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Orellano-Colón EM, Abdalla-Mukhaimer N, Rodríguez-Ramos BA, Rodríguez-Robles R, Rivero-Méndez M, Lizama-Troncoso M, Jutai JW, Jiménez-Velázquez IZ, Varas-Díaz N, Hallman-Navarro D. Self-Management Strategies Used by Older Hispanic Women to Overcome Functional Disabilities. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1788691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elsa M. Orellano-Colón
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Nelly Abdalla-Mukhaimer
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Bryan A. Rodríguez-Ramos
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Rebecca Rodríguez-Robles
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Marta Rivero-Méndez
- School of Nursing, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Mauricio Lizama-Troncoso
- Puerto Rico Assistive Technology Program, Central Administration, University of Puerto Rico, San Juan, Puerto Rico
| | - Jeffrey W. Jutai
- Interdisciplinary School of Science, University of Ottawa, Ottawa, Canada
| | | | - Nelson Varas-Díaz
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | - Deanna Hallman-Navarro
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Takeuchi Y, Otsuka R, Kojima H, Fetters MD. Comparison of self-report and objective measures of male sexual dysfunction in a Japanese primary care setting: a cross-sectional, self-administered mixed methods survey. Fam Med Community Health 2021; 9:e000403. [PMID: 33483417 PMCID: PMC7831740 DOI: 10.1136/fmch-2020-000403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Erectile dysfunction (ED) is a common problem among middle-aged males and men often do not talk about sexual problems with their primary care physicians (PCPs). We hypothesised that many Japanese men who meet the criteria for ED would not recognise their condition based on responses to an internationally validated scale. Our secondary aims were to examine potential barriers to seeking treatment for ED by their PCPs. We sought to elucidate their perspectives about male sexual dysfunction qualitatively. Through merging of the quantitative and qualitative findings, we sought an enhanced understanding of the factors affecting sexual dysfunction treatment. DESIGN A cross-sectional, self-administered mixed methods survey was distributed at a suburban family medicine clinic in Sapporo, Japan. Eligible participants were 40 to 69-year-old men who came for routine scheduled visits from 5 November to 21 December 2018. During the office visit, participants completed a confidential 11-item survey addressing sexual dysfunction including the 5-item version of the International Index of Erectile Function scale and open-ended questioning. SETTING Teine Family Medicine Clinic, a suburban family medicine clinic in Sapporo, Japan. PARTICIPANTS We enroled 66 male patients aged 40-69 years who presented for routine outpatient care in the Teine Family Medicine Clinic. RESULTS Of surveyed participants, 39% (26/66) reported having sexual dysfunction, but 92% (61/66) met ED criteria. Of respondents, 48% (16/33) had desire for treatment, but only one man had discussed sexual dysfunction with his PCP. Among the 12 desiring treatment from PCPs, the main barriers to discussing were shame (n=7) and lack of awareness that PCPs can treat ED (n=5). These men's perspectives about sexual dysfunction included viewing sexual dysfunction as normal ageing, attributing sexual dysfunction to decreased libido, considering sexual activity for a healthy life, having good rapport with PCPs, having incomplete knowledge about treatment and lacking an intimate relationship. Through a resulting model, the merged mixed methods findings illustrate how patient perceptions can reinforce or attenuate issues of awareness, desire for treatment and barriers to access. CONCLUSIONS In a Japanese primary care setting, the majority of participating male patients met ED criteria on an internationally validated measure, namely, the five-item version of the International Index of Erectile Function, but many were not aware of their ED. Misperceptions, lack of knowledge and personal factors are barriers to treatment. The mixed methods findings suggest misperceptions and personal attributes reinforce or attenuate awareness, preference for treatment and barriers to access. We conclude PCPs should routinely inquire about sexual dysfunction of men at risk and offer treatment to men who would benefit.
