Methodological Aspects of Focus Groups in Health Research: Results of Qualitative Interviews With Focus Group Moderators

Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members

BACKGROUND

Oncology healthcare professionals (HCPs), particularly nurses, experience moral distress. However, little is known about the impact of moral distress on oncology teams.

OBJECTIVES

The purpose of this study was to describe moral distress as it is experienced by oncology teams in practice.

METHODS

32 oncology team members participated in eight focus groups. Content analysis was used to identify key themes. Two investigators collaboratively analyzed the data, and findings were independently reviewed by two additional investigators.

FINDINGS

The following six themes emerged.

Expectations and Perceptions of Dutch Pharmacy Staff Regarding a New Framework for Continence Care: A Focus Group Study

Based on complaints that patients with urinary incontinence were not receiving the correct medical aids, the Dutch Ministry of Health, Wellbeing, and Sports requested further exploration. This resulted in a new framework based on considering individual activities of daily living when providing continence products. We aimed to explore the expectations of pharmacy staff regarding this new framework for continence care in the Netherlands and to establish the facilitators and barriers associated with that care. In total, 15 participants from 7 different pharmacies participated in 2 focus groups. Data analysis was by thematic content analysis. Pharmacy employees were positive about the idea of considering individual daily activities when providing continence products in the new framework, but they did have some reservations about the feasibility of implementation in daily practice. Barriers to optimal continence care included low reimbursement for patients with incontinence, especially with non-standard needs, and poor communication between the various stakeholders in continence care. Efforts must be extended to review the current reimbursement system and to change the policies and information provided by stakeholders in continence care, before the new framework will make a real impact in clinical practice.

Exploring the perspectives of key stakeholders on the design and delivery of an intervention to rehabilitate people with cognitive deficits post-stroke

Background: Stroke is a leading cause of death and disability worldwide. Cognitive impairment is common post-stroke and can result in negative sequalae such as a lower quality of life, increased carer burden and increased healthcare costs. Despite the prevalence and associated burden of post-stroke cognitive impairment, there is uncertainty regarding the optimum intervention to improve cognitive function post-stroke. By exploring the perspectives of people post-stroke, carers and healthcare professionals on cognitive impairment, this qualitative study aims to inform the design and development of an intervention to rehabilitate cognitive impairment post-stroke. Methods: A qualitative descriptive approach will be applied, using semi-structured interviews with people post-stroke, carers and healthcare professionals. People post-stroke will be recruited via gatekeepers from a local stroke support group and Headway, a brain injury support service. Carers will be recruited via a gatekeeper from a local carers branch. Healthcare professionals will be recruited via gatekeepers from relevant neurological sites and via Twitter. The final number of participants recruited will be guided by information power. Data will be collectively analysed and synthesised using thematic analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines will be used to standardize the conduct and reporting of the research. Conclusions: It is anticipated that exploring the perspectives of people post-stroke, carers and healthcare professionals on cognitive impairment post-stroke will inform the development of an evidence-based optimal intervention to rehabilitate cognitive deficits post-stroke. This study was granted ethical approval from the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. Study findings will be disseminated locally through presentations at stroke support groups, as well as internationally through academic conferences and peer-reviewed journals.

A study protocol of qualitative data sharing practices in clinical trials in the UK and Ireland: towards the production of good practice guidance

Background: Data sharing enables researchers to conduct novel research with previously collected data sets, thus maximising scientific findings and cost effectiveness, and reducing research waste. The value of sharing anonymised data from clinical trials is well recognised with a moderated access approach recommended. While substantial challenges to data sharing remain, there are additional challenges for qualitative data. Qualitative data including videos, interviews, and observations are often more readily identifiable than quantitative data. Existing guidance from UK Economic and Social Research Council applies to sharing qualitative data but does not address the additional challenges related to sharing qualitative data collected within trials, including the need to incorporate the necessary information and consent into already complex recruitment processes, with the additional sensitive nature of health-related data. Methods: Work package 1 will involve separate focus group interviews with members of each stakeholder group: trial managers, clinical trialists, qualitative researchers, members of research funding bodies and trial participants who have been involved in qualitative research. Data will be analysed using thematic analysis and managed within QSR NVivo to enhance transparency. Work package 2 will involve a documentary analysis of current consent procedures for qualitative data collected as part of the conduct of clinical trials. We will include documents such as participant information leaflets and consent forms for the qualitative components in trials. We will extract data such as whether specific clauses for data sharing are included in the consent form. Content analysis will be used to analyse whether and how consent is being obtained for qualitative data sharing. Conclusions: This study will provide insight into the existing practice of sharing of qualitative data in clinical trials and the current issues and opportunities, to help shape future research and development of guidance to encourage maximum learning to be gained from this valuable data.

Healthcare professionals' experiences with highly qualified nurses working in acute care teams in primary healthcare settings

OBJECTIVE

Strengthening primary healthcare with highly qualified nurses in acute care units or teams is a new Danish initiative intended to detect acute diseases and the deterioration of chronic diseases and to develop treatment for outpatients. This study explores healthcare professionals' experiences with this initiative.

DESIGN

Qualitative semi-structured interviews conducted in 2019-2020. Analysis was conducted with a systematic text condensation.

SETTING

This study is based on an acute care team in one Danish municipality called Acute Team Odense (ATO). ATO delivers acute nursing in patients' own homes (including nursing homes) in collaboration with different healthcare professionals.

SUBJECTS

Individual interviews with general practitioners (GPs) (n = 15), five focus-group interviews with nurses and nursing assistants from the municipality (n = 19) and one focus-group interview with staff from the emergency department (ED) (n = 10).

MAIN OUTCOMES

Experiences of different healthcare professionals' experiences with ATO.

RESULTS

In general, all of the participants were very satisfied with the new acute care team and the cross-sectorial possibilities. The GPs usually referred ATO to assessments in which paraclinical equipment, competencies, accessibility, response time and communication were important. The municipal nurses and nursing assistants tended to use ATO if they needed second opinions or acute nurse assistance. The ED most often used ATO to assist with intravenous therapy after an ED visit. All participants reported that ATO increased what could be assessed and treated in patients' homes, which is central to preventing unnecessary hospitalisations.

CONCLUSIONS

ATO created new possibilities in patient's homes which potentially might prevent unnecessary hospitalisations.KEY POINTSAcute care units or teams are mandatory in Danish health care, but limited knowledge in the area is found.Healthcare professionals found that the acute care teams provided new possibilities to assess and treat patients in their own homes.Healthcare professionals experienced that the acute care team potentially prevented hospitalisations by fast clinical nurse assessments with paraclinical tests.

A cross-country qualitative study on contraceptive method mix: contraceptive decisionmaking among youth

Background

Youth ages 15 to 24, who comprise a large portion of sub-Saharan Africa, face a higher burden of unmet contraceptive need than adults. Despite increased international and national commitments to improving young people’s access to contraception, significant barriers impede their access to a full range of methods. To further explore these barriers among youth in Kenya, Nigeria, and Uganda, we conducted a qualitative study to capture the challenges that affect contraceptive method decisionmaking and complicate youth access to the full method mix.

Methods

To understand factors that impact young people’s contraceptive decisionmaking process across all three countries, we conducted a total of 35 focus group discussions with 171 youth ages 15 to 24 and 130 in-depth interviews with key stakeholders working in youth family planning. Questionnaires aligned with the High Impact Practices in Family Planning’s elements of adolescent-friendly contraceptive services. Data were coded with MAXQDA and analyzed using a framework for contraceptive decisionmaking to identify relevant patterns and themes.

