experiences: (a) Physical Symptoms, (b) Mental Health Symptoms, (c) Symptom Intensity, (d) Symptom Burden, and (e) Symptom Trajectories. Subthemes reflected more nuanced experiences of suspected or confirmed COVID-19 disease. For those without COVID-19, anxiety and mental health symptoms were still present. Of those who attested to one of the PROMIS-measured symptoms, all but one had at least mild severity in one of their reported symptoms. CONCLUSION This study demonstrates the cross-cutting impact of the COVID-19 pandemic on individuals who identify as women. Future research and clinical practice guidelines should focus on alleviating physical and mental health symptoms related to the ongoing pandemic, regardless of COVID-19 diagnosis. Furthermore, clinicians should consider how patients can use symptom reconciliation apps and tracking systems.
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80
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Schonnop R, Dainty KN, McLeod SL, Melady D, Lee JS. Understanding why delirium is often missed in older emergency department patients: a qualitative descriptive study. CAN J EMERG MED 2022; 24:820-831. [PMID: 36138324 DOI: 10.1007/s43678-022-00371-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unrecognized delirium is associated with significant adverse outcomes. Despite decades of effort and educational initiatives, validated screening tools have not improved delirium recognition in the emergency department (ED). There remains a fundamental knowledge gap of why it is consistently missed. The objective of this study was to explore the perceptions of ED physicians and nurses regarding factors contributing to missed delirium in older ED patients. METHODS We conducted a qualitative descriptive study at two academic tertiary care EDs in Toronto, Canada. Emergency physicians and nurses were interviewed by a trained qualitative researcher using a semi-structured interview guide. We coded transcripts with an iteratively developed codebook. Interviews were conducted until thematic saturation occurred. Thematic data analysis occurred in conjunction with data collection to continuously monitor emerging themes and areas for further exploration. RESULTS We interviewed 26 ED physicians and nurses. We identified key themes at four levels: clinical practice, provider attitudes, systematic processes, and education. The four themes include: (1) there are varied approaches to delirium recognition and infrequent use of screening tools; (2) delirium assessment is perceived as overly time consuming and of lower priority than other symptoms and syndromes; (3) it is unclear whose responsibility it is to recognize delirium; and (4) there is a need for a deeper or "functional" understanding of delirium that includes its consequences. CONCLUSIONS Our findings demonstrate a need for ED leadership to identify clear team roles for delirium recognition, standardize use of delirium screening tools, and prioritize delirium as a symptom of an acute medical emergency.
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Affiliation(s)
- Rebecca Schonnop
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada.
| | - Katie N Dainty
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Don Melady
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacques S Lee
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
- Division of Emergency Services, Sunnybrook Research Institute, Toronto, ON, Canada
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81
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Liddell JL, Lilly JM. "There's so much they don't cover:" Limitations of healthcare coverage for Indigenous women in a non-federally recognized tribe. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100134. [PMID: 38770182 PMCID: PMC11104764 DOI: 10.1016/j.ssmqr.2022.100134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Access to healthcare is an essential component in addressing health disparities. However, the limitations of insurance coverage, and other barriers in paying for and accessing healthcare have seldom been researched for Indigenous peoples. In addition, state recognized tribes do not have access to the healthcare services provided by the Indian Health Service, and there is a need for research documenting their unique healthcare needs. Qualitative description was used to conduct 31 semi-structured interviews with women from an Indigenous tribe in the Gulf South to understand their experiences in paying for healthcare services. Participants described: (1) Discrimination Based on Perceived Ability to Pay for Healthcare; and (2) Limitations of Healthcare Coverage, with sub-themes (a) Difficulties Understanding Coverage Limitations; (b) Inadequate Coverage; and (c) Limited Choice of Providers. These findings indicate that state-recognized tribal members may need specialized insurance programs, and more comprehensive coverage of healthcare services and medications. Future actions should promote tribal sovereignty and increase access to healthcare resources for state-recognized tribes.
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Affiliation(s)
| | - Jenn M. Lilly
- Fordham University Graduate School of Social Service, New York, NY, USA
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82
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Currie G, Finlay B, Seth A, Roth C, Elsabbagh M, Hudon A, Hunt M, Jodoin S, Lach L, Lencucha R, Nicholas DB, Shakako K, Zwicker J. Mental health challenges during COVID-19: perspectives from parents with children with neurodevelopmental disabilities. Int J Qual Stud Health Well-being 2022; 17:2136090. [PMID: 36309898 PMCID: PMC9629071 DOI: 10.1080/17482631.2022.2136090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The global pandemic and subsequent denials, delays, and disruptions in essential daily activities created significant challenges for children with neurodevelopmental disorders (NDDs) and their parents. Public health restrictions during the COVID-19 pandemic limited access to supports and services required by children with NDDs to maintain their health and well-being. Objective This study sought to understand the impacts of these public health measures and restrictions on mental health from the perspective of parents with children with NDDs to inform pathways for public health policies responsive to the needs of this population. Method Interpretive descriptive design was used to guide data collection and data analysis. Forty caregivers were interviewed about their experience with pandemic restrictions. Findings Generic policy measures contributed to many gaps in families’ social support systems and contributed to mental health challenges for children and their parents. Four themes emerged: 1) lack of social networks and activities, 2) lack of access to health and social supports, 3) tension in the family unit, and 4) impact on mental health for children and their parents. Recommendations Emergency preparedness planning requires a disability inclusive approach allocating resources for family supports in the home and community. Families identified supports to minimize further pandemic disruptions and enhance recovery.
