A Guide to Field Notes for Qualitative Research: Context and Conversation

Psychosocial Care Delivery in Intensive Home Treatment During a Mental Health Crisis: A Qualitative Thematic Analysis

Community-based intensive home treatment (IHT) is delivered as an alternative to psychiatric hospital admission as part of crisis resolution services. People receiving IHT present with complex mental health issues and are acutely distressed. Home treatment options are often preferred and there is evidence of service fidelity, although less is known about psychosocial care in this setting. Underpinned by a critical realist epistemology, this study aimed to explore psychosocial care in the context of home treatment from the perspectives of staff, service users and family carers. Data were collected using individual interviews and focus groups in two NHS organisations in England. An inductive qualitative thematic analysis resulted in five themes focused on (1) the staffing model and effective care provision, (2) the organisation of work and effective care provision, (3) skills and training and service user need, (4) opportunities for involvement and personal choice, and (5) effective communication. Findings suggest that co-production may improve congruence between IHT service design, what service users and carers want and staff ideals about optimal care. Service designs that optimise continuity of care and effective communication were advocated. Staff training in therapeutic interventions was limited by not being tailored to the home treatment context. Evidence gaps remain regarding the most effective psychosocial care and related training and supervision required. There is also a lack of clarity about how carers and family members ought to be supported given their often-crucial role in supporting the person between staff visits.

A landscape of practice approach to enhance employability: insights from domestic and international postgraduates

Purpose

Drawing on a theoretical framework of sustainable career ecosystem theory, our paper aims to consider how domestic and international postgraduates can enhance their employability through participation in a landscape of practice.

Design/methodology/approach

The study employed an exploratory, longitudinal case study design to capture students' lived experiences on an 18-month Master of Professional Practice course at a higher education institution in New Zealand. The data collection procedure involved field note observations (months 1–4), a focus group (month 13) and narrative frames (months 16–18). The sample was domestic students from New Zealand (n = 2) and international students from Asia (n = 5).

Findings

One’s participation in multiple communities of practice represents their landscape of practice and a commitment to lifewide learning. Through participation in various communities of practice, domestic and international students can enhance their employability in three ways: (1) boundary encounters to develop social capital, (2) transcending contexts to enhance cultural capital, and (3) acknowledging the development of psychological capital and career agency.

Originality/value

Our work offers one of the earliest empirical validations of sustainable career ecosystem theory. Expressly, communities of practice represent various contexts whereby employability capital is developed over time. Additionally, the postgraduate students themselves are portrayed as interconnected and interdependent actors, presenting a novel framing of such dependencies at the micro-level of the ecosystem. The practical implications come from informing universities of the value of a landscape of practice to enhance the employability of domestic and international students in preparation for sustainable careers and to promote the sustainability of the career ecosystem.

Self-care styles of patients with chronic obstructive pulmonary disease: A mixed methods case study

BACKGROUND

In people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients.

OBJECTIVES

To explore the factors that could influence the self-care styles of patients with COPD.

METHODS

A mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases.

RESULTS

Thirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive.

CONCLUSIONS

Personal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.

"You're dealing with the bottom here…" understanding reasons for reduced utilisation: a qualitative study on colorectal cancer screening among vulnerable men at a drop-in centre in Denmark

BACKGROUND

Colorectal cancer (CRC) screening can reduce both CRC incidence and mortality, and faecal immunochemical testing (FIT)-based screening programmes are therefore now being implemented in many countries. However, social inequality in FIT-based screening participation is well documented, and initiatives to address this challenge are understudied. We explored the perceptions of CRC screening and the perceived barriers and facilitators towards FIT-based CRC screening among men visiting a drop-in centre for people with severe social problems in Denmark.

METHODS

The study was a qualitative interview study. Participants were sixteen men visiting a drop-in centre in Denmark. A local staff member provided supplementary information and assisted with the recruitment process. The interviews were transcribed verbatim, followed by an inductive content analysis.

RESULTS

The men were often dealing with health and social problems, and they often had low self-esteem. At first, they stated that they did not think much about cancer and their own risk of being diagnosed with it. They argued that they had little time, energy, and resources to participating in, for example, CRC screening programmes, and barriers to participating were facts of life such as comorbidity and cognitive difficulties. Further, they were not sure how to participate, and some misunderstood the concept of screening. However, during the interviews, the main part of the participants became very keen to participate, and they suggested that in the future, they could receive regular information about cancer screening in face-to-face interactions with someone who cared and was interested in helping them.

CONCLUSION

Men in a vulnerable position visiting a drop-in centre were interested in CRC screening. If we intervene in a way that meets the needs among these vulnerable citizens, it may contribute to reducing social inequality in FIT-based CRC screening programmes.

Patients and clinicians have different priorities when discussing pain in the IBD clinic

OBJECTIVE

Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians' conceptualisations of patients' pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain.

METHODS

In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups.

RESULTS

Clinicians state that they regularly ask about pain in Crohn's disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain).

CONCLUSION

The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.

Healthcare professionals' perceptions on providing support to informal carers within stroke care

BACKGROUND

The sudden nature of stroke onset does not provide carers with sufficient time to prepare for the demands associated with caring. Healthcare professionals can have a vital role in providing carers with support and training, which may reduce carer stress and strain, and allow for better health and rehabilitation outcomes for the stroke survivor. The experiences of healthcare professionals on supporting carers in stroke care, however, remain unclear.

OBJECTIVE

To understand the experiences and perceptions of healthcare professionals working in stroke care on implementing resources and support to informal stroke carers.

METHODS

Semi-structured interviews were conducted with 11 healthcare professionals (5 occupational therapists, 5 physiotherapists, 1 psychologist) with at least 12 months' experience in working with stroke survivors. Interviews ranged from 25-70 minutes in duration, and were recorded, transcribed, and analysed using thematic analysis.

RESULTS

Three overarching categories that were explored were: (1) Experiences of working in stroke care and supporting carers; (2) Recommendations for a program designed for carers; and (3) Future priorities in stroke care. Participants discussed a variety of strategies they utilised to support carers including collaborating with other healthcare professionals and utilising skills and experience. Healthcare professionals highlighted the need for additional resources that are designed specifically for carers and explored key topics including carer stress and fatigue, support services, stroke education, and how to look after oneself. Participants identified priorities for stroke care including additional professional training and resource availability.

CONCLUSION

This study provided a unique insight from the perspectives of healthcare professionals on supporting carers. Participants identified the need for additional training and resources to equip healthcare professionals to better support carers. Future programs designed for carers should be informed by the needs and experiences of both informal carers and healthcare professionals.

Facilitating psychiatric nurses' advocacy for mental healthcare users' human rights in a primary healthcare setting: a conceptual framework

BACKGROUND

Even though human rights advocacy is a part of mental health care, psychiatric nurses in South Africa's primary healthcare (PHC) setting face substantial challenges when advocating for the rights of mental health care users (MHCUs). The study aimed to develop a conceptual framework to facilitate psychiatric nurses' advocacy for mental healthcare users' human rights in a PHC setting.

METHODS

A qualitative, exploratory, descriptive, and contextual design was used to investigate the psychiatric nurses' experiences advocating for MHCUs' human rights in a PHC setting. Three phases were followed: the empirical phase, the classification of concepts, and a development phase. Following the empirical phase, a conceptual framework was developed to facilitate psychiatric nurses' advocacy for MHCUs human rights in a PHC setting.

RESULTS

Three themes were derived from focus group interviews with psychiatric nurses in the empirical phase. These themes yielded the central concept as 'the facilitation of empowerment' of psychiatric nurses in advocating for MHCUs' human rights. The central concepts were also classified. A conceptual framework was developed that included the relationship, working and termination phases.

CONCLUSION

The study described the development of a conceptual framework to facilitate psychiatric nurses' advocacy for mental healthcare users' human rights in a PHC setting. Psychiatric nurses play a key role in advocating for the human rights of MHCUs. This task is important and should be implemented from the government to the societal level, including all stakeholders.

