Commentary: Writing and Evaluating Qualitative Research Reports

Engaging With the Community to Promote Physical Activity in Urban Neighborhoods

PURPOSE

To describe perceptions of physical activity, opinions, on intergenerational approaches to physical activity and a vision for increasing physical activity in an underresourced urban community.

APPROACH

Focus groups embedded in a large Community-Based Participatory Research Project.

SETTING

West and Southwest Philadelphia.

PARTICIPANTS

15 parents, 16 youth, and 14 athletic coaches; youth were 13 to 18 years old and attended West Philadelphia schools; parents' children attended West Philadelphia schools; and coaches worked in West Philadelphia schools.

METHODS

Six focus groups (2 youth, 2 parent, and 2 coach) were conducted guided by the Socio-Ecological Model; transcriptions were analyzed using a rigorous process of directed content analysis.

RESULTS

Factors on all levels of the Socio-Ecological Model influence the perception of and engagement in physical activity for youth and their families. Future strategies to increase engagement in physical activity need to be collaborative and multifaceted.

CONCLUSION

When physical activity is reframed as a broad goal that is normative and gender-neutral, a potential exists to engage youth and their families over their lifetimes; with attention to cross-sector collaboration and resource sharing, engaging and sustainable intergenerational physical activity interventions can be developed to promote health in underresourced urban communities.

Challenges to Family Management for Caregivers of Adolescent and Young Adult Survivors of Childhood Brain Tumors [Formula: see text]

Due to the complexity of cancer late effects, the education required to provide anticipatory guidance and support to the caregivers of adolescent and young adult (AYA) survivors of childhood brain tumors can be difficult. Therefore, identifying challenges to family management (FM) could be helpful in anticipating complications with the integration of tumor and treatment late effects into family life. Building on previous research that described FM for children with chronic conditions, children who survived cancer, and the Family Management Styles Framework, the purpose of this study was to identify FM challenges for caregivers of AYA survivors of childhood brain tumors to guide clinical practice and research. Directed content analysis was used to identify FM challenges in data from semistructured interviews with 45 maternal caregivers for AYA survivors of childhood brain tumors living with them. Caregivers were largely White (89%) with an average age of 52 years, educated beyond the high school level (67%), and were partnered or married (53%). On average, caregivers had been caring for the AYA for 21 years since diagnosis, and 56% of their survivors had moderate functional restrictions. A primary and a secondary analyst were assigned to the data for each interview and completed a single summary matrix. A list of challenges was created by the research team based on Family Management Styles Framework, the literature, and clinical expertise. Seven core challenges to FM were identified: ensuring survivor well-being, supporting survivor independence, encouraging sibling well-being, planning family activities, sustaining parents as caregivers, attending to survivor late effects, and providing support and advocacy.

Screening for Family Psychosocial Risk in Pediatric Hematopoietic Stem Cell Transplantation with the Psychosocial Assessment Tool

Family psychosocial risk screening is an important initial step in delivering evidence-based care in hematopoietic stem cell transplantation (HCT). Establishing an evidence-based screening approach that is acceptable, reliable, and valid is an essential step in psychosocial care delivery. This is a 3-institution multimethod study. In part 1, caregivers of children about to undergo HCT (n = 140) completed the Psychosocial Assessment Tool-Hematopoietic Cell Transplantation (PAT-HCT), a brief parent report screener adapted for HCT, and validating questionnaires. Families received feedback on their risks identified on the PAT-HCT. In part 2, 12 caregivers completed a semistructured interview about their perceptions of the PAT and the feedback process. The reliability and validity of the PAT-HCT total and subscale scores were tested using Kuder-Richardson-20 (KR-20) and Pearson correlations. Thematic content analysis was used to analyze the qualitative interview data. Internal consistency for the total score (KR-20 = .88) and the Child Problems, Sibling Problems, Family Problems, and Stress Reactions subscales were strong (KR-20 >.70). Family Structure, Social Support, and Family Beliefs subscales were adequate (KR-20 = .55 to .63). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Feedback was provided to 97.14% of the families who completed the PAT-HCT, and the mean rating of acceptability was >4.00 (on a 5-point scale). The qualitative data indicate that families appreciate the effort to provide screening and feedback. The PAT-HCT is a psychometrically sound screener for use in HCT. Feedback can be given to families. Both the screener and the feedback process are acceptable to caregivers.

Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey

PURPOSE

To examine provider perceptions of practice behaviors and barriers related to fertility counseling, fertility preservation, and family building among transgender patients.

METHODS

Participants were medical and mental health professionals who treat adult and youth transgender patients. Recruitment occurred online and in person, via professional listservs for transgender professionals, conferences, and gender clinics. From August-November 2017, 110 participants representing nine countries responded to four open-ended questions included on a survey related to provider practice behaviors and perceived barriers to fertility counseling, fertility preservation, and family building with transgender patients. Thematic coding analysis was used to identify themes.

RESULTS

Multiple themes were identified including the following: access and cost issues; urgency for gender-affirming treatment; patient maturity and inability to make future-oriented decisions; and provider-related challenges pertaining to knowledge, role, and general lack of information in the nascent field of transgender reproductive health.

CONCLUSION(S)

This study yielded insights into practice behaviors, challenges, and perceived barriers to fertility counseling with transgender individuals and can serve as a basis for intervention development to optimize clinical practices with this population.

University⁻Community Partnerships Using a Participatory Action Research Model to Evaluate the Impact of Dance for Health

Little is known about fostering sustainable, collaborative community-academic partnerships that effectively improve physical activity and health in residents of under resourced communities using Participatory Action Research (PAR) driven models. The purpose of this PAR study was to evaluate the impact of an urban, intergenerational, and physical activity dance program by identifying community preferred measurable outcomes that promote program participation and sustainability. A descriptive, qualitative design was employed using semi-structured interview guides to facilitate discussions for two adult focus groups and one youth focus group. Exactly 19 community-residing adults and six youth who lived in urban neighborhoods in West Philadelphia participated in the discussions. The audiotapes were transcribed and analyzed using directed content analysis. Five outcome themes emerged and included: (1). Enhancing the psychological and emotional well-being of the individual, (2). Enhancement of social well-being and management of interpersonal relationships and responsibilities (3). Enhancing and promoting physiologic well-being (4). Changes in health promoting behaviors and skill acquisition, and (5). Concerns about accessibility of dance for health and other physical activity programs in the community. Focused attention to measuring community preferred outcomes can promote sustainability of Dance for Health and possibly other urban-based physical activity dance programs.

Perceived benefits of and barriers to psychosocial risk screening in pediatric oncology by health care providers

BACKGROUND

Although systematic psychosocial screening has been established as a standard of psychosocial care in pediatric oncology, this is not yet widely implemented in clinical practice. Limited information is available regarding the reasons behind this. In this study, we investigated perceptions of psychosocial screening by health care providers (HCPs) involved in pediatric cancer care.

METHODS

Using purposeful sampling, 26 HCPs (11 oncologists, 8 nurses, and 7 social workers) from a large North American pediatric cancer center participated in semistructured interviews. Interviews were recorded and transcribed verbatim. Themes were then derived using content analysis.

RESULTS

The themes were organized into perceived benefits of and barriers to psychosocial risk screening, and practical issues regarding implementation. Perceived benefits of screening included obtaining concise documentation of family psychosocial risk, identifying psychosocial factors important to medical treatment, starting a conversation, and triaging patients to psychosocial services. Barriers included perceived limited institutional support, commitment, and resources for psychosocial services, limited knowledge and appreciation of existing evidence-based validated tools, concerns about diverse family cultural backgrounds regarding psychosocial issues and language proficiency, and HCPs' personal values regarding psychosocial screening. Finally, practical issues of implementation including training in psychosocial risk screening, when and how to screen were discussed.

CONCLUSIONS

These findings highlight the importance of addressing HCPs' perceptions of benefits, barriers, and practical issues regarding implementing psychosocial risk screening.