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Affiliation(s)
- Yuki Takeuchi
- Teine Family Medicine Clinic, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Ryohei Otsuka
- Teine Family Medicine Clinic, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hajime Kojima
- Teine Family Medicine Clinic, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Michael D Fetters
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Misconceptions and Unmet Need for Modern Contraception among Cambodian Females: A Mix Methods Study. SEXES 2020. [DOI: 10.3390/sexes1010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an ‘unmet need for modern contraception’ instead of the current classification which presumes they have a ‘met need’. (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15–29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15–29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted; (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception; (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.
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Binns E, Kerse N, Peri K, Cheung G, Taylor D. Combining cognitive stimulation therapy and fall prevention exercise (CogEx) in older adults with mild to moderate dementia: a feasibility randomised controlled trial. Pilot Feasibility Stud 2020; 6:108. [PMID: 32724661 PMCID: PMC7382095 DOI: 10.1186/s40814-020-00646-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background People living with dementia (PLwD) have a high fall risk as cognitive impairment compromises control of gait and balance. Fall prevention exercises that are effective in healthy older adults may not work for PLwD. Cognitive stimulation therapy (CST) has been shown to improve global cognition in PLwD. A programme which combines cognitive (CST) with physical exercises may reduce falls in PLwD. The aim of this study was to assess the feasibility of undertaking a full scale randomised controlled trial to test the effectiveness of CogEx in decreasing falls in PLwD. Specific objectives included recruitment strategy, data collection, outcome measures, intervention fidelity and facilitator/participant experience. Methods A mixed methods feasibility randomised controlled trial recruited people from residential aged care. Inclusion criteria were ≥ 65 years old, Montreal Cognitive Assessment (MoCA) score of 10 to 26 and able to participate in a group. Participants were randomised to CST or CST combined with strength and balance exercises (CogEx). Both CST and CogEx groups were for an hour twice a week for 7 weeks. Descriptive statistics were used to report pre- and post-intervention outcome measures (MoCA, Geriatric Depression Scale–15, Quality of Life-Alzheimer’s Disease, Alzheimer’s Disease Assessment Scale—Cognitive 11, Brief Balance Evaluation Systems Test and Short Form Physical Performance Battery) and attendance. Qualitative analysis of participant focus groups and facilitator interviews used a conventional approach. Sessions were video recorded and exercise completion documented. Results Thirty-six residents were screened with 23 participants randomised to intervention (CogEx, n = 10) or control (CST, n = 13). The assessments took 45 min to 1.5 h, and there was repetition between two cognitive measures. Ten facilitators completed training with the manualised programme. Exercises were combined into the hour-long CST session; however, limited balance training occurred with participants exercising predominantly in sitting. The facilitators felt the participants engaged more and were safer in sitting. Conclusions The results demonstrated that while fall prevention exercises could be scheduled into the CST structure, the fidelity of the combined programme was poor. Other components of the study design need further consideration before evaluation using a randomised controlled trial is feasible. Trial registration anzctr.org.au (ACTRN12616000751471) 8 Jun 2016, Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Elizabeth Binns
- Physiotherapy Department, AUT University, Auckland, New Zealand.,Health and Rehabilitation Institute, AUT University, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Institute, AUT University, Auckland, New Zealand