Navigating HIV research among criminalized gender minority populations in Uganda: qualitative insights and lessons learned from novice researchers

BACKGROUND

Transgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts.

METHODS

This was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software.

RESULTS

Positive experiences, barriers, and challenges were captured. The positive experiences were 'respecting cultural diversity', 'expanding networks', 'addressing misconceptions' and 'finding allies'. The barriers included 'experiencing stigma', 'lengthy research processes', 'feeling isolated', 'fearing for personal safety', 'unexpected logistical costs', and 'criminalization of sexual and gender minorities'. The key themes that emerged from the lessons learned were: 'dealing with gatekeepers', 'diversity and sensitivity training', 'leveraging networks', 'meaningful community engagement', 'reflexivity', 'ensuring safety', 'equal partnership', 'giving feedback' and 'awareness of legal implications'.

CONCLUSIONS

This study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns.

Implementing absolute cardiovascular disease risk assessment into pathology collection services

BACKGROUND

Pathology services represent an ideal setting to integrate absolute cardiovascular disease (CVD) risk estimation when patients attend for routine cholesterol testing. This study aimed to explore the process of implementing CVD risk estimation into point-of-care service delivery by pathology staff to inform future implementation and sustainability.

METHODS

A new service for CVD risk estimation via a self-directed screening station was implemented into 14 pathology service sites across Tasmania, Australia. Before implementation, observations at pathology services (n = 26) and semi-structured interviews were undertaken with 26 pathology staff (88% female, 77% aged 41-60 years) to identify factors that could impact implementation of the service. The process of implementation was then evaluated using participant observations and clinical trial recruitment data. Transcripts and field notes were analysed thematically according to the Medical Research Council Framework and used to develop a programme logic model to understand how the service could be adapted to be successfully integrated into routine workflow at pathology services.

RESULTS

Eight key themes were identified during the pre-implementation phase as important factors that could impact upon integration of CVD risk estimation into pathology services. Themes related to factors within the organisation, including available resources, logistics and workflow, as well as having sufficient time to complete the intervention. Additional factors related to the individual motivations of staff, collaborative leadership and patient characteristics. Success of implementation varied among sites, requiring the trialling of different strategies to support uptake of the service and patient recruitment.

CONCLUSIONS

Implementing CVD risk estimation into point-of-care pathology services required an understanding of the core implementation components specific to each context, and for implementation strategies to be targeted to the individual and organisational contexts. The generated programme logic model may be useful in guiding future implementation endeavours within these services and aiding the selection of apt implementation strategies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04896021, registered 19/05/2021, https://clinicaltrials.gov/study/NCT04896021.

Implementing an artificial intelligence command centre in the NHS: a mixed-methods study

Background

Hospital 'command centres' use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom.

Objective

To evaluate the impact of the Bradford Command Centre on patient care and organisational processes.

Design

A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention.

Setting

The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield.

Participants

Thirty-six staff members were interviewed and/or observed.

Intervention

The implementation of a digitally enabled hospital command centre.

Main outcome measures

Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality.

Data sources

Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews.

Results

The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to 'the system'.

Conclusions

Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se.

Limitations

The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention.

Future work

We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes.

Study registration

The study is registered as IRAS No.: 285933.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

Exploring views of South African research ethics committees on pandemic preparedness and response during COVID-19

South African research ethics committees (RECs) faced significant challenges during the COVID-19 pandemic. Research ethics committees needed to find a balance between careful consideration of scientific validity and ethical merit of protocols, and review with the urgency normally associated with public health emergency research. We aimed to explore the views of South African RECs on their pandemic preparedness and response during COVID-19. We conducted in-depth interviews with 21 participants from RECs that were actively involved in the review of COVID-19 related research, at seven academic institutions across South Africa. Interviews were conducted remotely using an in-depth interview guide that included questions regarding REC preparedness and response to COVID-19. Interviews were conducted until data saturation, and audio-recordings were transcribed verbatim and coded. An inductive approach to thematic analysis was used to organise data into themes and sub-themes. This study focused on three main themes: coping during COVID-19, building REC capacity during pandemic times and a consistently cautious approach to mutual recognition of REC reviews. Despite an initial sense of unpreparedness, RECs were able to adapt and maintain careful ethical oversight of both COVID and non-COVID research, and the rigour of REC reviews. Several important lessons for preparedness and response to future pandemics were identified, including heightened awareness of publication, funding and political pressures, the importance of regular training for RECs and researchers, and strategies to enhance moral resilience of REC members. Incremental steps are needed to build trust and authentic partnerships among RECs in inter-pandemic times, to facilitate collaboration during future public health emergencies.

A hybrid type II effectiveness-implementation trial of a positive emotion regulation intervention among people living with HIV engaged in Ryan White Medical Case Management: protocol and design for the ORCHID study

BACKGROUND

The Ryan White Medical Case Management System, which serves more than half of people living with HIV (PLWH) in the USA, is an opportune setting for identifying and addressing depression among PLWH. A growing body of research suggests that interventions that promote positive emotion may lessen symptoms of depression and improve physical and psychological well-being among people experiencing a variety of health-related stress, including living with HIV. Research on how best to integrate standardized mental health screening and referral to evidence-based interventions in Ryan White Medical Case Management settings has the potential to improve the health and wellbeing of PLWH.

METHODS

This mixed-methods study will enroll up to N = 300 Ryan White clients who screen positive for depressive symptoms in ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery), a web-based, self-guided positive emotion regulation intervention. The study will be conducted in 16 Ryan White Medical Case Management clinics in Chicago, IL. Following pre-implementation surveys and interviews with Medical Case Managers (MCMs) and Supervisors to develop an implementation facilitation strategy, we will conduct a hybrid type 2 implementation-effectiveness stepped wedge cluster randomized trial to iteratively improve the screening and referral process via interviews with MCMs in each wedge. We will test the effectiveness of ORCHID on depression and HIV care outcomes for PLWH enrolled in the program. RE-AIM is the implementation outcomes framework and the Consolidated Framework for Implementation Research is the implementation determinants framework.

DISCUSSION

Study findings have the potential to improve mental health and substance use screening of Ryan White clients, decrease depression and improve HIV care outcomes, and inform the implementation of other evidence-based interventions in the Ryan White Medical Case Management System.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05123144. Trial registered 6/24/2021.

"I'm both smoking and vaping": a longitudinal qualitative study of US young adults who tried to quit smoking cigarettes by using electronic cigarettes

OBJECTIVE

To describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.

METHODS

Longitudinal qualitative data were collected annually from 2017 to 2019 for 25 young adult tobacco users (aged 18-29 years) in California (USA) who used ENDS to quit/reduce smoking. Thematic and trajectory analyses were used to identify key within-person and between-person changes in tobacco/nicotine use over time.

RESULTS

Five types of tobacco use transition were identified among baseline dual users of cigarettes and ENDS: sustained dual use without reduced smoking (n=8), transition to exclusive daily ENDS use (n=6), sustained dual use with reduced smoking (n=5), transition back to exclusive smoking (n=4) and transition to neither smoking nor vaping (n=2). Participants' ENDS use behaviour varied over time in terms of vaping quantity and device characteristics (eg, changing nicotine concentrations/flavours, switching between multiple devices). Three themes that related to successfully replacing cigarettes with ENDS were perceived positive physical effects, perceived satisfaction and enjoyment and context changes. Four themes for unsuccessful replacement were perceived negative physical discomforts, perceived addictiveness and harm, unsatisfactory substitution for cigarettes and device malfunction.

CONCLUSIONS

Young adults' experiences with using ENDS as a smoking cessation aid were highly variable. Adequate nicotine delivery and perceived safety and benefits contributed to successfully reducing or quitting cigarettes. Providing behavioural counselling and standardising ENDS products may enhance cessation for young adults.