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Affiliation(s)
- Genevieve Currie
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,School of Nursing and Midwifery, Mount Royal University, Calgary, AB, Canada
| | - Brittany Finlay
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Ashish Seth
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Christiane Roth
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Myada Elsabbagh
- Faculty of Medicine, McGill University, Montreal, Que., Canada
| | - Anne Hudon
- Faculty of Medicine, Universite de Montreal, Montreal, Que., Canada
| | - Matthew Hunt
- Faculty of Medicine and Health Sciences School of Physical and Occupational Therapy, McGill University, Montreal, Que., Canada
| | | | - Lucyna Lach
- School of Social Work, McGill University, Montreal, Que., Canada
| | - Raphael Lencucha
- Faculty of Medicine and Health Sciences School of Physical and Occupational Therapy, McGill University, Montreal, Que., Canada
| | - David B Nicholas
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Keiko Shakako
- Faculty of Medicine and Health Sciences School of Physical and Occupational Therapy, McGill University, Montreal, Que., Canada
| | - Jennifer Zwicker
- School of Public Policy; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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83
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Boyle EM, Fary RE, Lee S, Mikhailov A, Evans K, Rebbeck T, Beales DJ. Patient perspectives of care pathways for people with low back pain: A qualitative study. Musculoskelet Sci Pract 2022; 62:102657. [PMID: 36058010 DOI: 10.1016/j.msksp.2022.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/04/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low back pain (LBP) care pathways aim to enhance health outcomes through patient-clinician mutual decision-making and care coordination. However, challenges to successful translation into practice include patients' understanding, expectation, and acceptance of treatment and management strategies for LBP. This study explored patients' perspectives and/or experience of care pathways and their involvement in decision-making in primary care. METHODS A qualitative descriptive design was adopted. Semi-structured interviews were conducted with 14 participants with LBP recruited from the community. Inductive thematic analysis of the qualitative data was conducted within the design framework to enable a systematic comparison of experiences across participants and within individual cases. RESULTS Five themes described participant perspectives and understanding of care pathways: i) care pathways can guide decision-making; ii) familiarity with no and/or stepped care pathway, but preference for matched or blend of care pathways; iii) engaging in shared decision-making; iv) patient-related barriers to implementation; v) patient-related facilitators to implementation. CONCLUSIONS Participants felt that existing care pathways did not meet their needs when pain persisted. Participants preferred matched or hybrid care pathways and suggested that implementation of such pathways should focus on addressing an individual's needs. Adopting a holistic approach, and clarity in shared decision-making, were deemed crucial for effective implementation of LBP pathways in practice. Consumer (patient) engagement in the design of LBP care pathways is recommended.
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Affiliation(s)
- Eileen M Boyle
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.
| | - Robyn E Fary
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Samantha Lee
- Department of Allied Health, SingHealth Polyclinics, Singapore
| | - Anton Mikhailov
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Healthia Limited, Brisbane, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Darren J Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Abouchadi S, Godin I, Zhang WH, De Brouwere V. Eight-year experience of maternal death surveillance in Morocco: qualitative study of stakeholders’ views at a subnational level. BMC Public Health 2022; 22:2111. [DOI: 10.1186/s12889-022-14556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Since 2009, Morocco has been implementing the Maternal Death Surveillance System (MDSS). The results obtained indicate significant regional variations in terms of implementation stage, completeness of maternal death reporting, and information use for action. The objective of this research is to better understand the contextual factors involved in the implementation process and use of MDSS, with a focus on the facilitators and barriers, as experienced by stakeholders in health regions.
Methods
Evaluation research was conducted in 2017 based on a descriptive qualitative study using semi-structured in-depth interviews, in four out of the twelve health regions of Morocco. A total of thirty-one in-depth interviews were held with members of regional committees of maternal death reviews (RC-MDR) and other key informant staff. Interviews focused on participants’ views and their experiences with the MDSS since the introduction in 2009. We conducted thematic analysis relied on inductive and deductive approaches. Applying the Consolidated Framework for Implementation Research guided data analysis and reporting findings.
Findings
Engaging leadership at all health system levels, regular training of district and regional MDSS coordinators and supportive supervision at a national level were the most important MDSS implementation facilitators. Reported barriers were essentially related to the review system: Irregular review meetings, blame culture, high turn-over of RC-MDR members, lack of analytical capacity to inform the review process and formulate recommendations, finally limited accountability for recommendation follow-up. While financial incentives boosted MDSS adoption, they were nonetheless a substantial barrier to its sustainability.