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Gowran RJ, Clifford A, Gallagher A, McKee J, O'Regan B, McKay EA. Wheelchair and seating assistive technology provision: a gateway to freedom. Disabil Rehabil 2020; 44:370-381. [PMID: 32510246 DOI: 10.1080/09638288.2020.1768303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: The meaning of wheelchair and seating assistive technology and the impact inappropriate provision has on people's lives from a service user's perspective within an Irish context is highlighted. There is a dearth in evidence examining the process of wheelchair and seating provision and the interconnectedness between satisfaction, performance and participation from an equality and human rights perspective. The purpose if the study is to investigate wheelchair service users' perspectives of wheelchair and seating provision in Ireland.Method: This is a mixed-methods study with an exploratory sequential design that includes two phases. During phase one, wheelchair service users were invited to take part in qualitative in-depth semi-structured interviews, which were thematically analysed and formed part of a larger ethnographic study involving multiple stakeholders in sustainable wheelchair and seating provision strategy development. In phase two, an online Survey Monkey questionnaire was distributed to obtain a wider overview of wheelchair service provision from a wheelchair service users perspective. Data obtained from the closed questions and content analysis for open comments was analysed descriptively for this phase.Results: Eight wheelchair service users agreed to participate in the interviews and 273 responded to the online survey. Thematic analysis and questionnaire frequency and content analysis revealed the vital meaning of wheelchair and seating assistive technology provision. However, bottlenecks within the system affect daily living, with qualitative data highlighting the obstruction to experiences of independent living from initial appointment to wheelchair breakdowns during daily life.Conclusion: Appropriate wheelchair and seating assistive technology provision is a basic human right, supported by the essential and embodied nature of the wheelchair as demonstrated through the wheelchair service users' perspective throughout this study. These findings highlight the impact of ad-hoc services on individual freedoms and how the overall pace of the system affects a person's ability to organise their time as an equal member of the community across the lifespan. A national review of wheelchair and seating assistive technology provision services is called for, giving consideration to access to services, assessment and delivery, follow up and management, education and training.IMPLICATIONS FOR REHABILITATIONWheelchair and seating assistive technology provision as a basic human right is misunderstood.Appropriate wheelchair and seating assistive technology provision should be provided to meet this primary need as a pre-requisite for survival.Every aspect of the wheelchair and seating provision process impacts on occupational performance, equality of opportunity and community mobility. Wheelchair and seating assistive technology professionals and providers have a responsibility to review their practice and service provision systems.
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Affiliation(s)
- Rosemary J Gowran
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland.,School of Health and Sports Science, University of the Sunshine Coast, Maroochydore, Australia.,Assisting Living and Learning (ALL), Institute Maynooth University, Maynooth, Ireland
| | - Amanda Clifford
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Andrea Gallagher
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jennifer McKee
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Bernadette O'Regan
- Centre for Environmental Research, University of Limerick, Limerick, Ireland
| | - Elizabeth A McKay
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
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Wang Y, Guadalupe-Fernández V, Salamanca LF, Saiz PG, Saiz JG, Sánchez CS. Characteristics of patients seeking outpatient smoking cessation treatment before and after the implementation of a smoke-free law in Valencia (Spain): a cross-sectional study. BMJ Open 2020; 10:e035319. [PMID: 32414826 PMCID: PMC7232619 DOI: 10.1136/bmjopen-2019-035319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/06/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Explore potential changes in the characteristics of patients requesting smoking cessation treatment at an outpatient setting in Spain before and after Law 42/2010 was enacted. DESIGN This is a cross-sectional study with convenience sampling. The information was obtained from the medical records of patients receiving smoking cessation treatment from January 2008 to December 2014. SETTING Hospital Clinico Universitario de Valencia. PARTICIPANTS 423 patients who sought smoking cessation treatment 36 months before or 48 months after the enactment of the law. RESULTS After the enactment of a comprehensive smoke-free law in Spain, the patients seeking smoking cessation treatment were older (p=0.003), had lower values of exhaled CO (p<0.0001), lower number of previous attempts to quit (p=0.027) and more history of medical problems related to smoking (p=0.002). CONCLUSION Our findings support the idea that society-nation level interventions could have an impact at the individual level, reflected by the change of patients' characteristics. It seems that the Law 42/2010 mobilised certain group of patients to seek treatment.