Development of a maturity model for demand and capacity management in healthcare

BACKGROUND

The aim of this paper is to develop a maturity model (MM) for demand and capacity management (DCM) processes in healthcare settings, which yields opportunities for organisations to diagnose their planning and production processes, identify gaps in their operations and evaluate improvements.

METHODS

Informed by existing DCM maturity frameworks, qualitative research methods were used to develop the MM, including major adaptations and additions in the healthcare context. The development phases for maturity assessment models proposed by de Bruin et al. were used as a structure for the research procedure: (1) determination of scope, (2) design of a conceptual MM, (3) adjustments and population of the MM to the specific context and (4) test of construct and validity. An embedded single-case study was conducted for the latter two - four units divided into two hospitals with specialised outpatient care introducing a structured DCM work process. Data was collected through interviews, observations, field notes and document studies. Thematic analyses were carried out using a systematic combination of deductive and inductive analyses - an abductive approach - with the MM progressing with incremental modifications.

RESULTS

We propose a five-stage MM with six categories for assessing healthcare DCM determined in relation to patient flows (vertical alignment) and organisational levels (horizontal alignment). Our application of this model to our specific case indicates its usefulness in evaluating DCM maturity. Specifically, it reveals that transitioning from service activities to a holistic focus on patient flows during the planning process is necessary to progress to more advanced stages.

CONCLUSION

In this paper, a model for assessing healthcare DCM and for creating roadmaps for improvements towards more mature levels has been developed and tested. To refine and finalise the model, we propose further evaluations of its usefulness and validity by including more contextual differences in patient demand and supply prerequisites.

Unlocking the forest: An ethnographic evaluation of Forest Schools on developmental outcomes for 3-year-olds unaccustomed to woodland spaces

Background and purpose

Early years experiences shape a child's physical, cognitive and emotional development. Spending time in greenspaces offers benefits for children's development, but access and use can be limited in urban settings. There is increasing interest in the health and developmental benefits of Forest Schools for primary-aged children, but little is known about the benefits for pre-school children. This study aims to identify these and explore the processes and activities associated with a Forest School intervention for early years children that may influence outcomes.

Methods

This paper reports on an ethnographic approach involving 65 hours of observations with two cohorts of 10 3-year-olds attending 11 weekly Forest School sessions in an urban setting. The children attending had little or no previous experience of natural spaces. 14 in-depth interviews were conducted with parents, and nursery and Forest School staff. The data were analysed using thematic analysis, and outcomes were identified using the Early Years Foundation Stage Statutory Framework.

Results

Despite logistical challenges, the intervention benefitted age-specific health and development outcomes, particularly personal, socio- and emotional development, verbal communication, and mathematics. Unexpected benefits were observed among nursery staff and parents attending Forest School.

Conclusion

Forest Schools are a promising and feasible method to improve nature connectedness and development in children aged 3 years and support school readiness. The maintenance and protection of urban woodland spaces are paramount to facilitate this.

Family Experiences of Loss and Bereavement in Palliative Care Units during the COVID-19 Pandemic: An Interpretative Phenomenological Study

The COVID-19 pandemic significantly interrupted the grieving experiences of bereaved families and drastically changed their ways of dealing with loss. Our study aims to gain an in-depth understanding of the experience of bereaved relatives of patients who died in palliative care units during the COVID-19 pandemic. The phenomenological research design included sixteen family members of hospitalized palliative patients who died from November 2021 to June 2022. The study involved conducting qualitative in-depth semi-structured interviews with family members 12-24 months after the death of their loved ones. The interviews aimed to gather information about the experiences of the families both before and after the death. The COREQ guidelines were applied in the study. Participants were mainly female (n = 13) with a mean age of 47.25 (SD = 12.58). Data were analysed using the Interpretative Phenomenology Analysis (IPA). The following three categories were identified: (1) navigating loved ones' final weeks and days (troubled deaths); (2) the last farewell was robbed; (3) looking for adjustment after loss. One overall main theme emerged, which was as follows: "Struggling between stolen moments and painful losses to get back into the flow of life". This study provides novel insights into end-of-life care and bereavement from the perspectives of family. Our findings suggest that developing and promoting family-centred culture can lead to compassionate palliative care focused on a myriad ways of affirming that their loved one matters.

Experience from transport teams on interhospital transfer of patients with extracorporeal membrane oxygenation support: A qualitative study

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) can be a life-saving treatment for patients requiring advanced cardiopulmonary support. Several ECMO centres offer interhospital transport (ECMO IHT) services that involve establishing ECMO teams to initiate ECMO at referring hospitals and then transfer patients to ECMO centres. ECMO IHT is often high risk and complex. Understanding the experience of transport team members is crucial to ensure patient safety and promote quality improvement.

AIM

To explore the experiences of transport teams performing ECMO IHT.

STUDY DESIGN

A descriptive qualitative methodology was adopted.

RESULTS

Thirteen health care professionals who have performed ECMO IHT at a general hospital in China agreed to be interviewed and enrolled in this study. Two investigators conducted face-to-face individual interviews in September-November 2022. All interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Three main themes and nine sub-themes were developed: (1) practicing with good organizational management (conducting training programs, cultivating the spirit of good teamwork and developing a standardized transport procedure), (2) dedicated to ensuring patient safety (adequate preparation and regular checking to reduce risk, accurate evaluation to avoid futility and maintaining communication to increase safety) and (3) having confidence despite being uneasy (feeling stressed is common, facing insecurity in transport settings and gaining confidence through practice).

CONCLUSIONS

Health care professionals must adequately prepare and assess ECMO IHT to ensure patient safety. Supportive measures should be taken to ensure team members' health and improve patient safety. Good communication and teamwork could improve this challenging task. Further research is required for training programs and establishing standardized transport procedures.

RELEVANCE TO CLINICAL PRACTICE

This study presents multi-professional perspectives on the experience of performing ECMO IHT to help management identify what needs to be further developed. With the increasing number of ECMO IHT, promoting its standardization is warranted.

Impact of chronic kidney disease on everyday life: A descriptive qualitative study

BACKGROUND

Living with chronic kidney disease is stressful as the disease and its treatments impact on everyday physical, psychological, and social activities. As this disease has a long trajectory, it is important to understand everyday life experiences of those at different points along this trajectory.

OBJECTIVES

To explore the impact of chronic kidney disease and its treatment on everyday life.

DESIGN

Descriptive qualitative design PARTICIPANTS: Twenty-five adults with chronic kidney disease across various grades were purposively recruited.

APPROACH

Data were collected using semistructured interviews. Deductive content analysis informed by the revised Wilson and Cleary model was used to analyse data.

FINDINGS

There were four themes. Theme 1, experiencing deterioration of kidney function, reflected the physical and psychological problems experienced by participants. Theme 2, changes that happened to me and my family, explained the subsequent limitations in their physical, social and role functioning. Theme 3, responding to a new normal, identified adjustments needed in everyday life to cope with the disease and its treatments. The final theme, thinking ahead and making a decision, captured the future plans and decisions needed while living with chronic kidney disease.

CONCLUSIONS

People with chronic kidney disease experience complex challenges such as greater symptom burden and functional limitations across the disease grades which impact on their everyday life. Nurses' recognition of these challenges is crucial for identifying and addressing unmet needs. Early individualised interventions, such as routine symptom assessment and management strategies that improve the wellbeing of people are needed.

A Longitudinal Mixed Methods Case Study Investigation of the Academic, Athletic, Psychosocial and Psychological Impacts of Being a Sport School Student Athlete

BACKGROUND

Sport schools are popular environments for simultaneously delivering education and sport to young people. Previous research suggests sport school involvement to have impact (i.e. the positive/negative, intended/unintended and long/short-term outcomes, results and effects) on student athlete's holistic (i.e. academic, athletic, psychosocial and psychological) development. However, previous research is limited by (1) cross-sectional methods, (2) limited multidimensional assessments, (3) lack of consideration for athlete characteristics (e.g. sex) and (4) failure to evaluate how sport school features affect student-athlete impacts.