Conclusions
The MDSS is a complex process that requires taking numerous steps, including the commitment of multiple stakeholders with varying roles as well as information sharing across health system levels. Contextual factors that influence MDSS implementation at the sub-national level are to be considered. Horizontal and vertical communication about MDSS goals and feedback is crucial to strengthen stakeholders’ commitment, hence improving quality and use of MDSS. Furthermore, health regions should place emphasis on making high-quality recommendations in partnerships between the regional management teams, RC-MDR members and external stakeholders.
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Russell MJ, Scott CWM, Berrigan P, Murias K, Gibbard WB, Cui X, Tough S, Zwicker JD. The transition to adult income supports for youth that received special education in British Columbia, Canada: A cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4363-e4374. [PMID: 35574712 DOI: 10.1111/hsc.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Youth in special education have complex needs that are supported across multiple systems. Our research investigates the use of adult income assistance, as one structure that supports youth as they transition to adulthood. We created a cohort of youth (5-22 years old) using linked administrative data from British Columbia government ministries from 1996 to 2018. Youth were grouped by their special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education). We investigated (1) youth characteristics and service use patterns, (2) which youth used income supports after the child-to-adult transition (19-22 years old), and what youth characteristics and service use patterns were associated with use, and (3) how much income support they used (CAD$). Of 174,527 youth, 254 (0.1%) were Level 1, 6020 (3.4%) were Level 2, 4409 (2.5%) were Level 3, 21,232 (12.2%) were Unfunded, and 142,612 (81.7%) were not in special education. Youth assigned higher funding levels, compared to lower levels, generally had increased service use, and in the transition to adult services were more likely to use income supports, and received more income support. An important exception was youth with serious behavioural/mental health special education funding (Level 3), who had increased service use for their level of funding, but received less income support due to a reliance on Temporary versus Disability Assistance. Youth that received an accredited diploma were less likely to use income supports. Factors related to the use of income supports are further described. This study highlights differences in access to income support when youth transition to adult services and considerations around equitable access to support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | | | - Patrick Berrigan
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Kara Murias
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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86
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Petersen NN, Larsen HB, Pouplier A, Schmidt‐Andersen P, Thorsteinsson T, Schmiegelow K, Fridh MK. Childhood cancer survivors' and their parents' experiences with participation in a physical and social intervention during cancer treatment: A RESPECT study. J Adv Nurs 2022; 78:3806-3816. [PMID: 35942568 PMCID: PMC9804908 DOI: 10.1111/jan.15381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/21/2022] [Accepted: 07/09/2022] [Indexed: 01/09/2023]
Abstract
AIMS This study explores experiences of childhood cancer survivors and their parents with a combined physical and social activity intervention during treatment, including how the survivors and their parents perceive physical activity post-treatment. DESIGN A process evaluation using semi-structured interviews. METHODS Using a criterion-sampling strategy, 18 Danish childhood cancer survivors (aged 11-18 years) and their parents were interviewed from September 2019 through May 2020. Data analysis used an inductive thematic approach focused on meaning. RESULTS Three themes emerged: (1) being physically active during hospitalization; (2) peers as motivators and (3) physical activity post-treatment. During hospitalization, daily motivation to do physical activity was dependent on the daily well-being, that is, presence of the side effects from the child's treatment. Healthy classmates provided distraction, reduced loneliness and promoted normality for those hospitalized. For most of the survivors, their healthy peers provided motivation for being physically active during treatment. When surplus energy was lacking, some survivors preferred doing physical activity alone with a professional. Those who were physically active in the hospital sustained being physically active post-treatment while their parents continued seeking advice about appropriate activity levels. CONCLUSION Childhood cancer survivors and their parents benefited from the intervention which also provided guidance to remaining physically active post-treatment. This was particularly true for the participants with leukaemia. IMPACT Healthcare professionals should support children with cancer to be physically active during hospitalization. Including social and physical components in their care plan and being aware of individual preferences is pivotal to improving the survivors' level of physical and social well-being during and post-treatment. PATIENT OR PUBLIC CONTRIBUTION The participants were involved in designing the interview guides to ensure that the interview guides were understandable for the participants to provide rich descriptions of their experiences with a physical and social activity intervention during hospitalization.