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Affiliation(s)
- Yang Wang
- Editorial department, Chinese General Practice Press, Beijing, China
| | - Víctor Guadalupe-Fernández
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, Valencia, Spain
| | - Ludwing Florez Salamanca
- Department of Psychiatry, Columbia University, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Patricia Guillem Saiz
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, Valencia, Spain
| | - Javier Guillem Saiz
- Department of Psychology, University International of Valencia, Valencia, Spain
| | - Carmen Saiz Sánchez
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, Valencia, Spain
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Xu Z, Qian Y, Pan J, Fang L. The potential contribution of mixed methods research to primary care. Fam Med Community Health 2020; 7:e000196. [PMID: 32154800 PMCID: PMC6910754 DOI: 10.1136/fmch-2019-000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/29/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Zhijie Xu
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Qian
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjiang Pan
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lizheng Fang
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Fetters MD, Guetterman TC. Response to letter by Lingping Zhu: Small 'r' research as big 'R' research in general practice. Fam Med Community Health 2020; 7:e000218. [PMID: 32154794 PMCID: PMC6910761 DOI: 10.1136/fmch-2019-000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
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Chin J, Li S, Yim G, Zhou YA, Wan PJ, Dube ER, Volokitin M, Sahni S, Terrell MA, Lomiguen CM. Perceptions of the osteopathic profession in New York City's Chinese Communities. Fam Med Community Health 2020; 8:e000248. [PMID: 32201549 PMCID: PMC7069261 DOI: 10.1136/fmch-2019-000248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Chinese immigrant communities in New York City (NYC). Design A cross-sectional study was designed in which a culturally appropriate survey in Chinese and English versions was administered anonymously to measure immigrant perceptions and knowledge of osteopathic medicine. Setting Data collection occurred in the municipal delineations for the Chinatown neighbourhood within the New York, New York borough of Manhattan. Participants Community members were selected using convenience sampling from high-density areas to participate. Information gathered from the survey included demographics, education level, healthcare habits and knowledge of the osteopathic profession. Results 120 surveys were conducted with 68 males and 52 females, with an average age=40. Respondents in the age range of 18-29 years, those with fluent English-language proficiency, and participants with graduate-level education status demonstrated a higher proportion of knowledge of osteopathic manipulative medicine and osteopathic physicians (doctors of osteopathic medicine) among the study variables. Conclusion Compared with research on the general US population, a general lack of knowledge of osteopathic medicine exists within NYC's Chinese immigrant community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all healthcare resources available during the current shortage of US primary care physicians.
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Affiliation(s)
- Justin Chin
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Sarah Li
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Gregory Yim
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - YaQun Arlene Zhou
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Peter Justin Wan
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Emily R Dube
- Pathology, New York University School of Medicine, New York City, New York, USA
| | - Mikhail Volokitin
- Osteopathic Manipulative Medicine, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Sonu Sahni
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA.,Research Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Mark A Terrell
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Christine M Lomiguen
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA.,Pathology, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
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Lian S, Xia Y, Zhang J, Han X, Chi C, Fetters MD. Comparison of general practice residents' attitudes and perceptions about training in two programmes in China: a mixed methods survey. Fam Med Community Health 2019; 7:e000238. [PMID: 32148731 PMCID: PMC6910771 DOI: 10.1136/fmch-2019-000238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To understand general practice (GP) residents’ attitudes about their residency training in China. Design Mixed methods survey administered cross-sectionally. Setting Two GP training programmes similar in most regards according to current GP training policy of 5 years’ undergraduate degree in medicine and 3 years of postgraduate GP residency training—but differing as the Beijing programme has adopted educational innovations beyond the nationally prescribed standard curriculum used by the second Shenzhen programme. Participants 105 (85%) of eligible GP trainees, 35 (90%) in the innovative Beijing programme and 70 (83%) in the standard training Shenzhen programme. Results Overall, residents felt discrimination because of specialty choice, and that they lacked competency as a general practitioner. Many residents commented faculty had negative teaching attitudes. Beijing residents were more satisfied than Shenzhen residents with their training (p=0.001), and felt teaching faculty had sufficient knowledge (p<0.001), and appropriate attitudes towards teaching (p=0.004). Beijing residents more strongly agreed on five items about good future job prospects (all p<0.05). Conclusion These Chinese GP residents identify areas for improvement in their training as well as strengths. Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty, and can earn special certification, suggest that the educational innovations enhance training and promote positivity about job prospects. These findings imply that GP residents in China face many training challenges that are similar to other international reports, while also implicating benefits of using an innovative curricular approach.