OBJECTIVES

The study, using a mixed methods case study approach, aims to (1) longitudinally evaluate the impact of sport school involvement on the holistic development of student athletes, (2) evaluate the impact on holistic development by student-athlete characteristics and (3) explore the features and processes of the sport-school programme that drive/facilitate holistic impacts.

METHODS

A longitudinal mixed methods design was employed across one full academic school year (33 weeks). Six data-collection methods (i.e. online questionnaire, physical fitness testing battery, academic assessment grades, log diaries, field notes/observation and timeline diagram/illustration) were used to assess the academic, athletic, psychosocial and psychological impacts for 72 student athletes from one sport school in the United Kingdom (UK).

RESULTS

Student athletes developed positive long-term holistic overall impacts (i.e. academically, athletically and personally), including maintaining stable and relatively high levels of sport confidence, academic motivation, general recovery, life skills, resilience and friends, family and free time scores. Despite positive impacts, juggling academic and sport workload posed challenges for student athletes, having the potential to lead to negative holistic impacts (e.g. fatigue, stress and injury). Positive and negative impacts were linked to many potential features and processes of the sport school (e.g. academic and athletic support services versus insufficient training load build-up, communication, coordination, flexibility and planning). Furthermore, when considering student-athlete characteristics, females had lower sport confidence, higher general stress and body image concerns and less general recovery than males and student athletes who played sport outside the school had lower general recovery.

CONCLUSIONS

This mixed method, longitudinal study demonstrated sport school involvement resulted in many positive academic (e.g. good grades), athletic (e.g. fitness development), psychosocial (e.g. enhanced confidence) and psychological (e.g. improved resilience) impacts attributed to the academic and athletic support services provided. However, juggling heavy academic and athletic workloads posed challenges leading to negative impacts including fatigue, pressure, stress and injury. Furthermore, holistic impacts may be sex dependent and further support may be required for female student athletes in sport school environments. Overall, these findings demonstrate the complex nature of combining education and sport commitments and how sport schools should manage, monitor and evaluate the features of their programme to maximise the holistic impacts of sport-school student athletes.

Habituation for professional learning: a qualitative study of physiotherapy students' experiences working with anatomy cadavers

INTRODUCTION

Cadaveric dissection shapes the ways in which healthcare students understand the human body and the attitudes, identities and behaviors they exhibit as health professionals. There is however a paucity of related research with physiotherapy (PT) students.

PURPOSE

The purpose of this interpretivist study was to investigate PT students' conceptions of the human body in relation to experiences with human cadavers in anatomy education.

METHODS

Ten semi-structured interviews were conducted with PT students along with four optional written reflections completed. Data was thematically analyzed.

RESULTS

Students engaged in a continuous process of habituation involving oscillation between "humanization" and "dehumanization" of cadavers in the anatomy lab. We describe the contextual mediators that shaped the process, the multi-sensory and emotional experience of the students, and the "interruptions" that contributed to the variability in their conceptions over time and contexts. Students ultimately habituated toward dehumanization which had multiple effects on learning and professionalization.

CONCLUSION

Study findings highlight the complexity of PT students' experiences and learning within the cadaver lab outside of the formal goals of anatomy education. We discuss the implications for anatomy curricula, including the potential advantages of incorporating a biopsychosocial approach.

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program

IMPORTANCE

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors.

OBJECTIVE

To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles.

DESIGN

Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand.

SETTING

University-affiliated hospital.

PARTICIPANTS

Six laparoscopic surgeons.

OUTCOMES AND MEASURES

CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention.

RESULTS

There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life.

CONCLUSIONS AND RELEVANCE

The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

The parent perspective on paediatric delirium and an associated care bundle: A qualitative study

AIMS

To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle.

DESIGN

We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews.

METHODS

Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis.

FINDINGS

We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement.

CONCLUSION

The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium.

IMPACT

This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit.

REPORTING METHOD

The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution to the research design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: - It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.

Support provided by outreach team leaders to caregivers of HIV/AIDS orphans in the North-West province of South Africa

BACKGROUND

The human immunodeficiency virus (HIV) and acquired immunodeficiency deficiency syndrome (AIDS) epidemic have left an overwhelming impact on communities worldwide, particularly in Sub-Saharan Africa, where its effects on family structures are particularly pronounced. Caregivers of HIV/AIDS orphans encounter challenges in fulfilling their caring duties. Consequently, they rely on the outreach team leaders (OTLs) for support to care for HIV/AIDS orphans.

AIM

This study aimed to explore and describe support provided by OTLs to caregivers of HIV/AIDS orphans in the North West Province of South Africa.

METHODS

The exploratory, descriptive, and contextual design meaning the study was conducted was in the contexts where caregivers of HIV/AIDS orphans reside. The study was conducted in five local municipalities in the Ngaka Modiri Molema district of the North West Province of South Africa. Ward-based outreach nurses were participants in the study. Semi-structured focus group interviews were used for data collection. Thematic analysis was used to analyze data. Throughout the study, ethical principles were adhered to. The study also adhered to four trustworthiness principles: credibility, confirmability, transferability, and dependability.

RESULTS

Three main themes emerged from this study: the conduction of home visits to caregivers of HIV/AIDS orphans, the coordination of a multidisciplinary team for support, and the facilitation of support groups.

CONCLUSIONS

This study revealed that that caregivers of children orphaned by HIV/AIDS benefitted from the support provided by OTLs in the North West province of South Africa. The support provided by OTLs harnessed positive relationship between caregivers and children orphaned by HIV/AIDS.

Important aspects of experiences from patients and parents related to medications in Child and Adolescents Mental Health Services (CAMHS) - a qualitative study

PURPOSE

Patient-reported experiences are a key source of information on quality in mental health care. Most patient experience surveys are limited to assessments from adults, including those conducted by parents or proxies on behalf of others. The aim of this study was to produce findings to inform development of modules on patient and parent experiences with medication in outpatient CAMHS in Norway, for use in previously validated instruments applied in national surveys.

PATIENTS AND METHODS

We developed survey questions based on a systematic literature review, expert-group consultations, interviews with adolescents and parents, and pretesting of the modules in a pilot study. This study included adolescents aged 12-17 years and parents with experiences from outpatient CAMHS and we present findings from semi-structured interviews.

RESULTS

Adolescents with ADHD emphasized the following aspects as important concerning medication use in CAMHS: positive effects of medication like better function and concentration in school and change of behaviour. They also stressed the importance of side effects such as eating problems, nausea, loss of appetite, insomnia, and changes in thoughts and feelings. In addition, adolescents highlighted the significance of aspects as support in daily routines for taking medications, while parents highlighted needs for a professional follow-up care. Parents emphasized aspects regarding their children's medication included both positive effects and change in behaviour, as well as their identification of negative side effects.

CONCLUSION

Our findings from semi-structured interviews identified important aspects reported by both patients and parents on functions, side effects and follow-up care related to medication. The results indicated that both groups emphasized corresponding aspects of what was important regarding medication. However, when it came to follow-up care, the two groups highlighted distinct aspects, indicating differing priorities or concerns in this area.

An Exploration of LGBTQA+ Young People's Coping Strategies When Navigating Suicidal Thoughts and Behaviors

LGBTQA+ young people experience suicidal thoughts and behaviors at a much greater rate than their heterosexual and cisgender peers. This study explored firsthand accounts of the coping strategies employed by LGBTQA+ young people when experiencing suicidal thoughts and behaviors. LGBTQA+ young people (N = 27; ages 14-25) in Australia with a history of suicidal thoughts and/or attempts participated in semi-structured interviews. Using reflexive thematic analysis, four major themes were developed: (1) It's about the journey, not the destination, (2) Connecting with others, (3) When I knew better, I coped better, and (4) Doing the best I can with what I have. LGBTQA+ young people reported utilizing a range of coping strategies, however these were limited by a lack of knowledge around mental health, gender and sexuality diversity, and available resources. Experiences of discrimination within support settings and limited access to clinicians with knowledge of sexuality and gender diversity were cited as significant barriers. Interventions to increase mental health literacy in LGBTQA+ young people and improvements to clinician knowledge of sexuality and gender diversity are needed to enhance LGBTQA+ young people's access to effective coping strategies when experiencing suicidal thoughts and behaviors.