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Affiliation(s)
- Natasha Nybro Petersen
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark,Faculty of Health SciencesUniversity of Copenhagen and The Pediatric Clinic, Juliane Marie Centre, University Hospital (Rigshospitalet)CopenhagenDenmark
| | - Anna Pouplier
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark
| | - Peter Schmidt‐Andersen
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark
| | - Troels Thorsteinsson
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark,Faculty of Health SciencesUniversity of Copenhagen and The Pediatric Clinic, Juliane Marie Centre, University Hospital (Rigshospitalet)CopenhagenDenmark
| | - Martin Kaj Fridh
- Department of Pediatrics and Adolescent MedicineUniversity Hospital (Rigshospitalet)CopenhagenDenmark
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87
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Noyek S, Davies C, Champagne M, Batorowicz B, Fayed N. Emotional Well-Being of Children and Youth with Severe Motor and Communication Impairment: A Conceptual Understanding. Dev Neurorehabil 2022; 25:554-575. [PMID: 35900109 DOI: 10.1080/17518423.2022.2099997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Children and youth with severe motor and communication impairment (SMCI) have difficulty providing self-expression through typical speech, writing with a paper and pencil, or using a standard keyboard. Their emotional expressions can be missed by peers and novel caregivers. PURPOSE To describe the indicators and components of emotional experiences for children/youth with SMCI. METHODS Primary guardians of nine children/youth with SMCI were involved in photo/video data collection and follow-up qualitative interviews. Twenty-one familiar people (e.g., friends, family members, and/or care team) participated in semi-structured qualitative interviews. RESULTS A conceptual understanding of emotional well-being specific to the population has been developed consisting of nine themes, encompassed by four domains i) Core Attributes, ii) Personal Experiences, iii) Surroundings, iv) Expression and Reception. CONCLUSIONS Emotional experiences of children/youth with SMCI are diversely expressed. Primary guardian and familiar person insight can be amplified to positively impact care and participation.
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Affiliation(s)
- Samantha Noyek
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Claire Davies
- Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Maude Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Beata Batorowicz
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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88
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Liddell JL, Meyer S. Healthcare needs and infrastructure obstacles for a state-recognised Indigenous tribe in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5988-e5997. [PMID: 36134617 PMCID: PMC11104768 DOI: 10.1111/hsc.14031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state-recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community-based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life-course interviews with participants of a state-recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state-recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs.
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Affiliation(s)
| | - Sydney Meyer
- University of Montana School of Social Work, Missoula, Montana, USA
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89
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Myles SM, Wenghofer EF, Ellaway RH, Yeo MT. Ontario family physicians’ perspectives about their scope of practice: what is it, what drives it and how does it change? BMC PRIMARY CARE 2022; 23:251. [PMID: 36162984 PMCID: PMC9511454 DOI: 10.1186/s12875-022-01833-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
There is little evidence to show what scope of practice (SOP) means from the point of view of family physicians, how family physicians think about their SOP as it changes over time, or what factors shape and influence their SOP. Understanding family physician perspectives on SOP and the factors that influence it can aid our understanding of how it can constrain and enable physicians’ agency and autonomy in professional practice.
Methods
Using qualitative description and incorporating constructivist grounded theory data collection and analysis techniques, four focus groups were conducted involving twenty-four Ontario-based family physicians from different contexts, at different career stages, and with different practice experiences.
Results
Participants’ SOP was highly dynamic, changing throughout their careers due to factors both within and beyond their control. Their sense of their own SOP was the product of a continuous cycle of personal and professional transitions, exposures, and experiences throughout their careers. These family physicians sought regular and sustained mentorship, support, and engagement for their SOP throughout their careers. This was particularly the case during professional transitions and for drivers of their SOP for which they felt unprepared early in their careers, such as through the first years of independent practice, and when functioning as owner-operators of medical practices. Four descriptive themes were identified focusing on the nature of their current practice, their professional preparedness and supports, practice management dynamics, and ‘doctors are people, too’.
Conclusions
The SOP of the family physicians in this study was dynamic and unique to each individual, it emerged from interactions between their personal and professional lives and identities, and it was embedded in their lived experiences. SOP was also to some extent imposed and externally driven. This study advances understanding by exploring the ‘why’ and ‘how’ of SOP rather than focusing solely on what it is.
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90
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Carter AJE, Harrison M, Goldstein J, Arab M, Jensen J, Houde K, Urquhart R. Providing palliative care at home aligns with the professional identity of paramedics: a qualitative study of paramedics and palliative health care providers. CAN J EMERG MED 2022; 24:751-759. [PMID: 36117240 DOI: 10.1007/s43678-022-00369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/29/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND An innovative program, 'Paramedics Providing Palliative Care at Home,' was implemented in Nova Scotia, Canada in 2015. Roles like this are part of an evolving professional identity; role discordance or lack of clarity not only hinders professionalization but may impair the wellbeing, and career longevity of paramedics. This study explored the alignment of providing palliative support at home with paramedic professional identity. METHODS Qualitative description was employed, with thematic analysis of focus groups with paramedics and palliative health care providers. Recruitment posters were sent through the professional college (paramedics) and program managers (health care providers). Focus groups followed a semi-structured guide, discussing understanding of and experiences with the role and its alignment with professional identity. Challenges to paramedic palliative support and fit with professional identify were explored. Thematic content analysis was ongoing while focus groups were being conducted, until no new codes were found. Codes were combined, sorted into categories, and ultimately, agreed-upon themes. Saturation of themes was reached. RESULTS Eleven paramedics and twenty palliative health care providers participated. Four themes reflected paramedic's expanded role: (1) patient centeredness and job satisfaction with provision of palliative support, (2) a bridging role, (3) paramedic as advocate and educator, (4) provision of psychosocial support. Four themes reflected paramedic's professional identity: (1) evolution of paramedicine as a skilled clinical profession, (2) helping people and communities, (3) paramedic skill set aligns with work in palliative care, and (4) changing paramedic mindset. CONCLUSION Paramedics and palliative health care providers highlighted the provision of palliative care as part of a positive growth of paramedicine as a health profession, and a good fit with professional identity. Novel roles like this are important in the evolution of our health care system faced with increasing pressures to get the right care with the right provider at the right time.