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Affiliation(s)
- Siqing Lian
- General Practice Department, Peking University First Hospital, Peking, Xicheng District, China
| | - Yu Xia
- General Practice Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jinzhi Zhang
- General Practice Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoning Han
- Cardiology Department, Peking University First Hospital, Peking, Xicheng District, China
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Peking, Xicheng District, China
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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61
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Babchuk WA. Fundamentals of qualitative analysis in family medicine. Fam Med Community Health 2019; 7:e000040. [PMID: 32148701 PMCID: PMC6910734 DOI: 10.1136/fmch-2018-000040] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/01/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
Abstract
The primary purpose of this article is to provide family physician researchers interested in conducting a qualitative research study a concise guide to the analysis. Drawing from approaches outlined in popular research methodology textbooks and employing an exemplar from a minority health disparities research study, this article outlines specific steps useful for researchers and practitioners in the field of family medicine. This process of qualitative data analysis is situated within the larger framework of qualitative research to better position those new to qualitative designs to more effectively conduct their studies. A 10-step process useful for guiding qualitative data analysis is provided. The 10 steps include (1) assembling data for analysis, (2) refamiliarising oneself with the data, (3) open or initial coding procedures, (4) generating categories and assigning codes to them, (5) generating themes from categories, (6) strategies of validation, (7) interpreting and reporting findings from the participants, (8) interpreting and reporting findings from the literature, (9) visual representations of data and findings, and (10) strengths, limitations, delimitations and suggestions for future research. This work provides clear and accessible guidelines for conducting qualitative data analysis for emerging researchers that is applicable across a wide array of topics, disciplines and settings.
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Affiliation(s)
- Wayne A Babchuk
- Anthropology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.,Educational Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Fetters MD. Getting started in primary care research: choosing among six practical research approaches. Fam Med Community Health 2019; 7:e000042. [PMID: 32148702 PMCID: PMC6910736 DOI: 10.1136/fmch-2018-000042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/18/2018] [Accepted: 01/24/2019] [Indexed: 11/04/2022] Open
Abstract
While many primary care practitioners want to conduct research, many also struggle with getting started. This article’s purpose is to assist emerging researchers in identifying a topic of interest, to try the ‘fit’ of feasible research approaches and commit to a research approach. The article addresses six objectives: (1) identify how important primary care research comes from clinical stories; (2) recognise how clinical stories become the source of research topics; (3) discern how the research process resembles the care of patients; (4) distinguish the essential features of six research approaches feasible for primary care researchers; (5) evaluate the fit of the six research approaches featured in this special issue; and (6) develop a list of steps that need to be taken to implement primary care research projects. Using ‘HPV (human papilloma) vaccination’ as a hypothetical topic, the article illustrates how an emerging researcher can complete the worksheets. Using the HPV topic, a worksheet illustration shows how to complete the worksheets, and examples from the literature illustrate how actual studies have used six feasible research approaches for primary care: (1) survey research, (2) semistructured qualitative interviews, (3) curriculum development, (4) continuous quality improvement, (5) clinical policy analysis and (6) case study research. The worksheet exercises support choosing a feasible research approach for emerging researchers. Emerging researchers using these exercises can identify a topic, choose a research strategy aligned with the researcher’s interest, create a study title, develop a list of the next steps, and be well positioned to implement an original research project
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63
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Fetters MD, Guetterman TC. Discovering and doing family medicine and community health research. Fam Med Community Health 2019; 7:e000084. [PMID: 32148707 PMCID: PMC6910740 DOI: 10.1136/fmch-2018-000084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/17/2018] [Accepted: 01/24/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy C Guetterman
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Ursu A, Greenberg G, McKee M. Continuous quality improvement methodology: a case study on multidisciplinary collaboration to improve chlamydia screening. Fam Med Community Health 2019; 7:e000085. [PMID: 32148708 PMCID: PMC6910742 DOI: 10.1136/fmch-2018-000085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/03/2019] [Accepted: 01/23/2019] [Indexed: 11/03/2022] Open