Waiting for a Pediatric Chronic Pain Clinic Evaluation: A Prospective Study Characterizing Waiting Times and Symptom Trajectories

Chronic pain during childhood is prevalent and costly, but the access to interdisciplinary pain care is limited. Studies investigating adults waiting for pain clinic evaluation found that symptoms and quality of life deteriorate over the waiting period, but little is known about the experience of adolescents. Therefore, we aimed to determine wait list times and the longitudinal trends of pain and physical, mental, and social health over a 12-week period. In total, 97 adolescents, aged 10 to 18 years (M = 14.7 years, 82% female), waiting for evaluation at an interdisciplinary pediatric pain clinic completed assessments at enrollment and at 4-, 8-, and 12-week follow-up. We performed a review of the medical record of attendance patterns 12 months later. Twelve adolescents and their parents also completed qualitative interviews, describing their experience of waiting for evaluation. Wait times averaged 197.5 days (range = 69-758 days) from the time of referral to the first-attended appointment, and 86.6% of youths completed appointments. Longitudinal repeated measures analyses demonstrated little improvement in pain or other domains of functioning over the 12-week period. In qualitative interviews, families described anxious anticipation for the upcoming appointment, combined with frustration in waiting. Findings highlight the need to consider approaches to reduce wait times and provide early intervention for youths awaiting pain clinic evaluation. Perspective: This study extends the literature on the characteristics and symptom trajectories of adolescents during the wait period for interdisciplinary pain clinic evaluation, described previously only in adults with chronic pain. Findings demonstrated an average wait time of 6.5 months, during which youths' pain and physical and social health remained impaired.

Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families

OBJECTIVES

As implementation of evidence-based practices (EBPs) in publicly funded children's mental health services has become increasingly common, concerns have been raised about the appropriateness of specific EBPs to the diverse client populations served in these settings. Exploring stakeholder perspectives can provide direction for refinements of EBPs when delivered with Latinx families. The current study used qualitative methods to examine therapist and Latinx parent perceptions of therapist-parent interactions and the intervention process when therapists are trained to deliver AIM HI (An Individualized Mental Health Intervention for ASD), a structured, parent-mediated intervention for autism spectrum disorder (ASD).

METHOD

Therapist and parent participants were a subset of participants from a large-scale community effectiveness trial. Perceptions were gathered through focus groups with therapists (n = 17) and semistructured interviews with Latinx parents (n = 29). Therapists were 94% female, 35% Latinx, and 47% were fluent in Spanish. Parents were 93% female, 100% Latinx, and 66% preferred Spanish. A coding, consensus, co-occurrence and comparison approach was used to analyze data.

RESULTS

Three primary themes emerged: (a) limited parental knowledge about ASD and the need to address knowledge gaps; (b) differing perceptions regarding parental participation in treatment; and (c) identification of influences on parent-therapist interaction, including the cultural value of respeto/deference (emphasized by therapists), and importance of personalismo/personal connection (emphasized by parents).

CONCLUSIONS

The themes provide specific direction for enhancements to AIM HI to maximize engagement of Latinx families. The themes also have broader implications for intervention development and community implementation including refinement of EBPs to facilitate fit and sustained implementation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A Qualitative Study of Chronic Pain and Self-Management in Adults with Sickle Cell Disease

Acute, intermittent vaso-occlusive pain is the hallmark of sickle cell disease (SCD) and is associated with substantial morbidity and impaired quality of life (QOL). The subgroup of adults with SCD who transition from recurrent, acute pain to chronic, persistent pain have even greater QOL impairment and higher rates of healthcare utilization. Self-management is central to SCD management; however, its role in chronic pain management is not established. This qualitative study was conducted to answer the following research questions: (1) What is the chronic pain experience of adults with SCD? (2) What self-management strategies do adults with SCD use for chronic pain? and (3) Do adults with SCD have any needs in the self-management of chronic pain? Eighteen Black adults with SCD completed a demographics questionnaire and an interview. The majority of the participants were 21-30 years of age (mean 33.5, SD 7.6), female (61.1%), employed at least part-time (61.1%), single/never married (72.2%), and had a SCD type of sickle cell anemia (55.5%). Interview analysis revealed three major themes: (1) the chronic pain experience; (2) strategies for managing chronic pain; and (3) challenges and needs in managing chronic pain. Study findings can be used to support chronic pain management among adults with SCD. Further research is needed to devise and implement effective strategies for the prevention and management of chronic SCD pain.

Endovascular therapy after acute ischaemic stroke-Experiences and needs of relatives

AIMS AND OBJECTIVES

To explore the experiences and needs of relatives being part of the endovascular therapy (EVT) pathway.