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Affiliation(s)
- Alix J E Carter
- Emergency Health Services Nova Scotia, Halifax, Canada. .,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada. .,Nova Scotia Health Authority, Halifax, Canada.
| | - Michelle Harrison
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | - Judah Goldstein
- Emergency Health Services Nova Scotia, Halifax, Canada.,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | | | - Jan Jensen
- Emergency Health Services Nova Scotia, Halifax, Canada.,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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91
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Chin JC, Chen YY. Mother-child dyad support needs to be expressed by mothers diagnosed with breast cancer. J Clin Nurs 2022. [PMID: 36081318 DOI: 10.1111/jocn.16509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To investigate the support needs identified by Taiwanese breast cancer diagnosed mothers for themselves and their 6-12-year-old children for implementation in a support group. BACKGROUND Mothers with dependent children are burdened with diverse child-centered concerns while battling breast cancer. A better understanding of the concomitant support needs of mothers and their children can yield tailored support for ill mothers and their children. DESIGN A qualitative descriptive study employing content analysis of collected data. METHODS Between February and June of 2020, semi-structured individual interviews were conducted with 20 mothers who had been diagnosed with breast cancer in the last 2 years. Qualitative content analysis was used. This study followed the COREQ guidelines. RESULTS Ill mothers favoured a hybrid format for support groups, consisting of mother-only, child-only, and mother-child group sessions. The content analysis yielded four themes for mother-only group sessions: (1) learning to reach out to children; (2) dealing with negative emotions; (3) how to say goodbye to children; and (4) resetting for the future. Three themes related to child-only group sessions emerged: (1) emotional and health education; (2) getting along with a sick mother; and (3) preparing for uncertainty. The core theme for mother-child group sessions was relationship enhancement. CONCLUSION The findings revealed that mother-reported support needs of ill mothers and their children included support for improving children's emotional well-being and mothers' emotional coping, preparing for uncertainty, and promoting intimacy in the mother-child relationship. RELEVANCE TO CLINICAL PRACTICE A relation-focused approach to psychosocial support group development that allows mother-child mutual influences on each other's coping to be addressed bilaterally is suggested. PATIENT OR PUBLIC CONTRIBUTION Mothers diagnosed with breast cancer were interviewed for data collection and invited to review and validate the synthesised data for enhancing the credibility of the study.
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Affiliation(s)
- Jui-Chih Chin
- Department of Early Childhood Education, University of Taipei, Taipei City, Taiwan
| | - Yin-Ying Chen
- Department of Early Childhood Education, University of Taipei, Taipei City, Taiwan
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92
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Gaitán-Rossi P, Vilar-Compte M, Cruz-Villalba V, Sabina N, Villar-Uribe M. A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors. Healthcare (Basel) 2022; 10:healthcare10091619. [PMID: 36141231 PMCID: PMC9498609 DOI: 10.3390/healthcare10091619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Bangladesh suffered disruptions in the utilization of essential health and nutrition services (EHNS) during the COVID-19 pandemic. The magnitude of the pandemic has been documented, but little is known from the perspectives of health administrators. A rapid qualitative assessment of division-level capacity identified successes and bottlenecks in providing EHNS- and COVID-19-related services during the first months of the pandemic in Bangladesh. Semi-structured interviews were held with the Health and Family Planning Divisional Directors of the Ministry of Health and Family Welfare. The Primary Health Care System Framework guided the content analysis, focusing on (i) service delivery, (ii) communication and community outreach, and (iii) surveillance and service monitoring. Our findings identified low care seeking due to fears of getting infected and unawareness that EHNS were still available. Adaptations to telemedicine were highly heterogeneous between divisions, but collaboration with NGOs were fruitful in reinstating outreach activities. Guidelines were centered on COVID-19 information and less so on EHNS. The inflexibility of spending capacities at divisional and clinic levels hindered service provision. Misinformation and information voids were difficult to handle all around the country. Community health workers were useful for outreach communication. EHNS must be guaranteed during sanitary emergencies, and Bangladesh presented with both significant efforts and areas of opportunity for improvement.