Results

In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms, complicating their ability to take full advantage of other available methods. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, and only a few youth reported that they are completely unable to access contraceptives, other barriers still present a major deterrent for youth, including cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers.

Conclusions

Young people’s ability to fully exercise their method choice remains limited despite availability of services, leading them to take the path of least resistance. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01160-5.

Despite increased international and national commitments to improving young people’s access to contraception, youth ages 15 to 24 face significant barriers to accessing a full range of contraceptive methods. This study conducted in-depth interviews with key stakeholders and focus group discussions with youth in Kenya, Nigeria, and Uganda to understand what factors impact youth’s decision to use or not use certain contraceptive methods. In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, other barriers like cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers still present a major deterrent for youth who want information on contraceptive methods. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.

Nurses' experience of caring for people living with HIV: a focused ethnography

BACKGROUND

Healthcare providers have been found to have limited knowledge and skills in interacting with people living with HIV. These factors can adversely affect providers' practice, jeopardize their safety and compromise the care of the patients.

AIMS

This study aimed to explore the experiences of Iranian nurses who were caring for patients with HIV.

METHODS

A focused ethnography approach was used. Participants consisted of 12 nurses working in teaching hospitals affiliated to Urmia University of Medical Sciences and recruited by purposeful sampling. Semi-structured interviews, field observations and field notes were used for data collection. Data were analysed employing content analysis.

FINDINGS

Three main themes emerged from the analysis of the participants' experiences of providing care to patients with HIV: 'excessive fear of being infected', 'concerns about the possible consequences' and 'lack of self-confidence in care provision'.

DISCUSSION/CONCLUSION

Nurses have experienced a great deal of fear of self and cross-contamination when providing care to people living with HIV. Social stigma and discrimination against people living with HIV amplified the nurses' experience of fear. Providing appropriate education and training for nurses can improve their attitudes, emotions and self-confidence while providing care to such people and increasing the quality of care provided.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Planning more educational programmes focusing on improving their misunderstandings about HIV could result in positive outcomes: for nurses to provide high-quality care and for people living with HIV who receive this care. The healthcare system should consider the culture of care provided by nurses to these people.

A study protocol of qualitative data sharing practices in clinical trials in the UK and Ireland: towards the production of good practice guidance

Background: Data sharing enables researchers to conduct novel research with previously collected data sets, thus maximising scientific findings and cost effectiveness, and reducing research waste. The value of sharing anonymised data from clinical trials is well recognised with a moderated access approach recommended. While substantial challenges to data sharing remain, there are additional challenges for qualitative data. Qualitative data including videos, interviews, and observations are often more readily identifiable than quantitative data. Existing guidance from UK Economic and Social Research Council applies to sharing qualitative data but does not address the additional challenges related to sharing qualitative data collected within trials, including the need to incorporate the necessary information and consent into already complex recruitment processes, with the additional sensitive nature of health-related data. Methods: Work package 1 will involve separate focus group interviews with members of each stakeholder group: trial managers, clinical trialists, qualitative researchers, members of research funding bodies and trial participants who have been involved in qualitative research. Data will be analysed using thematic analysis and managed within QSR NVivo to enhance transparency. Work package 2 will involve a documentary analysis of current consent procedures for qualitative data collected as part of the conduct of clinical trials. We will include documents such as participant information leaflets and consent forms for the qualitative components in trials. We will extract data such as whether specific clauses for data sharing are included in the consent form. Content analysis will be used to analyse whether and how consent is being obtained for qualitative data sharing. Conclusions: This study will provide insight into the existing practice of sharing of qualitative data in clinical trials and the current issues and opportunities, to help shape future research and development of guidance to encourage maximum learning to be gained from this valuable data.

Graduates' perceptions of the role and availability of career guidance at medical school

BACKGROUND

Very limited research has investigated the extent or the impact of career guidance provided to medical students.

AIMS

We aimed to explore the perceptions of recent graduates of Irish medical schools of the availability, accessibility and utility of both formal and informal career advice resources during their university experience.

METHODS

The study population was junior doctors in their first postgraduate year. Both an online questionnaire, distributed nationally, and a focus group were conducted to explore the topic via mixed-methods research methodology. Findings were synthesised, with quantitative and qualitative analysis applied as appropriate.

RESULTS

Graduates of all medical schools within Ireland were invited to participate in the survey. Questionnaire responses were received from 117 junior doctors enrolled in intern networks across the country, from a potential population of 580 (response rate 20.2%). Five interns participated in the focus group discussion. The existence of a formal career advice programme at medical school was reported by 10.3% of questionnaire participants (12/117). Fifty-three per cent (62/117) did not recall any career advice sessions being organised by their university. Only 7.7% (9/117) perceived that adequate career advice had been available at medical school. Focus group participants reiterated a lack of career guidance but highlighted the importance of authentic clinical exposure to a specialty to complement guidance programmes.

CONCLUSIONS

Career guidance at medical school is sparse, and recent graduates feel this should be improved upon.

Faculty's attitudes and perceptions related to applying motivational principles to their teaching: a mixed methods study

BACKGROUND

It is uncommon for faculty development professionals to assess faculty attitudes towards their teaching responsibilities and their perceived obstacles to teaching effectiveness. The purposes of this study were (a) to document faculty attitudes and practices related to applying motivation principles, and (b) to identify the perceived contextual factors that may shape these attitudes and practices.

METHODS

A sequential explanatory mixed methods design was used. Faculty members (n = 272; 32% response rate) were surveyed about their responsibility for and application of the five motivational principles that are part of the MUSIC Model of Motivation: eMpowerment, Usefulness, Success, Interest, and Caring. Repeated measures ANOVAs and Student's t-tests were computed to detect differences. Subsequently, two focus groups of faculty members (n = 11) interpreted the survey results. We conducted a thematic analysis and used the focus group results to explain the survey results.

RESULTS

Faculty rated their responsibilities for applying principles related to Usefulness, Interest, and Caring significantly higher than they did for Success and eMpowerment. Most faculty also reported that they actually applied Usefulness, Interest, and Caring strategies within the past year, whereas over half of the faculty applied Success strategies and about a third of faculty applied eMpowerment strategies. Focus group participants identified factors that affected their ability to apply eMpowerment strategies, (e.g., offering choices), including students lacking generic skills (e.g., critical thinking, problem-solving), a lack of confidence in their abilities to implement empowering strategies and meet the needs of students, passive students, and large lecture-type courses. Focus group participants cited obstacles to implementing Success strategies (e.g., providing feedback), including difficulty in providing feedback in large courses, lacking time and assistant teachers, limited knowledge of technologies, and lacking skills related to guiding effective student peer feedback.

CONCLUSIONS

Faculty appear adequately prepared to implement some types of motivational strategies, but not others, in part due to contextual factors that can influence their attitudes and, ultimately, their application of these strategies. We discuss how these factors affect attitudes and application of motivational strategies and formulate suggestions based on the results.