BACKGROUND

Ischaemic stroke is the third leading cause of death and the most common cause of acquired disability among adults in the Western world. The most recently approved treatment for major stroke is EVT. Removing the arterial occlusion has proven to be the best predictor of outcome. While patients are treated, relatives are left waiting. Facing the massive shock of their loved ones having a stroke may cause emotional turmoil and leave relatives with various needs. No previous studies have explored experiences and needs of relatives who are part of an EVT pathway.

DESIGN

A qualitative design using a phenomenological-hermeneutic approach.

METHODS

Semi-structured interviews and participant observations were carried out. Data were collected from April 2016-January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding.

RESULTS

Four themes emerged are as follows: (a) The first phase-shock, chaos and feeling paralysed; (b) the all-important information-sharing is pivotal; (c) professional loving care-being seen and heard by caring health professionals; and (d) adjusting to new roles. One essential finding that emerged across all themes was relatives' constant need for care, for support and for health professionals to "be there."

CONCLUSION

Relatives need support and care during the entire EVT pathway. They tend to be modest and ignore their own needs. Relatives who experience chaos, fear and worry need to be met by professionals with real presence.

RELEVANCE TO CLINICAL PRACTICE

These findings will be used as a foundation for development of local structures and policies that should provide knowledge and ensure a consistent and proactive approach to meet the needs of the relatives in a timely and efficient manner.

Pediatric to Adult Care Transition: Perspectives of Young Adults With Sickle Cell Disease

Objectives

The aim of this study was to explore perspectives of transition and transition readiness of young adult patients (YAs) with sickle cell disease (SCD) who have transitioned to adult health care.

Methods

In all, 19 YAs with SCD (ages 18-30 years) participated in one of three focus groups and completed a brief questionnaire about transition topics. Transcripts were coded and emergent themes were examined using the social-ecological model of adolescent and young adult readiness for transition (SMART).

Results

Themes were consistent with most SMART components. Adult provider relationships and negative medical experiences emerged as salient factors. YAs ranked choosing an adult provider, seeking emergency care, understanding medications/medication adherence, knowing SCD complications, and being aware of the impact of health behaviors as the most important topics to include in transition programming.

Conclusions

The unique perspectives of YAs can inform the development and evaluation of SCD transition programming by incorporating the identified themes.

Patient and Provider Perspectives on Communication About Body Image With Adolescents and Young Adults With Cystic Fibrosis

Objective

This mixed-methods study examined perspectives of adolescents and young adults (AYAs) with cystic fibrosis (CF) and health care providers on body image communication.

Methods

Interviews and questionnaires were completed by 20 AYAs and 28 providers.

Results

Although 85% of patients reported they had never had a body image conversation with a health care provider, 74% of providers reported discussing this topic with patients. Patients and providers described body image as an important issue, which should be discussed comfortably and supportively. However, patients often preferred to discuss body image as a distinct topic, separate from physical health, whereas providers preferred integrating body image conversations within weight- and health-based discussions.

Conclusions

Body image is an important topic for AYAs with CF that often goes unaddressed or addressed in ways that are less preferred by patients. Providers should reduce barriers to effective communication about this important topic, particularly through increased awareness of AYA preferences.

Health Care Transition for Young Adults With Type 1 Diabetes: Stakeholder Engagement for Defining Optimal Outcomes

Objectives

Research on the transition to adult care for young adults with type 1 diabetes (T1D) emphasizes transition readiness, with less emphasis on transition outcomes. The relatively few studies that focus on outcomes use a wide variety of measures with little reliance on stakeholder engagement for measure selection.

Methods

This study engaged multiple stakeholders (i.e., young adults with T1D, parents, pediatric and adult health care providers, and experts) in qualitative interviews to identify the content domain for developing a multidimensional measure of health care transition (HCT) outcomes.

Results

The following constructs were identified for a planned measure of HCT outcomes: biomedical markers of T1D control; T1D knowledge/skills; navigation of a new health care system; integration of T1D into emerging adult roles; balance of parental involvement with autonomy; and "ownership" of T1D self-management.

Discussion

The results can guide creation of an initial item pool for a multidimensional profile of HCT outcomes.

Medication adherence in pediatric asthma: A systematic review of the literature

OBJECTIVE

To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains.

METHODS

Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality.