Development and implementation of a self-directed violence prevention training program for correctional behavioral health providers: a clinical trial study protocol

BACKGROUND

Self-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills.

METHODS

This pilot trial is a type 3 hybrid implementation-effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50-100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points.

DISCUSSION

The primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024.

Experiences with a national team-based learning program for advance care planning in pediatric palliative care

BACKGROUND

Advance Care Planning (ACP) enables patients and relatives to define and share values, goals and preferences for future medical treatment and care. The IMplementing Pediatric Advance Care Planning Toolkit (IMPACT), developed in the Netherlands, is a method for conducting ACP in pediatric palliative care. Healthcare professionals who were trained to use IMPACT, indicated their need for ongoing support to practice ACP communication skills optimally over time. Therefore, we developed a team-based learning program aimed at teaching participants how to transfer knowledge on ACP, continue practicing ACP communication skills and reflect on ACP conversations within their own team context. The aim of this study was to evaluate the program's transfer of knowledge as well as the professionals' experience and team reflection on ACP.

METHODS

A one-day IMPACT train-the-trainer course was developed and a selection of healthcare professionals (facilitators) from pediatric palliative care teams (PPCTs) from all seven Dutch university hospitals and the specialized Center for Pediatric Oncology were invited to participate. Hereafter, facilitators were asked to transfer their course-acquired knowledge to their team members (learners) by organizing two coaching-on-the-job sessions. A mixed-methods design, combining questionnaires and field notes, was used to evaluate the level of knowledge transfer and team reflection achieved.

RESULTS

Eighteen healthcare professionals in the role of facilitator participated in the train-the-trainer course. In seven PPCTs one (n = 3) or two (n = 4) coaching-on-the-job session(s) took place, attended by 29 and 17 learners, respectively. In the questionnaires, 11 facilitators indicated that they had to some extent transferred acquired knowledge to their team members as intended. Sixteen out of 21 learners who participated in at least one coaching-on-the-job session, reported (somewhat) increased self-confidence for conducting ACP conversations. The reported main strength of the program was practicing with/learning from colleagues whereas dealing with workload and variation in existing ACP skills within PPCTs need more attention.

CONCLUSIONS

The newly developed team-based learning program resulted in intended transfer of knowledge and methodical reflection on ACP in coaching-on-the-job sessions in most participating PPCTs. Planning coaching-on-the-job sessions regarding ACP in pediatric palliative care with multiple healthcare professionals is challenging and needs more emphasis in the training.

Facilitators, barriers and acceptability of implementing a communication board in Sri Lankan intensive care units: A qualitative descriptive study

OBJECTIVES

To explore patients' and nurses' views of potential facilitators, barriers, and prospective acceptability of implementing a communication board in Sri Lankan intensive care units.

DESIGN

A qualitative, descriptive study.

RESEARCH METHODOLOGY

Eight patients who received mechanical ventilation and nine nurses who worked in adult medical and surgical intensive care units were purposively selected. Data were collected via audio-taped, semi-structured, face-to-face interviews in January/February 2023. Interview guide questions were informed by the knowledge-to-action framework and the theoretical framework of acceptability. Data were analysed using inductive and deductive content analysis. The 32-item checklist of the consolidated criteria for reporting qualitative research (COREQ) was used to ensure the quality of reporting.

SETTING

A 3,000 bed Sri Lankan teaching hospital with 18 intensive care units.

FINDINGS

Four categories reflecting patients' and nurses' anticipated use of the board were found. The first category described patients' and nurses' 'readiness to use the communication board' and their positive attitudes towards it. The second category focused on the 'potential benefits of the communication board', while the third category emphasised the 'individual patient characteristics' that should be taken into consideration when implementing communication boards. The final category described practical aspects related to 'integrating communication boards into routine practice'.

CONCLUSION

This study demonstrates communication boards may improve communication between ventilated patients and nurses, and they are acceptable to end users. Adopting these tools may be a pivotal step to enhancing patient-centred care in demanding intensive care settings.

IMPLICATIONS FOR CLINICAL PRACTICE

An inability to communicate effectively with ventilated intensive care patients creates negative experiences for both patients and nurses. Communication boards may act as a medium to better understand patients' needs during mechanical ventilation.Understanding patients' and nurses' views is beneficial when designing patient-centred communication interventions in intensive care units.

Lived Experience of Health and Wellbeing Among Young People with Early Psychosis in Aotearoa New Zealand

First episode psychosis (FEP) can disrupt a young person's life and future health. Those with lived experience of FEP can inform effective support. This study investigated how young people with FEP experience good health and wellbeing living in Aotearoa New Zealand. Recent clients of early intervention services (n = 12) shared their stories across varying traditional and creative platforms. Thematic analysis revealed seven themes important for living well with FEP: whanaungatanga (relationships), addressing stigma, finding out who I am with psychosis, getting the basics right, collaborative healthcare, understanding psychosis, and access to resources. The themes informed five supporting processes: whakawhanuangatanga (relationship-building), using holistic approaches, creating space for young people, reframing, and improving access to appropriate resources. These findings deepen our understanding of how we can support young people to live well with FEP. This study highlights the value of creative methods and partnering with lived experience experts to conduct meaningful health research.This trial was registered at Australian New Zealand Clinical Trials Registry (ANZCTR) CTRN12622001323718 on 12/10/2022 "retrospectively registered"; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384775&isReview=true .

Public perception and acceptance of CCUS: preliminary findings of a qualitative case study in Greece

The development and implementation of carbon capture, utilisation and storage (CCUS) technologies plays an increasingly important part in European Union (EU) countries' decarbonisation policies and strategies. Several studies have shown the important role social acceptance plays in determining the outcomes of CCUS projects and how social acceptance is shaped by the national and local contexts. Yet most studies on CCUS and social acceptance have focused on a few northern European countries despite the increasing numbers of CCUS projects across the European Union. This study seeks to help address this gap by conducting a case study on how local dynamics shaped people's acceptance and awareness of CCUS in two separate Greek communities. Based on semi-structured interviews with community members near a CCUS pilot plant, and a focus group with community members from a potential storage site, this single case study explores the factors and dynamics that shaped the participants' perceptions of CCUS technologies. Our findings indicate that, despite the low level of awareness of CCUS technologies, participants could draw on their situated knowledge to identify potential drawbacks with their application. We identified scepticism regarding the adoption of new technologies and the organisations involved based on past experiences, and a notable lack of provision of technology and location-specific information as well as public engagement by the project consortium. Our recommendations for future projects and community engagement include the early involvement of the public in project development, location-based transparent information, appropriate channels to facilitate knowledge exchange, and educational initiatives to build communities' capability to influence projects.

Applying Kumpfer's resilience framework to understand the social adaptation process of the trailing parents in China

BACKGROUND

Trailing parents, a distinct group emerging from China's rapid social change and urbanization, are experiencing migration in old age, posing challenges for their social adaptation. Existing research has mainly focused on the hardships faced by this group, but few studies have focused on how they cope with change and achieve some degree of successful social adaptation. This study aimed to understand the coping and social adaptation process of trailing parents in China.

METHODS

This study used a qualitative research approach. A total of 24 trailing parents were invited to participate in a semi-structured interview and share their experiences and efforts to cope with the many challenges. Kumpfer's resilience framework was used as the theoretical framework for the study design, data collection, and data analysis.