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Affiliation(s)
- Pablo Gaitán-Rossi
- Instituto de Investigaciones para el Desarrollo con Equidad, EQUIDE, Universidad Iberoamericana, Ciudad de México 01219, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ 07043, USA
- Correspondence:
| | - Valeria Cruz-Villalba
- Instituto de Investigaciones para el Desarrollo con Equidad, EQUIDE, Universidad Iberoamericana, Ciudad de México 01219, Mexico
| | | | - Manuela Villar-Uribe
- Health, Nutrition and Population Global Practice of the World Bank Group, Washington, DC 20433, USA
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93
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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2022; 6:e38916. [PMID: 35951444 PMCID: PMC9400841 DOI: 10.2196/38916] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that “one size does not fit all,” and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care. Conclusions This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Alliance for Healthier Communities, Toronto, ON, Canada
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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94
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Lukman NA, Merry L. Religion, support and self-care experiences: A qualitative descriptive study with Indonesian adults with the chronic disease living in Montreal, Canada. J Adv Nurs 2022; 79:1765-1777. [PMID: 35975318 DOI: 10.1111/jan.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/17/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
AIM To explore and describe the chronic illness self-care experiences of Indonesian immigrants living in Montreal, Canada and to gain a better understanding of how religion and support shaped these experiences. DESIGN Qualitative description. METHODS Data were collected from January to March 2020 via semi-structured interviews. Eight men and women participated. The data were thematically analysed. RESULTS Major themes identified were (1) religion, (2) being helpful to others, (3) family support, (4) transnational family support, (5) community support and (6) being in Indonesia versus Canada. Religion and faith were sources of motivation for self-care and provided guidance and strength to heal and accept the illness, mainly through the practice of prayer. 'Being helpful to others' (collectivism), including aiding others to avoid getting sick or giving 'health tips', and also just generally taking care of family also contributed to overall well-being. Spouses were the main source of assistance with disease monitoring and management and health maintenance, whereas support from the Indonesian community was minimal and mostly consisted of informational and social support. Transnational relationships with family members in Indonesia, however, provided an additional means for obtaining emotional support, advice and access to traditional medicines. Overall, there was little expectation that family or the community offer or provide support with self-care. These low expectations may partially be explained by the different cultural and social contexts in Canada compared with Indonesia. CONCLUSION Religious, cultural, social and family factors may be carried over from the home country and/or may be altered post-migration, and this may impact how Indonesian immigrants with chronic illness engage in self-care. IMPACT Cultural factors (collectivism, traditional medicines), religious beliefs and support networks, both locally and transnationally should be assessed and considered during care to better support and promote self-care among immigrants living with chronic diseases. PATIENT OR PUBLIC CONTRIBUTION Two Indonesian community organizations facilitated recruitment and data collection.
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Affiliation(s)
- Nurul Akidah Lukman
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada.,Jewish General Hospital, CIUSSS West-Central Montreal, Montreal, Quebec, Canada
| | - Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada.,SHERPA, The University Institute with Regards to Cultural Communities, CIUSSS West-Central Montreal, Montreal, Quebec, Canada.,InterActions, Centre de recherche et de partage des savoirs, CIUSSS North Montreal, Montreal, Quebec, Canada
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95
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Blöndal K, Sverrisdóttir SH, Hafberg A, Ragnarsdóttir ED, Ingadóttir B, Hafsteinsdóttir EJG, Zoëga S, Jónsdóttir H. Confronting the unknown-Nursing surveillance of COVID-19-infected patients through remote telephone calls and in an on-site urgent clinic. J Adv Nurs 2022; 78:3782-3794. [PMID: 35975315 PMCID: PMC9538875 DOI: 10.1111/jan.15355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
Aim To describe nursing surveillance of coronavirus disease 2019 (COVID‐19)‐infected patients through remote telephone calls and in an on‐site urgent clinic during the first wave of the pandemic as experienced by nurses providing the care. Design Qualitative descriptive study. Methods Data were collected through seven semi‐structured, audio‐recorded, focus group interviews with 24 nurses. Interviews were conducted in May and June 2020, transcribed and analysed using deductive and inductive content analysis into an overarching category, main categories and subcategories. Reporting followed the COREQ guidelines. Results Nurses relied on intensive listening when assessing and caring for COVID‐19‐infected patients. They realized that the patients had complex needs for nursing and healthcare which was beyond the scope of a tentatively prescribed assessment scheme. They designed their care to ensure holistic care, reflected in the overarching category, ‘Confronting an unfamiliar health condition in unprecedented circumstances’ and the categories: ‘Digging into the unknown’ and ‘Ensuring holistic nursing care’. The category ‘Contributing to averting catastrophe’ reflects the wealth of knowledge, support and experience that the nurses used to independently deliver care, albeit in interdisciplinary collaboration, working to their greatest potential. They were proud of the significance of their work. Conclusion Novel nursing surveillance through remote telephone calls and in an on‐site urgent care clinic delivered to COVID‐19 patients self‐managing at home resulted in holistic nursing care during the first wave of the pandemic. This has relevance for professionalism in nursing. Impact Findings give a unique insight into nursing surveillance of COVID‐19‐infected patients provided through telephone calls and in on‐site urgent care clinics. The potential of intensive listening as conducted in the study suggests that it may be feasible to assess and holistically take care of COVID‐19‐infected patients, and other patient groups as well, with this form of healthcare. This has relevance for healthcare beyond crisis management during pandemics. Patient or Public Contribution There was no patient or public contribution as the study only concerned the providers of the service, i.e. the nurses themselves.