"You Cannot Catch Fish Near the Shore nor Can You Sell Fish Where There Are No Customers": Rethinking Approaches for Reaching Men With HIV Testing Services in Blantyre Malawi

HIV testing is the entry point to the cascade of services within HIV care. Although Malawi has made positive strides in HIV testing, men are lagging at 65.5% while women are at 81.6%. This study explored the preferences of men on the avenues for HIV testing in Blantyre, Malawi. This was a descriptive qualitative study in the phenomenological tradition in seven public health facilities in Blantyre, Malawi, among men and health-care workers (HCWs). We conducted 20 in-depth interviews and held 14 focus group discussions among 113 men of varying HIV statuses. All our participants were purposively selected, and data were digitally recorded coded and managed through NVivo. Thematic analysis was guided by the differentiated service delivery model. Men reported a preference for formal and informal workplaces such as markets and other casual employment sites; social places like football pitches, bars, churches, and "bawo" spaces; and outreach services in the form of weekend door-to-door, mobile clinics, men-to-men group. The health facility was the least preferred avenue. The key to testing men for HIV is finding them where they are. Areas that can be leveraged in reaching men are outside the routine health system. Scaling up HIV testing among men will require targeting avenues and operations outside of the routine health system and leverage them to reach more men with services. This suggests that HIV testing and counseling (HTC) uptake among men may be increased if the services were provided at informal places.

Stakeholder Perspectives in Anticipation of Sharing Physicians' Notes With Parents of Hospitalized Children

OBJECTIVE

Elicit stakeholder perspectives on the anticipated benefits and challenges of sharing hospital physicians' admission and daily progress notes with parents at the bedside during their child's hospitalization and identify strategies to aid implementation of inpatient note sharing.

METHODS

Five semistructured focus groups were conducted with 34 stakeholders (8 parents, 8 nurses, 5 residents, 7 hospitalists, 6 administrators) at a tertiary children's hospital from October to November 2018 to identify anticipated benefits, challenges, and implementation strategies prior to sharing inpatient physicians' notes. A facilitator guide elicited participants' perspectives about the idea of sharing notes with parents during their child's hospitalization. Three researchers used content analysis to analyze qualitative data inductively.

RESULTS

Anticipated benefits of sharing inpatient notes included: Reinforcement of information, improved parental knowledge and empowerment, enhanced parent communication and partnership with providers, and increased provider accountability and documentation quality. Expected challenges included: Increased provider workload, heightened parental confusion, distress or anxiety, impaired parent relationship with providers, and compromised note quality and purpose. Suggested implementation strategies included: Setting staff and parent expectations upfront, providing tools to support parent education, and limiting shared note content and family eligibility.

CONCLUSIONS

Stakeholders anticipated multiple benefits and drawbacks of sharing notes with parents during their child's hospital stay and made practical suggestions for ways to implement inpatient note sharing to promote these benefits and mitigate challenges. Findings will inform the design and implementation of an intervention to share notes using an inpatient portal and evaluation of its effect on child, parent, and healthcare team outcomes.

Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

Background

Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics.

Methods

We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA.

Results

The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient’s values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients’ perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation.

Conclusions

We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.

The Great Gamble? A Mixed-Methods Study of Factors In˜fluencing Medical Students in Specialty Choice

BACKGROUND

Career planning remains relatively unexplored as a domain of medical education. Our aim was to explore the career planning journey undertaken by medical students. Results Approximately one third of participants had decided their future specialty. Important factors in career choice were 'interest in specific [specialty] aspects,' 'work-life balance,' 'personality type' of others in the specialty, an enjoyable experience on rotation and role models. Negative influential factors included poor conduct of doctors encountered and negative portrayals of specialities by practicing doctors. Conclusion The undergraduate and early postgraduate periods are formative times in career planning for junior doctors. Students and interns/FY1s are strongly influenced by doctors in the clinical setting, and clinicians should be aware of this power to exert both positive and negative influence.

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents

INTRODUCTION

Although clinical leadership in physicians is associated with improved healthcare, leadership training is rarely integrated into residency training. Our objective was to perform a comprehensive needs assessment of our pediatric residents' existing leadership experiences and knowledge and to identify training gaps within our program.

METHODS

First, we held focus groups with senior pediatric residents to understand their clinical leadership experiences and identify training needs. Notes were transcribed and independently coded by 2 researchers, with thematic saturation achieved. Next, we focused each session on 1 leadership content area identified from the aforementioned themes to better understand the specific training needs for each topic.

RESULTS

Four major themes were identified: (1) Effective and timely communication with supervisors, learners, ancillary staff, and patients is indispensable in promoting safe patient care, avoiding conflict, and preventing misunderstanding. (2) Training in teaching methods is desired, especially gaining the skills needed to teach various levels of learners, in different settings and under time constraints. (3) Time management, availability of resources, and team logistics were often learned through trial-and-error. (4) Self-care, self-acceptance, emotional regulation, and peer debriefing are relied upon to manage negative emotions; rarely are resilience and wellness strategies employed in "real-time."

CONCLUSION

Senior residents currently face gaps in clinical leadership training and may benefit from additional instruction in content areas related to these 4 themes. Our next steps are to utilize the identified themes to develop a longitudinal and skills-based clinical leadership curriculum to address the gap in graduate medical education.

Innovative Medical Technology and the Treatment Decision-Making Process in Multiple Sclerosis: A Focus Group Study to Examine Patient Perspectives

BACKGROUND

Disease-modifying therapies are given to people with multiple sclerosis (MS) to reduce disease progression and relapse frequency. Current modes of administration include oral, injectable and infusion therapy and the treatment decision-making process is complex. A novel mode of treatment administration, an implantable device, is currently under development, yet patient attitudes about the device are unknown. The aim of this study was 1) to understand the treatment decision-making process from the patient perspective and 2) to explore the possible acceptance of an implant to treat MS.

METHODS

Focus groups with people with MS were conducted in the Netherlands. Three topics were addressed: the treatment decision-making process, the current treatment landscape, and attitudes about the implantable device. All focus groups were recorded and transcribed and data were analyzed by raw data coding and creating themes. An online survey was conducted in the Netherlands to quantify interest in an implant.

RESULTS

Two focus group sessions were held (n=16 participants) and n=93 persons filled out the survey. The main theme that emerged was the constant uncertainty persons with MS face throughout their disease course and during treatment decisions (when to start, stop, continue or switch treatment). Patients were generally positive towards the implant but felt that efficacy and safety should be guaranteed.

CONCLUSION

People with MS want some form of control over their disease and treatment course. New medical technologies, such as an implant, may enhance the treatment landscape and with caution we postulate that it may be accepted by patients as a new mode of administration, though further research is needed. For medical technologies to be successful, patients should be engaged early on in the design process.

"I was raped by the broker on the first day of my arrival in the town." Exploring reasons for risky sexual behavior among sexually-active unmarried young female internal migrants in Ethiopia: A qualitative study

BACKGROUND

Studies revealed that internal migrants are one of the most vulnerable groups for poor sexual and reproductive health (SRH) information and services. Risky sexual behavior (RSB) is a threat to public health and might lead to serious health problems such as unintended pregnancy, abortion, and sexually transmitted infections (STIs) including HIV/AIDS. The reported prevalence of RSB among young female internal migrants in Ethiopia was as high as 70.3%. This requires in-depth understanding of the underlying cause. So, this study aimed at exploring reasons for RSB among sexually-active unmarried young female migrants in Ethiopia.

METHODS

A descriptive qualitative study was conducted using focus group discussions among sexually-active young female migrants working Burayu town. The focus group discussions were done in the local languages of participants (Afaan Oromo and Amharic). The recorded data were transcribed verbatim and translated into English for analysis and presentation in the study. The data were coded and Atlas.ti 7.5 software packages were used for data analyses. Then, the findings were thematically organized and analyzed using content analysis.

RESULTS

This study revealed that poor socio-economic status, social media indulgence, rape, substance use, poor knowledge of condom use, unfavorable attitude toward condom use, misconceptions about emergency pills, and the nature of the new environment and work place were responsible for RSB among internal migrants. The participants described that the migrants' economic conditions and workplace sexual violence are pushing them toward engaging in unprotected sex, being sexually abused, commercial sex, and transactional sex.