RESULTS

This study identified several intra-family and community stressors that trailing parents may face when moving to a new environment and uncovered five key resilience characteristics that may be triggered or fostered in the presence of these stressors, including physical fitness, psychological stability, open-mindedness, learning ability, and nurturing hobbies. Individuals with resilience traits have been observed to engage in positive cognitive processing and transform the new environment. Consistent with Kumpfer's resilience framework, this study revealed the dynamics of the stressors faced by trailing parents in the new environments, the role of resilience characteristics, and the critical influence of social support in shaping the interplay between the individual and the environment that enabled them to adapt positively.

CONCLUSIONS

This study highlights the importance of fostering resilience traits and leveraging positive coping mechanisms to facilitate a smoother adaptation process for trailing parents. Meanwhile, there is an urgent need to focus on creating opportunities that strengthen their social support networks.

Guaranteeing the Achievement of Sustainable Development Goals 3 and 4 through Temporary Guardianship in Times of Sudden Public Emergencies: Analytical Evidence from China’s Policies during the COVID-19 Pandemic

The requirements for children’s health, well-being, and education are covered in Sustainable Development Goals 3 and 4. In response to the crisis in survival and development sustainability faced by children during the COVID-19 pandemic, China adopted the temporary guardianship system. The purpose of this study is to examine whether this system does contribute to safeguarding children’s sustainable development, well-being, and health. The study adopted a descriptive qualitative approach with content analysis and applied qualitative document analysis of relevant regulations. Data were obtained through 12 semi-structured, in-depth interviews with the institutional staff and individuals. The results indicate that the multiple supports provided to children during the COVID-19 pandemic by the institutions and individuals responsible for assuming temporary guardianship were basically adequate to meet the needs for achieving children’s objective well-being and sustainable development and safeguarding their health. Despite some deficiencies, the temporary guardianship system is worthy of becoming a sustainable system for supporting children’s sustainable personal development and safeguarding their health and well-being, and of serving as a blueprint for other countries to pursue Sustainable Development Goals in times of sudden public emergencies.

Examining Ableism Through the Physical Activity Experiences of Blind and Visually Impaired Women

PURPOSE

This study examined how ableism influences blind and visually impaired women's experiences accessing and engaging in exercise, physical activity, and sport.

METHODS

Ten women between the ages of 27 and 45 years completed a one-on-one audio-recorded virtual interview where they reflected on the meaningfulness of their exercise, physical activity, and/or sport experiences, as well as described any experiences related to direct, indirect, systemic, or internalized ableism within or when attempting to access those physical activity experiences. The interview transcripts were analyzed using reflexive thematic analysis.

FINDINGS

The analysis resulted in the construction of 2 themes that depicted the participants' experiences: (1) "It's exhausting": navigating inaccessibility and (2) "You feel like a fish out of water": internalized ableism.

DISCUSSION

The themes highlight the participants' experiences which were largely focused on being forced to navigate inaccessible environments which resulted in exhaustion and expressions of internalized ableism. These findings provide insight into what makes and does not make a physical activity space accessible and welcoming for blind and visually impaired adults.

Recording antimicrobial use on Irish dairy farms: Barriers and facilitators to using technology and sharing data

Antimicrobial use (AMU) data are essential to monitor the effect of AMU reduction strategies in animal health. The use of technology and herd recording software to record AMU will be vital to scale the collation of these data in the future. The aim of this study was to determine the barriers and facilitators to Irish dairy farmers recording their AMU using a herd recording software and sharing AMU data. Thirty-three Irish dairy farmers involved in a study on AMU monitoring were asked to record their AMU using a herd recording software over a 12-mo period. At the end of the 12-mo period, 10 of these farmers were selected to take part in semi-structured interviews exploring their opinions on recording AMU, the use of herd recording software, and sharing AMU data. Interviews were transcribed and qualitatively analyzed using inductive thematic analysis. Several barriers and facilitators to farmers recording their AMU using a herd recording software and sharing AMU data were identified. Barriers included the age and generation of the farmer, farm infrastructure, a lack of training and education, a lack of knowledge around the benefits of digital data, a lack of incentive to digitize records, and a fear of repercussions. Facilitators identified by the farmers included the benefits of having instantly available data for making herd management decisions, reduced paperwork, increased organization for inspections, and a potential positive effect on the image of the dairy industry. To increase the uptake of new technology to record AMU at farm-level, farmers will need support in terms of education and training around the software available to them and reassurance around the perceived risks of repercussions with sharing data in a digital format.

Orienteering promoting community and nature connectedness in Italian VET students. An ethnographic Study of a nature-based intervention

This ethnographic study examines the effects of a health-promotion intervention involving orienteering in urban parks for first-year Italian vocational students. Green exercise, known to enhance psychological well-being and foster a sense of kinship with nature and community, was chosen to address risk factors in vocational education and training (VET) institutions. Orienteering offers mental and physical benefits while encouraging participation. This study involved 53 students (mean age 14.51) from a VET institution in Milan, employing interviews with teachers and ethnographic observations. Findings indicate that the intervention promoted group cooperation, reduced conflicts, and helped students develop navigation skills while exploring their city. It also strengthened students' connestion with nature and community spaces, fostering a sense of belonging and engagement.

Toward a strengths-based model for designing virtual reality learning experiences for autistic users

LAY ABSTRACT

Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences.

'It is important to feel invited': what patients require when using the Utrecht Symptom Diary - 4 Dimensional, a qualitative exploration

Background

In palliative care, the Utrecht Symptom Diary - 4 Dimensional (USD-4D), a Dutch-adapted and validated patient-reported outcome measure, supports multidimensional symptom management through identification and monitoring of, as well as dialogue on symptoms and needs. For the USD-4D to optimally support patients' autonomy, it is essential to know what patients need to use it.

Objective

This study aims to identify what patients need when using the USD-4D in clinical palliative care.

Design

A generic qualitative design with primary and secondary analyses of semistructured interviews.

Methods

Patients ⩾18 years with a life-limiting illness were purposefully recruited within hospice and home care settings if they were in their last year of life as identified by the surprise question. Patients had to be aware of their life-threatening condition. Patients were selected in two tranches. In the first tranche, patients had to have completed the USD-4D at least once. The second tranche consisted of patients who were not familiar with the USD-4D in clinical practice and were interviewed in a previous study on the content validity of the USD-4D. The interviews were transcribed verbatim and were subjected to thematic analysis.

Results

Twenty-five patients were included (14 men, ages 44-87). Patients' needs when using the USD-4D were summarized in three themes: (1) feeling invited, (2) being aware of the purpose and function of the USD-4D, and (3) experiencing a personal and nonjudgmental approach.

Conclusion

For patients to optimally benefit from the USD-4D as a supportive measure of their autonomy in clinical palliative care, it is essential that they feel invited to use it. Healthcare providers are tasked with setting the right preconditions for patients to want and to be able to use the USD-4D. For patients, this means healthcare providers should always be attuned to their personal preferences when communicating the purpose and function of the USD-4D and when they enter into dialogue with them.

Infection prevention and control in Dutch general practices before and during the COVID-19 pandemic and its implications for pandemic preparedness and seasonal respiratory epidemics: a qualitative study on lessons learned

BACKGROUND

The COVID-19 pandemic has prompted a re-evaluation of infection prevention and control (IPC) in general practices, highlighting the need for comprehensive IPC implementation. This study aimed to evaluate healthcare workers' (HCWs) experiences and perspectives regarding IPC in general practices before and during the COVID-19 pandemic, and its implications for post-pandemic IPC implementation.

METHODS

This qualitative study involved semi-structured, in-depth interviews during two time periods: (1) prior to the COVID-19 pandemic (July 2019-February 2020), involving 14 general practitioners (GPs) and medical assistants; and (2) during the COVID-19 pandemic (July 2022-February 2023), including 22 GPs and medical assistants. Data analysis included thematic analysis that addressed multiple system levels.