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Affiliation(s)
- Katrín Blöndal
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Hafberg
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Brynja Ingadóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Sigríður Zoëga
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Helga Jónsdóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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96
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Johnston K, Baker J. Sources of information used by elite distance running coaches for selection decisions. PLoS One 2022; 17:e0268554. [PMID: 35939423 PMCID: PMC9359569 DOI: 10.1371/journal.pone.0268554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Talent identification and selection are critical components of competitive sport success. Despite the time, effort, and resources invested, the accuracy of selection decisions remains generally poor. While much of the scholarship in this area has focused on the factors discriminating skilled and less-skilled individuals, limited research exists on what information is used in the decision-making process for athlete selection. The current study seeks to gain a better understanding of the information used by elite distance running coaches when forming judgements for athlete selection. Ten semi-structured interviews with elite distance running coaches from across Canada were transcribed and analyzed using inductive thematic analysis. It was interpreted that coaches mainly gather information using their coach’s eye to determine an athlete’s ‘fit’ to the team. Coaches also use more objective information such as race times and movement analyses to assess performance and judge future ‘potential’. As well, the decisions were believed to be influenced by situational considerations at the time of the selection procedure. Specifically, these considerations affecting a coach’s selection included length of time to make a decision, personal limitations in decision-making abilities, and team circumstances. Interestingly, coaches recognized limitations in their selection practices and procedures and discussed some of their personal and system-level biases, highlighting their awareness of potential selection inefficiencies/inaccuracies. Overall, distance running coaches used a variety of techniques to gather information before a selection was made, relying on both subjective and objective information for crafting judgments. Findings are discussed in relation to implications for coaches, sport organizations, and talent identification and selection programs.
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Affiliation(s)
- Kathryn Johnston
- Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Joseph Baker
- Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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97
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Dhaliwal SK, Dabelea D, Lee-Winn AE, Glueck DH, Wilkening G, Perng W. Characterization of Maternal Psychosocial Stress During Pregnancy: The Healthy Start Study. WOMEN'S HEALTH REPORTS 2022; 3:698-708. [PMID: 36147836 PMCID: PMC9436384 DOI: 10.1089/whr.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/12/2022]
Abstract
Objective: To capture multidimensional maternal psychosocial stress using responses from the Edinburgh Postnatal Depression Scale (EPDS) and Cohen's Perceived Stress Scale (PSS) administered during pregnancy, and to identify sociodemographic, biological, and health behavioral correlates of the stress domains. Methods: Using data from 1,079 pregnant women, we implemented principal component analysis on EPDS and PSS responses and retained factors based on the Scree plot and Eigenvalues >1. We then used linear regression to identify perinatal correlates of each domain. Results: We identified three stress domains: “Feeling Overwhelmed,” “Anhedonia,” and “Lack of Control,” which accounted for 10.6% of variance in questionnaire responses. In multivariable analyses, household income ≤$70,000 (β = 0.21 confidence interval [95% CI: 0.05–0.39]), primiparity (0.36 [0.02–0.71]), inadequate (0.21 [0.04–0.39]) or excessive gestational weight gain (0.27 [0.11–0.42]), and Healthy Eating Index (HEI) score ≤57 (0.14 [0.00–0.28]) were associated with Feeling Overwhelmed. Older age (0.02 [0.00–0.03] per 1-year), Hispanic ethnicity (0.19 [0.00–0.38]), and HEI score ≤57 (0.15 [0.02–0.28]) were associated with Anhedonia. Non-Hispanic Black race/ethnicity (0.37 [0.10–0.63]), not having graduated from college (0.16 [−0.02 to 0.35]), having a partner born outside the United States (0.17 [−0.02 to 0.37]), household size of ≥5 persons (0.21 [−0.02 to 0.37]), receiving public assistance (0.18 [−0.02 to 0.37]), and prenatal smoking (0.32 [0.05–0.59]) were associated with Lack of Control. Conclusions: Three domains of maternal psychosocial stress during pregnancy (Feeling Overwhelmed, Anhedonia, and Lack of Control) were differentially related to sociodemographic, biological, and health behavioral characteristics that may be targets for interventions to ameliorate stress in pregnant women. Clinical Trial Registry : The Healthy Start study is registered as an observational study at clinicaltrials.gov (NCT #002273297).