Abstract
This article illustrates quality improvement (QI) methodology using an example intended to improve chlamydia screening in women. QI projects in healthcare provide great opportunities to improve patient quality and safety in a real-world healthcare setting, yet many academic centres lack training programmes on how to conduct QI projects. The choice of chlamydia screening was based on the significant health burden chlamydia poses despite simple ways to screen and treat. At the University of Michigan, we implemented a multidepartment process to improve the chlamydia screening rates using the plan-do-check-act model. Steps to guide QI projects include the following: (1) assemble a motivated team of stakeholders and leaders; (2) identify the problem that is considered a high priority; (3) prepare for the project including support and resources; (4) set a goal and ways to evaluate outcomes; (5) identify the root cause(s) of the problem and prioritise based on impact and effort to address; (6) develop a countermeasure that addresses the selected root cause effectively; (7) pilot a small-scale project to assess for possible modifications; (8) large-scale roll-out including education on how to implement the project; and (9) assess and modify the process with a feedback mechanism. Using this nine-step process, chlamydia screening rates increased from 29% to 60%. QI projects differ from most clinical research projects by allowing clinicians to directly improve patients' health while contributing to the medical science body. This may interest clinicians wishing to conduct relevant research that can be disseminated through academic channels.
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Affiliation(s)
- Allison Ursu
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Grant Greenberg
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Michael McKee
- Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
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Fàbregues S, Fetters MD. Fundamentals of case study research in family medicine and community health. Fam Med Community Health 2019; 7:e000074. [PMID: 32148705 PMCID: PMC6910739 DOI: 10.1136/fmch-2018-000074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/07/2018] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
The aim of this article is to introduce family medicine researchers to case study research, a rigorous research methodology commonly used in the social and health sciences and only distantly related to clinical case reports. The article begins with an overview of case study in the social and health sciences, including its definition, potential applications, historical background and core features. This is followed by a 10-step description of the process of conducting a case study project illustrated using a case study conducted about a teaching programme executed to teach international family medicine resident learners sensitive examination skills. Steps for conducting a case study include (1) conducting a literature review; (2) formulating the research questions; (3) ensuring that a case study is appropriate; (4) determining the type of case study design; (5) defining boundaries of the case(s) and selecting the case(s); (6) preparing for data collection; (7) collecting and organising the data; (8) analysing the data; (9) writing the case study report; and (10) appraising the quality. Case study research is a highly flexible and powerful research tool available to family medicine researchers for a variety of applications.
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Affiliation(s)
- Sergi Fàbregues
- Department of Psychology and Education, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Schneiderhan J, Guetterman TC, Dobson ML. Curriculum development: a how to primer. Fam Med Community Health 2019; 7:e000046. [PMID: 32148703 PMCID: PMC6910735 DOI: 10.1136/fmch-2018-000046] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 11/25/2022] Open
Abstract
Curriculum development is a topic everyone in the field of medical education will encounter. Due to the breadth of ages and types of care provided in Family Medicine, family medicine faculty in particular need to be facile in developing effective curricula for medical students, residents, fellows and for faculty development. In the area of medical education, changing and evolving learning environments, as well as changing requirements necessitate new and innovative curricula to address these evolving needs. The process of developing a medical education curriculum can seem daunting but when broken down into smaller components can become very straightforward and easy to accomplish. This paper focuses on the curriculum development process using a six-step approach: performing a needs assessment, determining content, writing goals and objectives, selecting the educational strategies, implementing the curriculum and, finally, evaluating the curriculum. This process may serve as a template for Family Medicine educators, and all medical educators looking to design (or redesign) their own medical education curriculum.
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Affiliation(s)
- Jill Schneiderhan
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Margaret L Dobson
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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