RESULTS

Findings indicated a shift towards comprehensive IPC implementation and organisation during the pandemic compared to the pre-pandemic period. Since the Omicron variant, some general practices maintained a broad set of IPC measures, while others released most measures. HCWs' future expectations on post-pandemic IPC implementation varied: some anticipated reduced implementation due to the desire to return to the pre-pandemic standard, while others expected IPC to be structurally scaled up during seasonal respiratory epidemics. Main contextual challenges included patient cooperation, staff shortages (due to infection), shortages of IPC materials/equipment, and frequently changing and ambiguous guidelines. Key lessons learned were enhanced preparedness (e.g., personal protective equipment supply), and a new perspective on care organisation (e.g., digital care). Main recommendations reported by HCWs were to strengthen regional collaboration within primary care, and between primary care, public health, and secondary care.

CONCLUSION

HCWs' experiences, perspectives and recommendations provide insights to enhance preparedness for future epidemics and pandemics, and sustain IPC in general practices. For IPC improvement strategies, adopting an integrated system-based approach that encompasses actions across multiple levels and engages multiple stakeholders is recommended.

Exercise and diet support in breast and prostate cancer survivors: findings from focus groups

PURPOSE

Cancer survival is improving, making optimal management of long-term treatment-related adverse effects increasingly important. Exercise and a healthy diet are beneficial and regularly recommended in cancer survivorship guidelines; however, few cancer survivors meet these recommendations so there is a need to explore why. This study aimed to understand experiences receiving exercise and diet support among Australian breast and prostate cancer survivors during and following treatment, and to explore what support they would like to receive.

METHODS

Adults who completed active treatment for breast or prostate cancer were recruited via a private cancer care centre. Using a qualitative descriptive study design, participants attended in-person focus groups that were recorded, transcribed, then analysed using reflexive thematic analysis.

RESULTS

In total, 26 cancer survivors (15 breast, 11 prostate) participated in one of seven focus groups (4 breast, 3 prostate). Two themes were developed: 1) It was just brushed over, and 2) Wanting more. Theme 1 reports that exercise, and especially diet, were rarely discussed. If they were, it was often limited to general recommendations. Theme 2 shows that participants wanted more specific and personalised support, and information about how exercise and/or diet could benefit their cancer treatment.

CONCLUSION

Despite strong interest in receiving personalised exercise and diet support, neither are routinely provided to Western Australian breast and prostate cancer survivors. If support was provided, there was inconsistency in the level and type of support provided. These findings identify important gaps in exercise and diet support provision to cancer survivors and will inform future strategies aiming to improve cancer survivorship care.

Compounding stress: A mixed-methods study on the psychological experience of miscarriage amid the COVID-19 pandemic

BACKGROUND

Experiencing a miscarriage can have profound psychological implications, and the added strain of the COVID-19 pandemic may have compounded these effects. This study aimed to explore the psychological experiences, assess the levels of psychological distress (depression, anxiety, and post-traumatic stress disorder), and examine the relationships of personal significance of miscarriage and perceived stress with psychological distress of women in North Carolina who suffered a miscarriage of a desired pregnancy between March 30, 2020, and February 24, 2021, of the COVID-19 pandemic, at 14 to 31 months after the loss.

METHODS

We conducted a cross-sectional mixed-methods study using a convergent parallel design. A total of 71 participants from North Carolina completed the online survey and 18 completed in-depth interviews. The survey assessed demographics, mental health and reproductive history, personal significance of miscarriage, perceived stress, anxiety, depression, and PTSD. Interview questions asked about the psychological experience of the miscarriage and how the COVID-19 pandemic affected them and their experience.

RESULTS

Findings indicated moderate to severe levels of depression, anxiety, and PTSD, which persisted 14 to 31 months post-miscarriage. After conducting hierarchical binary logistic regressions, we found that perceived stress and prior trauma increased the odds of depression, perceived stress increased the odds of anxiety, and personal significance and prior trauma increased the odds of PTSD symptoms 14-31 months post-miscarriage. Notably, a subsequent successful childbirth emerged as a protective factor against depression, anxiety, and PTSD. Qualitative findings depicted emotions such as profound isolation, guilt, and grief. Women noted that additional pandemic-specific stressors exacerbated their distress. The categories identified via conventional content analysis fell under five broader thematic groups: mental health disorders, negative emotions/feelings, positive emotions/feelings, thoughts, and other experiences.

CONCLUSIONS

Miscarriage during the COVID-19 pandemic intensified and added complexity to the psychological distress experienced by affected women. The study underscores the need for comprehensive mental health screenings, specialized support for vulnerable groups, and the necessity of trauma-informed care. Providers are strongly encouraged to adopt a multifaceted, individualized approach to patient care that is cognizant of the unique stressors introduced by the pandemic.

Treatment trajectories of individuals diagnosed with rectal cancer: an interpretative phenomenological study

Rectal cancer affects almost every aspect of an individual's daily life. However, there are gaps in understanding the complete spectrum of experiences spanning from diagnosis to recovery. Therefore, the aim of this study was to explore the treatment trajectories of individuals diagnosed with rectal cancer. Adopting an interpretative phenomenological approach, seven participants were recruited using purposive sampling. Data were collected using semi-structured, in-depth interviews that were digitally recorded, transcribed and analysed using thematic analysis. Study rigour was established following the four-dimension criteria of credibility, dependability, transferability and confirmability. Four prominent themes emerged from the participants' experiences of undergoing rectal cancer treatment: uncovering the inner battles; navigating the physical challenges; anchors of support and conquering the summit. These findings contribute to knowledge and practice by highlighting the importance of providing a comprehensive and individualised treatment plan for individuals that takes account of the physical and psycho-emotional implications of rectal cancer treatment.

Allied health professionals' views on important outcomes of children's elective lower limb orthopaedic surgery: a qualitative interview study to inform a core outcome set

PURPOSE

A common methodological limitation of research that guides surgical procedure selection for children's elective lower limb orthopaedic surgeries is inconsistent outcome selection. Improving outcome consistency can be achieved through the development of a core outcome set (COS). The aim of this study is to identify which outcomes are considered important for children's elective lower limb orthopaedic surgeries by allied health professionals (AHPs) and explore why they select these outcomes, to inform a COS development project.

METHODS

Online semi-structured interviews were conducted with relevant AHPs. Participants were selected using maximum variation purposive sampling; selection was based on profession and inpatient/outpatient role. The data set was analysed using an inductive and deductive approach to thematic analysis.

RESULTS

Four physiotherapists, three orthotists, three prosthetists, and two occupational therapists were interviewed. Most identified outcomes of importance related to "activities and participation". From the data, we conceptualised that AHPs with effective multidisciplinary communication focused on child-centred outcomes, while clinicians with limited multidisciplinary teamwork focused on role-based outcomes.

CONCLUSIONS

There is concurrence between outcomes identified as important in this study, and other qualitative studies in similar populations. These important outcomes were seldom measured in previous studies or in routine clinical practice.Implications for rehabilitationAllied health professionals (AHPs) prioritise activity and participation outcomes after children's elective lower limb orthopaedic surgery.It is important to the rehabilitation of children after elective lower limb orthopaedic surgery that all involved AHPs collaborate with the wider multidisciplinary team.Multidisciplinary team communication encourages collaborative outcome identification, and discourages role defined outcome focus.

Experience of decision-making for home breech birth: An interpretive description

Despite research and recommendations supporting shared decision-making and vaginal birth as a reasonable option for appropriately screened candidates with a term breech pregnancy, cesarean remains the only mode of birth available in most hospitals in the United States. Unable to find care for planned vaginal birth in a hospital setting, some individuals choose to pursue breech birth at home, potentially placing themselves and their infants at increased risk. Through this analysis of qualitative data gathered from a mixed methods study, we explored the experience of decision-making of 25 individuals who left the US hospital system to pursue a home breech birth. Data were gathered through open-ended survey responses (n = 25) and subsequent in-depth, semi-structured interviews (n = 23) and analyzed using an interpretive description approach informed by situational analysis. Five interwoven and dynamic themes were identified in this complex decision-making process: valuing and trusting in normal birth, being "backed into a corner," asserting agency, making an informed choice, and drawing strength from the experience. This study provides a foundation for understanding the experience of decision-making and can inform future research and clinical practice to improve the provision of safe and respectful, person-centered care for breech pregnancy and birth.