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Affiliation(s)
- Satvinder K. Dhaliwal
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela E. Lee-Winn
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Deborah H. Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Greta Wilkening
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department or Neuropsychology, Colorado Children's Hospital, Aurora, Colorado, USA
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
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98
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Liddell JL, Doria CM. Barriers to Achieving Reproductive Justice for an Indigenous Gulf Coast Tribe. AFFILIA 2022; 37:396-413. [PMID: 38770206 PMCID: PMC11104769 DOI: 10.1177/08861099221083029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Reproductive justice is increasingly being utilized as a framework for exploring women's reproductive health experiences. However, this topic has not yet been explored among Indigenous state-recognized tribes who do not utilize the Indian Health Service, and little research explores what other factors impact women's ability to reach their reproductive goals. A qualitative descriptive research methodology was used to explore experiences of reproductive justice among members of an Indigenous state-recognized tribe in the Gulf Coast. Data were collected through qualitative semi-structured life-history interviews with female tribal members. Several key themes emerged illustrating barriers related to women achieving their reproductive desires. These included: (a) High Prevalence of Hysterectomy or Sterilization; (b) Experiences with Infertility Common; and (c) High Frequency of Polycystic Ovary Syndrome or Endometriosis. Findings of this study reveal that Indigenous women face multiple barriers to achieving reproductive justice. This study is unique in exploring the family planning desires and goals, and the barriers experienced in achieving these reproductive desires, for women in a Gulf Coast, non-federally recognized Indigenous tribe. These results contextualize national trends and suggest that Indigenous women in this study experience reproductive injustices that harm their ability to achieve their reproductive desires.
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Affiliation(s)
| | - Celina M. Doria
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, Chicago, IL, USA
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99
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Caxaj S, Tran M, Mayell S, Tew M, McLaughlin J, Rawal S, Vosko LF, Cole D. Migrant agricultural workers' deaths in Ontario from January 2020 to June 2021: a qualitative descriptive study. Int J Equity Health 2022; 21:98. [PMID: 35842656 PMCID: PMC9287708 DOI: 10.1186/s12939-022-01692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nine migrant agricultural workers died in Ontario, Canada, between January 2020 and June 2021. Methods To better understand the factors that contributed to the deaths of these migrant agricultural workers, we used a modified qualitative descriptive approach. A research team of clinical and academic experts reviewed coroner files of the nine deceased workers and undertook an accompanying media scan. A minimum of two reviewers read each file using a standardized data extraction tool. Results We identified four domains of risk, each of which encompassed various factors that likely exacerbated the risk of poor health outcomes: (1) recruitment and travel risks; (2) missed steps and substandard conditions of healthcare monitoring, quarantine, and isolation; (3) barriers to accessing healthcare; and (4) missing information and broader issues of concern. Conclusion Migrant agricultural workers have been disproportionately harmed by the COVID-19 pandemic. Greater attention to the unique needs of this population is required to avoid further preventable deaths.
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Affiliation(s)
| | | | | | - Michelle Tew
- Occupational Health Clinic for Ontario Workers, Hamilton, Canada
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100
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South K, George M, Sadeghi H, Piane V, Smaldone A. Moving up: Healthcare transition experiences of adolescents and young adults with cystic fibrosis. J Pediatr Nurs 2022; 65:116-123. [PMID: 35367087 PMCID: PMC9246909 DOI: 10.1016/j.pedn.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The experience of healthcare transition from pediatric to adult care in cystic fibrosis (CF) remains poorly understood, particularly among racially and ethnically diverse adolescents and young adults (AYAs) with CF. The objective of this qualitative study was to explore the perspectives of a diverse sample of AYAs with CF at one urban academic medical center regarding healthcare transition. DESIGN AND METHODS Guided by qualitative descriptive methodology, we purposively selected AYAs who represented the pre and post transition experience: some AYAs had experienced the transition preparation program CF R.I.S.E. Demographic information and responsibility for self-management behaviors were collected using an online survey. Semi-structured video interviews were conducted following an iterative interview guide. A codebook directed inductive coding. QSR NVivo Version 12 software was used to organize the data. RESULTS 12 AYAs with CF were enrolled (25% female, 25% Black AYA, 33% Hispanic/Latina/o AYA, 50% White AYA; mean age 20.8 years). Three themes were identified: independent care of the whole self, preparing for change and the unknown and transition experiences vary. CONCLUSIONS Not all participants experienced a smooth transition. Participants identified suggestions for the development of transition preparation interventions, specifically around involving AYAs in transition decisions and beginning transition preparation early in adolescence. PRACTICE IMPLICATIONS Participants expressed uncertainty about transition when they felt little control over the process or lacked sufficient information about adult care. Therefore, comprehensive early transition preparation for all AYAs with CF with a focus on involving AYAs in transition decisions is recommended.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America.
| | - Maureen George
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
| | - Hossein Sadeghi
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Victoria Piane
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
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