CONCLUSIONS

Internal migrants' sexual behavior is a complex process influenced by multiple interrelating systems. We have explored a set of factors namely poverty, pressure and sexual abuse from brokers, sexual exploitation and abuses against domestic workers by their bosses, indulgence in social media, sexting, inadequate knowledge, and unfavorable attitude toward condom use that led young female internal migrants to risky sexual practices. An intervention to promote safe sex targeted to this population is urgently needed with a focus on an intervention to eliminate misconceptions about condoms, increase proper condom use, and end sexual violence. Moreover, a relevant policy is needed to safeguard internal migrants from sexual exploitation and abuses at their work place.

The needs of key-stakeholders for evaluating client's experienced quality of home care: a qualitative approach

BACKGROUND

To optimize home care, it is essential to determine how care recipients experience quality of care. Traditionally, quality of care is measured with normative quality indicators such as safety, efficiency, or prevalence rates such as falls. The growing interest for qualitative patient-reported experience measures in home care requires insight into the needs of care receivers, providers, and organizations as key-stakeholders. Each stakeholder has their own needs that are important to communicate and use to conduct thorough comparisons before implementing new experience measures. This study aims to understand the needs of clients, formal/informal caregivers, and managers/policy officers in measuring client's experienced quality of care in home care.

METHODS

Four focus group interviews and 25 semi-structured interviews with key-stakeholders were conducted and analyzed by means of content analysis. The value-proposition canvas was used as a thematic framework to explore the purpose of experience quality of care measures and related pains and gains.

RESULTS

There were two main purposes for measuring experienced quality of care: first improving the primary care process of individual clients and second for learning and improving in home care team. Using experienced quality of care measures for external accountability and transparency on an organizational or national level were considered less relevant. Among others, participants described not having time and no clear procedure for conducting an evaluation as a pain of the current methods used to evaluate perceived quality of home care. As gains they put forward the ability to informally evaluate experiences during care delivery and to openly discuss complaints with a familiar caregiver.

CONCLUSIONS

This study advocates that home care organizations should be aware of the goal of quality of care measures. They should consider selecting experienced quality of care measures mainly for improving primary care processes of individual clients. The results also underline the relevance of adopting next to quantitative evaluations, more narrative evaluation methods which support communicating openly on care experiences, leading to concrete point-of-improvement. The findings of this study can serve as a guide for both the development or selection of adequate methods, from the perspectives of key-stakeholders, in assessing experienced quality in home care.

Adaptation and qualitative evaluation of Ask 3 Questions - a simple and generic intervention to foster patient empowerment

BACKGROUND

Patients are often not actively engaged in medical encounters. Short interventions like Ask 3 Questions (Ask3Q) can increase patient participation in decision-making. Up to now, Ask3Q was not available in German.

OBJECTIVE

To translate Ask3Q and evaluate its acceptability and feasibility.

METHODS

We translated and adapted several English versions of Ask3Q using a team translation protocol and cognitive interviews. Acceptability and feasibility of the final German Ask3Q version were assessed via focus groups and interviews with patients and healthcare professionals (HCPs). Data were analysed via qualitative content analysis.

RESULTS

Translation and adaptation were successful. Participants of focus groups and interviews perceived Ask3Q as a tool to empower patients to ask more questions. Moreover, it was seen as a guideline for physicians not to forget conveying important information. Several characteristics of patients, HCPs, the clinical setting and the intervention were identified as facilitators and barriers for an effective implementation of Ask3Q.

CONCLUSION

We provide the German version of Ask3Q. According to participants, implementation of Ask3Q in the German healthcare system is feasible. Future studies should evaluate if positive effects of Ask3Q can be replicated for patient participation and communication behaviour of HCPs in Germany.

Assessing oral health of crack users in Brazil: Perceptions and associated factors, findings from a mixed methods study

This study explores associated factors and perceptions of oral health among crack users recruited in open drug scenes in Brazil. A mixed methods approach was used. The quantitative component analysed findings from a large (N = 7381), population-based survey. The outcomes under analysis were 'self-perception of oral health' and 'self-reporting of problems affecting the mouth, teeth and gingiva (gums)'. The qualitative component comprised a focus group, with 12 individuals recruited from a drug treatment clinic. Lower self-perception of oral health problems vis-à-vis a higher prevalence of problems affecting the mouth, teeth, and gingiva were found in users who had a lower level of education, used substances daily, had worse self-perception of physical health, did not receive health care and regularly used alcohol and/or tobacco. The results show an association between substance use and decline in oral health, as well as the lack of health services focusing on such issues. Oral health services should be emphasised as a gateway to the health system. So far, the putative cross-referral between services and professionals working in oral health and other health professionals working in the field of drug dependence has not been observed.

The application of Herzberg's two-factor theory of motivation to job satisfaction in clinical laboratories in Omani hospitals

BACKGROUND

Job satisfaction is an important condition for staff retention in most healthcare Organizations. As a concept, job satisfaction is linked to motivation theory. Herzberg's two factor theory of motivation is used in this study to explore what motivational elements are associated with job satisfaction among medical laboratory professionals (MLPs) in Oman.

METHODS

A mixed-method approach was adopted, and focus group discussions (FGDs) were used for data collection. The FGDs were conducted in the main hospitals in Oman. Data were analyzed by directed content analysis, and frequencies of statements related to factors were calculated for a comparison with the Herzberg theory.

RESULTS

The following job dissatisfaction factors (hygiene) were identified: health and safety, heavy workload, salary, promotion, recognition and organizational policies. The satisfaction (motivators) were: relationships with co-workers, relationship with leaders, and professional development.

CONCLUSIONS

The job dissatisfaction reported was resulted from the absence of hygiene factors and some of the motivators in accordance with Hertzberg's theory. Hospital managers need to address these factors, defined by Hertzberg, in order to improve motivation and job satisfaction.

Evaluation of Implementation of Intermittent Screening and Treatment for Control of Malaria in Pregnancy in Jharkhand, India

This study evaluated intermittent screening and treatment during pregnancy (ISTp) for malaria using rapid diagnostic tests (RDTs) at antenatal care (ANC) compared with passive case detection within the routine health system. The mixed-method evaluation included two cross-sectional household surveys (pre- and post-implementation of ISTp), in-depth interviews with health workers, and focus group discussions (FGDs) with pregnant women. Differences in proportions between surveys for a number of outcomes were tested; 553 and 534 current and recently pregnant women were surveyed (pre- and post-implementation, respectively). In-depth interviews were conducted with 29 health providers, and 13 FGDs were held with pregnant women. The proportion of pregnant women who received an RDT for malaria at ANC at least once during their pregnancy increased from pre- to post-implementation (19.2%; 95% CI: 14.9, 24.3 versus 42.5%; 95% CI: 36.6, 48.7; P < 0.0001), and the proportion of women who had more than one RDT also increased (16.5%; 95% CI: 13.1, 20.5 versus 27.7%; 95% CI: 23.0, 33.0; P = 0.0008). Post-implementation, however, only 8% of women who had completed their pregnancy received an RDT on three visits to ANC. Health workers were positive about ISTp mainly because of their perception that many pregnant women with malaria were asymptomatic. Health workers perceived pregnant women to have reservations about ISTp because of their dislike of frequent blood withdrawal, but pregnant women themselves were more positive. Intermittent screening and treatment during pregnancy was not sufficiently adopted by health workers to ensure the increased detection of malaria infections achievable with this strategy in this setting.

Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies

BACKGROUND

The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. The Internet offers a potentially scalable solution to improve access to support, however a dearth of research in this area means that work is needed to better understand women's experience of PNA, so that potential targets for intervention can be identified and possible barriers to support overcome. This study aimed to qualitatively explore women's experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA.

METHODS

Women who were either pregnant or within one-year postpartum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed.

RESULTS

Five key themes emerged in relation to women's experience with PNA: holding unrealistic expectations of birth and motherhood; stigma; the importance of peer support; uncertainty and poor maternal confidence; and a lack of mental health support and knowledge. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations and the reality of their experience, alongside a pressure to be the 'perfect mum' was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort.

CONCLUSIONS

This work provides unique insight into potential sources of anxiety for women in the perinatal period, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA.

Strategies to achieve population control of HCV infection: results of a multidisciplinary focus group

BACKGROUND

To meet the World Health Organization's ambitious target to eradicate hepatitis C virus (HCV) by 2030, a comprehensive strategy is needed in Canada to ensure everyone infected with HCV is identified, diagnosed, and treated. The purpose of this study was to highlight the barriers to any strategy aimed at achieving this goal.

METHODS

A focus group was formed (N = 11) that consisted of clinicians, patients, drug program budget managers, industry representatives, and individuals from provincial public health and federal agencies in Canada. The group met in person for a half-day focus group session. Two discussions were held: one on future barriers related to HCV treatment and one related to HCV screening. A grounded theory approach was used to elicit key themes from the day's discussion.

RESULTS

Nine themes were identified. Four themes related to HCV screening: public awareness and engagement, resource infrastructure and capacity, heterogeneity between provinces, and mechanisms of screening. Three themes related to HCV treatment: access to treatment and illicit drug use, linkage to care, and predicting post-treatment outcomes. Two overarching themes that contributed to most discussions were a focus on baby boomers versus persons who inject drugs and the need for further education and training.

CONCLUSION

The views and findings extracted from this qualitative research complement proposals of national strategies from organizations such as the Canadian Network on Hepatitis C. This work highlights the financial, logistical, and ethical constraints that need to be tackled to make HCV elimination proposals a reality.

Staff experiences of a new tool for comprehensive geriatric assessment in primary care (PASTEL): a focus group study

Objective: Comprehensive geriatric assessment (CGA) is recommended for the management of frailty. Little is known about professionals' experiences of CGA; therefore we wanted to investigate the experiences of staff in primary care using a new CGA tool: the Primary care Assessment Tool for Elderly (PASTEL).Design: Focus group interviews. Manifest qualitative content analysis.Setting: Nine primary health care centres in Sweden that participated in a CGA intervention. These centres represent urban as well as rural areas.Subjects: Nine nurses, five GPs and one pharmacist were divided into three focus groups.Main outcome measures: Participants' experiences of conducting CGA with PASTEL.Results: The analysis resulted in four main categories. A valuable tool for selected patients: The participants considered the assessment tool to be feasible and valuable. They stated that having enough time for the assessment interview was essential but views about the ideal patient for assessment were divided. Creating conditions for dialogue: The process of adapting the assessment to the individual and create conditions for dialogue was recognised as important. Managing in-depth conversations: In-depth conversations turned out to be an important component of the assessment. Patients were eager to share their stories, but talking about the future or the end of life was demanding. The winding road of actions and teamwork: PASTEL was regarded as a good preparation tool for care planning and a means of support for identifying appropriate actions to manage frailty but there were challenges to implement these actions and to obtain good teamwork.Conclusion: The participants reported that PASTEL, a tool for CGA, gave a holistic picture of the older person and was helpful in care planning.Key pointsTo manage frailty using comprehensive geriatric assessment (CGA) in primary care, there is a need for tools that are efficient, user-friendly and which support patient involvement and teamwork•This study found that the Primary care Assessment tool for Elderly (PASTEL) is regarded as both valuable and feasible by primary care professionals•Use of carefully selected items in the tool and allowing enough time for dialogue may enhance patient-centeredness•The PASTEL tool supports the process of identifying actions to manage frailty in older adults. Teamwork related to the tool and CGA in primary care needs to be further investigated and developed.

Sustainability of high flow in a Peruvian PICU: A qualitative analysis

AIM

To describe nurse and physician perspectives on enabling factors that promote sustainability of high flow use in resource-limited settings.

BACKGROUND

Over 650 000 children died from respiratory infections in 2016 globally. Many deaths could be prevented with access to advanced paediatric respiratory support, but sustainability of technology in resource-limited settings remains challenging.

INTRODUCTION

Local providers have expertise related to site-specific barriers to sustainability. Engaging local providers during implementation can identify strategies to promote ongoing technology use beyond initial deployment.

METHODS

This qualitative descriptive study was conducted five focus groups with nineteen nurses and seven individual interviews with physicians in a Peruvian paediatric intensive care unit. Data were analysed using a realist thematic approach.

RESULTS

Providers described five important factors for high flow sustainability: (i) Applying high flow to a broader patient population, including use outside the paediatric intensive care unit to increase opportunities for practice; (ii) Establishing a multidisciplinary approach to high flow management at all hours; (iii) Willingness of nurses and physicians to adopt standardization; (iv) Ongoing high flow leadership; (v) Transparency of high flow impact, including frequent reporting of clinical outcomes of high flow patients.

DISCUSSION

Local providers described strategies to overcome barriers to sustainability of high flow in their clinical setting, many of which are generalizable to implementation projects in other resource-limited settings.

CONCLUSION AND POLICY IMPLICATIONS

These findings provide nursing, administrative leaders and policymakers with strategies to promote sustainability of new technology in resource-limited settings, including development of guidelines for appropriate clinical use, change management support, leadership development and clinical outcome reporting procedures. Administrative support and oversight are paramount to foster successful implementation in these settings.

Men living through multiple miscarriages: protocol for a qualitative exploration of experiences and support requirements

INTRODUCTION

Up to 1 in 4 pregnancies and 1 in 20 subsequent pregnancies end in miscarriage. Despite such prevalence the psychosocial effects are often unrecognised and unsupported. In the absence of any biomedical sequelae among men such marginalisation may be intensified. Men living through multiple miscarriages may also find any grief or anxiety intensified by loss of hope for future parenthood, but robust qualitative studies of these experiences are limited. We aim to rectify the deficiency.

METHODS AND ANALYSIS

Our qualitative study will adopt the sounds of silence framework designed by Serrant-Green to hear the voices of populations possibly marginalised. We will listen and learn from 30 to 50 men with a history of two or more miscarriages. The research participants will be recruited from a recurrent miscarriage clinic at a large tertiary hospital in England, and from advertisements to be disseminated by the project sponsor and miscarriage charities.Individual telephone interviews supported by a semistructured discussion guide will be audio-recorded, transcribed and anonymised. The transcriptions and any field notes will be interpreted by the framework method of Ritchie and Lewis embedded within the sounds of silence framework. Tentative findings will be presented to research participants in face-to-face focus group discussion, to enable member synthesis to enhance authenticity. The focus group discussion will be audio-recorded, transcribed, anonymised and similarly interpreted to contribute to our final synthesis.

ETHICS AND DISSEMINATION

The protocol of this project received a favourable opinion from the West Midlands South Birmingham Research Ethics Committee (16/WM/0423). Results will be submitted for publication in peer-reviewed journals and at conferences, and disseminated via newsletters and social media of our clinical collaborators and miscarriage charities. Outputs are anticipated to inform future policy and practice in the management of multiple miscarriages.

TRIAL REGISTRATION NUMBER

ISRCTN 21828561.