"I'm telling you my story, not publishing a blog": Considerations and suggestions on data sharing in qualitative health psychology research on sensitive topics

Qualitative research plays a pivotal role in health psychology, offering insights into the intricacies of health-related issues. However, the specificity of qualitative methodology presents challenges in adhering to standard open science principles, including data sharing. The guidelines to address these issues are limited. Drawing from the author's experience in conducting in-depth interviews with middle-aged and older adults regarding their sexuality, this article discusses various challenges in implementing data sharing requirements. It emphasizes factors like participants' reasonable reluctance to share in specific populations, the depth of personal information gleaned from comprehensive interviews, concerns surrounding potential data misuse both within and outside academic circles, and the complex issue of obtaining informed consent. A universal approach to data sharing in qualitative research proves impractical, emphasizing the necessity for adaptable, context-specific guidelines that acknowledge the methodology's nuances. Striking a balance between transparency and ethical responsibility requires tailored strategies and thoughtful consideration.

Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk

BACKGROUND

Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone.

METHODS

In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework.

RESULTS

Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk.

CONCLUSION

Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.

Severe malaria-related disability in Ethiopian children from the perspectives of caregivers: an interpretive description study

PURPOSE

This study explored severe malaria-related disability in children from the perspectives of their caregivers.

MATERIALS AND METHODS

The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child's history of severe malaria, age (0-10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors' review, trustworthiness was enhanced.

RESULTS

The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework.

CONCLUSIONS

The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods.IMPLICATIONS FOR REHABILITATIONVarious contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created.The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria.Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability.Rehabilitation interventions for children with severe malaria-related disability should consider patient- or caregiver-reported outcomes (components of disability).

Diverting Food Waste From Landfill in Exemplar Hospital Foodservices: A Qualitative Study

BACKGROUND

The US Environmental Protection Agency Food Recovery Hierarchy suggests methods for diverting food waste from landfill. Knowledge of how hospital foodservices implement food waste management strategies could help modernize food waste practices.

OBJECTIVE

The aim of this study was to explore hospital staff members' experiences of implementing a food waste management strategy to divert food waste from landfill in their hospital foodservice, including the journey, challenges, and facilitators of this practice change.

DESIGN

A qualitative study was conducted in 2022-2023 using semi-structured interviews.

PARTICIPANTS/SETTING

Eighteen participants were staff members with knowledge of the food waste management strategy from 14 exemplar hospitals in United States, Spain, Scotland, and Australia using strategies to divert food waste from landfill within the last 10 years.

ANALYSES PERFORMED

Mapping and thematic analysis were undertaken to code and identify themes from the interviews that described staff members' experiences of the journey to implement the strategy.

RESULTS

Six hospitals donated food, 1 transferred food waste for animal feed, 4 used an industrial solution, and 3 sent food waste for composting. A common journey pathway for successful implementation was identified from participants' experiences. It features the following 6 phases: idea, preparation, roll out, maintenance, established practice, and evolution. Facilitators included legislation, enthusiastic staff members, executive support, and "luck." Challenges were smells, occasions when food waste was not collected, equipment breakage, and funding depletion.

CONCLUSIONS

This study identified a common journey pathway for implementing a food waste management strategy in hospital foodservices that can be used to anticipate and prepare for the steps in the implementation process.

Evaluation of the Parkinson's Remote Interactive Monitoring System in a Clinical Setting: Usability Study

BACKGROUND

The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient's symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient's condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson's Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely.

OBJECTIVE

We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting.

METHODS

Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics.

RESULTS

In total, 11 people with PD participated in the study (female individuals: n=5, 45%; male individuals: n=6, 55%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer's notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant's orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants' perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70.

CONCLUSIONS

Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients' needs.

A qualitative exploration of health care workers' approaches to relational harm reduction in HIV primary care settings

BACKGROUND

Structural harm reduction is an approach to care for people who use drugs (PWUD) that incorporates services and resources (e.g., naloxone, sterile syringes). As conceptualized in our previous research, harm reduction is also "relational," encompassing a patient-provider relationship that is non-judgmental and respectful of patients' autonomy. Little is known about health care workers' (HCW) knowledge or attitudes towards harm reduction beyond structural strategies, whose availability and legality vary across geographical settings. To operationalize how relational harm reduction is both characterized and employed in HIV care settings, where nearly half of patients have a diagnosed substance use disorder, we qualitatively explored HCWs' knowledge of and use of harm reduction via individual in-depth interviews.

METHODS

Our study sample included three HIV clinics, one in Birmingham, Alabama (AL) and two in Pittsburgh, Pennsylvania (PA). We conducted individual interviews with n = 23 health care workers via Zoom, using a semi-structured interview guide to probe for questions around health care workers' attitudes towards and experiences with providing care to PWH who use drugs and their knowledge of and attitudes towards relational and structural harm reduction. Data was analyzed in Dedoose using thematic analysis.

RESULTS

Qualitative analyses revealed two primary themes, Continuum of Relational Harm Reduction in Practice and Limited Harm Reduction Training. Nearly all HCWs (n = 19, 83%) described a patient interaction or expressed a sentiment that corresponded with the principles of relational harm reduction. Yet, over half of participants (n = 14, 61%) used language to describe PWH who use drugs that was stigmatizing or described an interaction that was antithetical to the principles of relational harm reduction. Five HCWs, all from Birmingham, were unaware of the term 'harm reduction.' Few HCWs had any harm reduction training, with most learning about harm reduction from webinars/conferences or on the job.

CONCLUSION

Our findings suggest that relational harm reduction in HIV care settings is practiced along a continuum, and that a range of behaviors exist even within individual HCWs (e.g., used stigmatizing terms such as "addict" but also described patient interactions that reflected patients' autonomy). Given that harm reduction is typically described as a structural approach, a broader definition of harm reduction that is not dependent on policy-dependent resources is needed.

"God is going to help me get through this": spirituality perspectives from Hispanic adolescent and young adult cancer survivors

PURPOSE

Describe spirituality's role in a sample of Hispanic adolescent and young adult (AYA) cancer survivors.

METHODS

This phenomenology-informed convergent parallel mixed-methods study aimed to explore participants' lived experiences with hope during cancer treatments and cancer survivorship. A purposive sample of Hispanic AYAs who completed cancer treatments 2-5 years ago were virtually recruited for participation. Participants completed virtual semi-structured interviews about their experiences with hope during cancer treatments and cancer survivorship and prepared narratives about their experiences. Thematic analyses were iteratively performed across the data set to identify final themes.

RESULTS

Ten Hispanic AYA cancer survivors (mean age 30.2, SD = 4.5) years participated in this pilot study. Seven participants (70%) were female, and three participants (30%) were male. Six participants (60%) experienced non-hematologic malignancies, and four participants (40%) experienced hematologic malignancies. Eight (80%) participants' language preference was Spanish, while two (20%) participants' language preference was English. The theme spirituality and subthemes living by faith, god as a resource, and spiritual gratitude were identified as concepts participants linked to their conceptualization of hope during cancer treatment and survivorship.

CONCLUSIONS

Hope and spirituality may be conceptually linked to coping behaviors among Hispanic AYA cancer survivors. Hope through faith may be a learned spiritual value in Hispanic AYAs and might play a role in their spiritual and cognitive development. Further research is needed to explore the potentially protective value of hope and spirituality for the Hispanic AYA population.