Individual and Community Engagement in Response to Environmental Challenges Experienced in Four Low-Income Urban Neighborhoods

Low-income urban communities, and the individuals that live within them, continue to face disproportionate interconnected social, economic, and environmental challenges related to their built, natural, and social environments. The aim of our phenomenological research study was to elevate the experiences of residents living in low-income urban neighborhoods in terms of their communities' environmental challenges. Our objectives were to (1) identify challenges across neighborhoods, (2) identify ways individuals and communities are addressing those challenges, and (3) assess the individual and collective efficacy and engagement of communities to lead environmental improvements in neighborhoods. This study brings forward the voices that are often ignored or misunderstood in these communities and uses an ecological-social perspective. We conducted focus groups (N = 68) in four low-income urban neighborhoods across two Ohio cities in the United States. Participants described five key challenges in their communities: Pollution, abandoned buildings with associated crime, low food access and health concerns, trash and illegal dumping, and lack of trees. We assessed engagement and efficacy using two frameworks focused on individual and community readiness to engage in and lead community change. Policymakers should acknowledge the valuable contributions and leadership capacity of residents in low-income communities to implement environmental initiatives.

The Dunedin dementia risk awareness project: pilot study in older adults

AIMS

The USA and UK governmental and academic agencies suggest that up to 35% of dementia cases are preventable. We canvassed dementia risk and protective factor awareness among New Zealand older adults to inform the design of a larger survey.

METHOD

The modified Lifestyle for Brain Health scale quantifying dementia risk was introduced to a sample of 304 eligible self-selected participants.

RESULTS

Two hundred and sixteen older adults (≥50 years), with mean ± standard deviation age 65.5 ± 11.4 years (50-93 years), completed the survey (71% response rate). Respondents were mostly women (n = 172, 80%), European (n = 207, 96%), and well educated (n = 100, 46%, with a tertiary qualification; including n = 17, 8%, with a postgraduate qualification). Around half of the participants felt that they were at a future risk of living with dementia (n = 101, 47%), and the majority felt that this would change their lives significantly (n = 205, 95%), that lifestyle changes would reduce their risk (n = 197, 91%), and that they could make the necessary changes (n = 189, 88%) and wished to start changes soon (n = 160, 74%). Only 4 of 14 modifiable risk or protective factors for dementia were adequately identified by the participants: physical exercise (81%), depression (76%), brain exercises (75%), and social isolation (83%). Social isolation was the commonly cited risk factor for dementia, while physical exercise was the commonly cited protective factor. Three clusters of brain health literacy were identified: psychosocial, medical, and modifiable.

CONCLUSION

The older adults in our study are not adequately knowledgeable about dementia risk and protective factors. However, they report optimism about modifying risks through lifestyle interventions.

Patient Decision Aid (PDA) for Patients with Rheumatoid Arthritis Reduces Decisional Conflict and Improves Readiness for Treatment Decision Making

OBJECTIVES

The aim of this study was to develop and assess the effectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy.

METHODS

The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efficacy using the Decisional Conflict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS).

RESULTS

The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarification section. Alpha-testing revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA significantly reduced overall patients' decisional conflict [33.2 (DE: 21.4) vs 24.6 (23.5); p < 0.001] and prepared the patient for decision making [PDMS: 67.5 (21.0)].

CONCLUSIONS

We developed a PDA for Spanish patients with moderate-to-severe RA that reduces patients' decisional conflict and increases their readiness for decision making. The use of this PDA in routine clinical practice may improve the quality of the decision-making process and the quality of the choices made.

Toward Integration of mHealth in Primary Care in the Netherlands: A Qualitative Analysis of Stakeholder Perspectives

Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views.

Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis.

Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers.

Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation.

Patients' and Clinicians' Preferences on Outcomes and Medication Attributes for Type 2 Diabetes: a Mixed-Methods Study

BACKGROUND

Patients' views on the relative importance of treatment outcomes and medication attributes for type 2 diabetes may differ from clinicians' perceptions.

OBJECTIVE

To assess which treatment outcomes and medication attributes are considered important by patients and clinicians for therapeutic decisions in type 2 diabetes.

DESIGN

Exploratory, sequential, mixed-methods design comprising a qualitative (focus groups) and a quantitative (survey) phase.

PARTICIPANTS

Patients in the focus groups (n = 33) and the survey study (n = 656) were recruited from 4 and 9 diabetes clinics across Greece, respectively. Clinicians in the survey study (n = 363) were identified from Greek registries for healthcare professionals.

MEASUREMENTS

We conducted 6 focus groups to obtain patients' views regarding the impact of type 2 diabetes on their lives. Identified themes informed the development of a survey, which aimed to assess which outcomes and medication attributes are considered most important by patients and clinicians. We calculated odds ratios to compare patients' and clinicians' responses.

RESULTS

The focus groups identified 6 main themes and 15 subthemes. In the survey study, patients were more likely than clinicians to rate prevention of amputation (odds ratio, 9.32; 95% CI, 6.51 to 13.35), diabetic eye disease (6.16; 4.63 to 8.21), sexual dysfunction, and stroke as important, while clinicians were more likely than patients to choose risk for hypoglycemia, and reduction of all-cause mortality, HbA1c, and body weight. Compared with clinicians, patients were less concerned about drug cost (0.16; 0.11 to 0.23), but more concerned about route of administration and need for less frequent glucose self-monitoring.

CONCLUSIONS

Patients and clinicians differ in the perception of the relative importance of treatment outcomes and drug characteristics. Individual patient preferences should be explored and implemented in the therapeutic decision-making for type 2 diabetes.

Using Focus Groups to Explore Evolving Perceptions of Student Pharmacists' Curricular Experiences

Objective. To explore student pharmacists' shared experiences as they transitioned through the first three years of a Doctor of Pharmacy curriculum, from dependent learners to autonomous contributors. Methods. The researchers used interpretive phenomenology to examine the lived experiences of student pharmacists. Previously gathered focus group data for 309 student pharmacists from the 2015-2016 academic year were explored. A step-wise approach to data analysis was used to perpetuate the natural emergence of themes and alignment with theory. Utilizing Arthur Chickering's Seven Vectors of Identity Development as a lens, the researchers analyzed findings related to self-realization and identification of purpose. Results. The research team identified several themes associated with the teaching and learning process: professionalism, autonomy, and managing the expectations of the curriculum. A connection between the researchers' findings and Chickering's seven vectors was seen as students' comments demonstrated their progress along the vectors over three academic years. Conclusion. This exploration provided a glimpse into the lived experiences of student pharmacists at three different stages in their journey from dependent learners to autonomous contributors. By comparing students in one year with those in the next, the researchers were able to see the evolution that occurred over time as students became self-authored individuals, which is the ideal outcome for pharmacy graduates.

Partial or total knee replacement? Identifying patients' information needs on knee replacement surgery: a qualitative study to inform a decision aid

Purpose

For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients’ experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid.

Methods

Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis.

Results

Participants described a process of arriving at ‘readiness for surgery’ a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. ‘Information for decisions’ details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery.

Conclusions

Patients’ experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients’ understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended.

Electronic supplementary material

The online version of this article (10.1007/s11136-019-02381-9) contains supplementary material, which is available to authorized users.

Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study

Background

There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap.

Objective

This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda.

Methods

This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis.

Results

Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey.

Conclusions

Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors.

Patient Perspectives on Short-Course Pharmacotherapy: Barriers and Facilitators to Medication Adherence

Background:

Medication nonadherence is a public health issue that contributes to poor health outcomes and health-care costs. Factors influencing long-term medication adherence are known; however, little is known about short-course medication adherence.

Objective:

This study examined patient perspectives on adherence and factors that influence adherence to short-course pharmacotherapy in diarrhea-predominant irritable bowel syndrome.

Method:

Twenty-seven participants were interviewed to identify their perceptions of barriers and facilitators to thrice-daily, 14-day rifaximin.

Results:

Participants were primarily female (89%), aged 18 to 65 years. Sixty-eight percent of interviewees were identified as “low-adherers,” meaning the percentage of days with correct daily dosing of rifaximin was <80%. The final coding framework identified social/economic-related (family support and medication expense), system-related (relationship with provider and medication knowledge), condition-related (symptom severity), therapy-related (inconvenient dosing), and patient-related (forgetfulness and busyness of daily life) factors that influenced adherence.

Conclusion:

The resulting patient perspectives highlight a diverse set of factors that influence short-course adherence and the need for tailored interventions that address these various factors resulting in enhanced patient outcomes.

Factors influencing access to kidney transplantation: a research protocol of a qualitative study on stakeholders' perspectives

INTRODUCTION

Unequal access to kidney transplantation is suggested, but no systematic inventory exists about factors influencing access to kidney transplantation. There is an absence of any research that has combined stakeholder perspectives along the complete trajectory of transplantation. The present qualitative study explores the contributing factors from the perspectives of multiple stakeholders in this trajectory, including patients, health professionals and health insurance and financial representatives in the Netherlands. Moreover, stakeholders will be invited to suggesting strategies and solutions for handling the facilitating and hindering factors found. By means of interaction, stakeholder groups will arrive at a consensus for new policymaking in the field of a Dutch transplantation care.

METHODS AND ANALYSIS

The different stakeholders' perspectives and possible solutions will be explored by interviewing in three phases. In the first phase, stakeholders' group perspectives will be explored with individual interviews and focus group interviews without confrontation of views from other perspectives. In the second phase of focus group interviewing, perspectives will be confronted with the other stakeholders' perspectives assessed. Finally, in the third phase, stakeholders will be invited to focus group discussions for suggesting solutions to overcome barriers and promote facilitators for improving access to transplantation. Approximately, groups from six to twelve participants per focus group and four to maximal six focus groups will be held per stakeholder, depending on the level of saturation, as prescribed by grounded theory. The interviews will be audio-recorded and transcribed verbatim, and qualitative data will be analysed according to the principles of grounded theory supported by using NVivo software.

ETHICS AND DISSEMINATION

The Medical Ethical Committee of Erasmus MC, Rotterdam, The Netherlands, has approved this study. The results will be disseminated in peer-reviewed journals and major international conferences.

Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study

Background

Measures exist to improve early recognition of, and response to deteriorating patients in hospital. Despite these, 7% of the deaths reported to the National Reporting and Learning System from acute hospitals in 2015 related to a failure to recognise or respond to deterioration. Interventions have been developed that allow patients and relatives to escalate patient deterioration to a critical care outreach team. However, there is not a strong evidence base for the clinical effectiveness of these interventions, or patients' ability to recognise deterioration.

Aims

The aims of this study were as follows. (a) To identify methods of involving patients in recognising deterioration in hospital, generated by health professionals. (b) To develop and evaluate an identified method of patient involvement in practice, and explore its feasibility and acceptability from the perspectives of patients.

Methods

The study used a mixed-methods design. A measure to capture patient-reported wellness during observation was developed (Patient Wellness Questionnaire) through focus group discussion with health professionals and patients, and piloted on inpatient wards.

Results

There was limited uptake where patients were asked to record ratings of their wellness using the Patient Wellness Questionnaire themselves. However, where the researcher asked patients about their wellness using the Patient Wellness Questionnaire and recorded their responses during observation, this was acceptable to most patients.

Conclusions

This study has developed a measure that can be used to routinely collect patient-reported wellness during observation in hospital and may potentially improve early detection of deterioration.

Strengthening behavioral clinical trials with online qualitative research methods

Qualitative methods are integral to the systematic development of effective health behavioral interventions, as noted in recent translational models, such as the Obesity-Related Behavioral Intervention Trials model. To our knowledge, however, no scholarly literature describes how online qualitative research methods can be used to benefit the development and conduct of behavioral clinical trials. We emphasize the value of qualitative methodologies to behavioral clinical trial research more broadly and provide an introductory overview of online qualitative research methods. We highlight the specific affordances of these methods in maximizing the quality of behavioral clinical trials as well as note their potential limitations. Finally, we argue that online qualitative research methods ought to be incorporated in behavioral trial development and call for future research in this area.

Exploring the perspectives of stroke survivors and healthcare professionals on the use of mobile health to promote physical activity: A qualitative study protocol

Background: Physical inactivity is both the second-highest population attributable risk factor for and a common consequence of stroke. Despite well-documented health benefits associated with physical activity, its levels typically remain below recommended guidelines in stroke survivors. Consequently, calls have been made for novel interventions targeting the promotion of physical activity in stroke survivors. Mobile health is an emerging field which can offer personalised health interventions through mobile and wireless technology. However, a paucity of research has focused on mobile health to promote physical activity in stroke survivors and, more broadly, this field has been criticised for not incorporating the views of stakeholders. This study aims to explore the perspectives of stroke survivors and healthcare professionals on the development of a mobile health intervention for the promotion of physical activity. Methods: The current study will employ a qualitative descriptive approach using separate, semi-structured focus groups for two key stakeholder groups. Community-dwelling stroke survivors will be recruited through an early supported discharge service for acute stroke and stroke support groups. Healthcare professionals will be recruited through the same early supported discharge service, relevant professional bodies and Twitter. The final number of focus groups will depend on data saturation. Thematic analysis will be conducted using NVivo 12 and findings will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. Conclusion: This study was granted ethical approval from the HSE Mid-Western Regional Hospital Research Ethics Committee and the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. Output will consist of recommendations for the development of a mobile health intervention aimed at the promotion of physical activity in stroke survivors. Findings will be disseminated locally through presentations at stroke support groups, as well as internationally through academic conferences and peer-reviewed journals.

Pharmacotherapy Literacy and Parental Practice in Use of Over-the-Counter Pediatric Medicines

Background and objectives: Pharmaceutical literacy skills of parents are crucial for appropriate and safe medication use in pre-school children (ages 1⁻7 years). A recent study on pharmacotherapy literacy from Serbia showed that one in five parents have difficulty understanding common information about the use of medicines. Because antipyretics are considered to be the most frequently used group of over-the-counter (OTC) medications during the pre-school period, we aimed to: (i) examine parental practice and expectations in antipyretic medication use, and (ii) analyze associations of parental practice and expectations related to socio-economic status and pharmacotherapy literacy. Materials and methods: A cross-sectional survey using a self- report validated specific instrument was conducted with the parents of pre-school children in kindergartens in Belgrade, Serbia. Pharmacotherapy literacy refers to the knowledge and personal skills needed to meet the complex demands of medicine use in both healthcare and non-healthcare settings. A comprehensive literature review, expert-focus group consultation, and pre-testing were employed in 4-item multiple-choice test development to explore practice and expectations related to the use of OTC pediatric antipyretic medicines. Results: The final analytical cohort was comprised of 813 participants, the majority (63.3%) chose a medicine based on a physician's suggestion and only 15.4% of parents reported they would follow the advice of a pharmacist. More than a half of parents (54.1%) would need advice about antipyretic medicine from a pharmacist, firstly in a simpler language. Parents satisfied with the information given by a pharmacist had higher pharmacotherapy literacy, compared to parents with lower levels (OR⁻0.718, 95%CI (0.597⁻0.865), p < 0.001). Men had a higher expectation of pharmacists to explain medicine use in a simpler language (OR⁻1.630, 95%CI (1.063⁻2.501), p = 0.025), as well as parents with three or more children (OR⁻2.527, 95%CI (1.43⁻4.459), p = 0.001). Parents with higher knowledge about medicine use were less likely to ask for simpler information (OR⁻0,707; 95%CI (0,583⁻0,856), p < 0,001). Conclusions: Our main finding is that practice in antipyretic OTC medicine use was associated with levels of parental pharmacotherapy literacy. The expectations of pharmacists were higher among parents with lower levels of pharmacotherapy literacy, who expected more information in a simpler and more precise language. This study highlighted the need for pharmacists to identify risks in parental practice and to provide information about medicines to parents of pre-school children in a simpler and more appropriate way.

Identification and assessment of health-related quality of life issues in patients with sporadic desmoid-type fibromatosis: a literature review and focus group study

PURPOSE

Sporadic desmoid-type fibromatosis (DTF) is a rare, chronic, non-metastasising, disease of the soft tissues. It is characterised by local invasive and unpredictable growth behaviour and a high propensity of local recurrence after surgery thereby often having a great impact on health-related quality of life (HRQL). This study aims to review currently used HRQL measures and to asses HRQL issues among DTF patients.

METHODS

A mixed methods methodology was used consisting of (1) a systematic literature review, according to the PRISMA guidelines (2009), using search terms related to sporadic DTF and HRQL in commonly used databases (e.g. Embase, Medline Ovid, Web of science, Cochrane Central, Psyc Info, and Google scholar), to provide an overview of measures previously used to evaluate HRQL among DTF patients; (2) focus groups to gain insight into HRQL issues experienced by DTF patients.

RESULTS

The search strategy identified thirteen articles reporting HRQL measures using a wide variety of cancer-specific HRQL tools, functional scores, symptom scales (e.g. NRS), and single-item outcomes (e.g. pain and functional impairment). No DTF-specific HRQL tool was found. Qualitative analysis of three focus groups (6 males, 9 females) showed that participants emphasised the negative impact of DTF and/or its treatment on several HRQL domains. Six themes were identified: (1) diagnosis, (2) treatment, (3) follow-up and recurrence, (4) physical domain, (5) psychological and emotional domain, and (6) social domain.

CONCLUSION

A DTF-specific HRQL tool and consensus regarding the preferred measurement tool among DTF patients is lacking. Our study indicates that HRQL of DTF patients was negatively affected in several domains. A DTF-specific HRQL measure could improve our understanding of short- and long-term effects and, ideally, can be used in both clinic and for research purposes.

Qualitative and quantitative analysis of the relevance, clarity, and comprehensibility of the Scale of Quality of Diet (ESQUADA)

The study of the diet quality should include not just the nutritional adequacy but also incorporate the multidimensional understanding and the current dietary recommendations. This study aimed to evaluate the relevance, clarity, and comprehensibility of the Scale of Quality of Diet (ESQUADA). Nutritionists’ perspectives about the relevance and clarity of the items were evaluated through focus groups between November and December 2016. An exploratory content analysis investigated the themes that emerged from the focus groups, which were organized in a structured codebook. Two reviewers applied it to the data. Inter-rater reliability was analyzed by the kappa coefficient. The coding was analyzed using the frequencies and central aspects of the sub-themes. Laypersons’ comprehension of the items was evaluated using a question regarding whether they understood each item in online questionnaire in February 2018. Descriptive statistics investigated the comprehensibility of each item. The reviewers presented adequate reliability on coding the data. Three themes emerged from the data considering the nutritionists’ suggestions. The theme Item relevance indicated that the items assessed diet quality while considering sociocultural influences. However, the nutritionists suggested attention was needed to how some items were expressed and their response options. Of relevance, the themes Item clarity and Clarity of alternatives primarily encompassed discussions regarding item text (44%) and discrimination of alternatives (24%). The study of the comprehensibility indicated that all items were readily understood. These results support the relevance of the ESQUADA for evaluating quality of diet as well the comprehensibility of all the items by individuals uneducated in public health.

Acceptability and accessibility of child nutrition interventions: fathers' perspectives from survey and interview studies

BACKGROUND

Against a background of changing family structures and socioeconomic demands in contemporary families, fathers are more actively engaged in meal preparation and feeding of their children, yet in research studies targeting improvement in nutrition and feeding practices fathers are under-represented. Among possible explanations for this bias are acceptability of research projects and accessibility to male research participants. The aims of this study were to identify (i) fathers' preferences for participation in child nutrition research and interventions and (ii) the potential to recruit fathers through their workplaces with the possibility of delivering interventions through those workplaces.

METHODS

This paper draws on two independent yet linked studies that explored fathers' roles in family feeding, and intervention studies aimed at supporting father's dietary knowledge and feeding practices. For Study 1 (conducted first) secondary data analysis was conducted on survey data (n = 463 fathers of preschool children) to determine preferences related to type of program, delivery mode, and location and timing. For Study 2 six focus groups and one individual interview were conducted with n = 28 fathers to determine acceptability of recruitment of fathers working in traditionally blue-collar occupations and service industries (as defined by the Australian Bureau of Statistics) and potential of intervention delivery through their workplaces.

RESULTS

Fathers were engaged in child feeding and indeed sought nutrition-related information. Fathers indicated a preference for family-focused and online delivery of interventions. Whilst potential to recruit through blue-collar workplaces was evident, participants were divided in their views about the acceptability of interventions conducted through the workplace. There was a sense of support for the logic of such interventions but the focus group participants in this study showed only modest enthusiasm for the idea.

CONCLUSIONS

With limited support for the workplace as an intervention setting, further systematic exploration of technology-based intervention design and engagement is warranted. Based on findings, interventions should target a) content that is focused on the family and how to make changes at the family level, rather than the father individually; and b) online delivery, such as Apps or online video chat sessions, for convenience and to facilitate sharing of information with family members.

"A bumpy road": Kindergarten staff's experiences with an intervention to promote healthy diets in toddlers

This study explores the experiences of kindergarten staff with a multi-component kindergarten-based intervention, the aims of which were to reduce levels of food neophobia and to promote healthy diets in toddlers (aged 2-3 years). A qualitative design was chosen for the study, and the data are based on three focus group interviews. Altogether, 15 kindergarten staff were interviewed using a semi-structured interview guide. The focus group interviews were analyzed using qualitative content analysis. Five main themes emerged from the interviews: i) Successful development of sensory knowledge, ii) Food neophobia, iii) Implementing new routines, a challenge for some, iv) Lack of cooking skills, and v) Inspired to continue. A main finding was that all kindergarten staff perceived the sensory education sessions as successful and reported that both toddlers and staff expanded their food vocabulary and increased their attention to sensory impressions of food. However, the staff reported that some toddlers were less willing to taste new lunch dishes than to taste new foods in the sensory education sessions. The staff also noted that the guidelines for feeding practices resulted in unfamiliar situations at the lunch table. The staff agreed that cooking novel foods was time consuming and left less time for other tasks. Finally, all kindergarten staff expressed that they would like to continue with portions of the food intervention. Our main interpretation is that the intervention presented several challenges, especially regarding cooking and feeding practices. If kindergartens are to be a place to promote healthy eating habits in the early years, sufficient time and resources for cooking seem to be needed and food and feeding practices included in the curriculum of kindergartens and higher education for kindergarten teachers.

TRIAL REGISTRATION

ISRCTN74823448.