RESULTS

Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies.

CONCLUSIONS

All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.

Acceptability and Feasibility of Examining Physical Activity in Young Children with Type 1 Diabetes

Physical activity is important but may be difficult to evaluate in young children (YC) with Type 1 diabetes (T1D) because of parents' fears of hypoglycemia, difficulties engaging YC in physical activity, and use of assessment devices. This study aimed to explore the acceptability and feasibility of an in-lab exercise session for YC with T1D. Ten YC ages 3 through7 years with T1D participated in a 20-minute exercise session while wearing blinded continuous glucose monitors and accelerometers. High acceptability was found for participation in the exercise session; high feasibility and acceptability were reported for the assessments. Although most children completed the session, it did not produce moderate to vigorous physical activity. YC were found to spend most of their day sedentary, and they had frequent blood glucose excursions. Findings support the feasibility of conducting a more extensive examination of the relationship among blood glucose levels and physical activity in YC with T1D.

The Ups and Downs of Parenting Young Children With Type 1 Diabetes: A Crowdsourcing Study

Objectives

Parenting young children with type 1 diabetes (YC-T1D) entails pervasive challenges; parental coping may influence child and parent outcomes. This study used a qualitative descriptive design to describe these challenges comprehensively to inform the user-centered design of an Internet coping resource for parents.

Methods

A "Parent Crowd" of 153 parents of children with T1D onset at ≤ 5 years old submitted textual responses online to open-ended questions about parenting YC-T1D. Systematic coding organized responses into domains, themes, and examples. A supplemental focus group of racial/ethnic minority parents enhanced the sample's diversity and validated findings from the Parent Crowd.

Results

Similar domains and themes emerged from responses of crowdsourcing and focus group participants. In each domain, parenting YC-T1D was challenging, but there was also substantial evidence of positive coping strategies and adaptability.

Conclusions

The study yielded rich data to inform user-centered design of an Internet resource for parents of YC-T1D.

Experiences of women and men living with urinary incontinence: A phenomenological study

AIMS

To explore and understand, from a gender-based perspective, the quality-of-life experiences of men and women who suffer from urinary incontinence.

BACKGROUND

Urinary incontinence (UI) is a major health problem with significant social, psychological, occupational, sexual and economic effects leading to a substantial decrease in quality of life. Although this condition is increasingly frequent in men, research has tended to focus on women, adopting a quantitative approach.

DESIGN

The data were examined using interpretive phenomenological analysis (IPA).

METHODS

The data were collected through a semi-structured interview conducted between January and June 2016. An inductive discourse content analysis was performed in three stages: preparation, organization and report. Participants were recruited until data saturation was achieved.

FINDINGS

A sample of 33 participants was recruited: 17 women and 16 men. Gender-specific features were found. Six categories emerged: (i) normalization of incontinence; (ii) verbalization of the problem; (iii) social isolation; (iv)experienced feelings and emotions; (v) impact on daily routine; (vi) self-care strategies to address the problem in the most suitable way.

CONCLUSION

Urinary incontinence has a negative effect on the quality of life of men and women. However, there are gender differences as to how this phenomenon is experienced, particularly with regard to its psychological and social dimensions. A comprehensive, targeted assessment of the needs of these men and women is required on the part of professional nurses.

Using Qualitative Perspectives of Adolescents with Sickle Cell Disease and Caregivers to Develop Healthcare Transition Programming

Youth with sickle cell disease (SCD) are living longer, requiring transition from pediatric to adult health care. Transition programs have been created to improve transition readiness and help patients take responsibility for their health. The aim of this study was to explore the usefulness of current transition materials and identify unmet transition needs from the perspective of adolescents with sickle cell disease (SCD) and caregivers to refine transition programming and interventions. Focus groups were conducted with 14 adolescents with SCD (Mean age = 14.6 years, SD = 1.9) and 20 caregivers (Mean age = 43.2 years, SD = 9.3) to gather perspectives about transition to adult care, current transition program materials and recommendations for future programming. Four themes emerged: (a) transition skills and knowledge needs, (b) change in health care responsibility, (c) concerns with adult SCD care, and (d) useful transition readiness strategies and resources. The findings of this study were used to develop Web based educational modules, experiential transition skills learning, and an adolescent and caregiver hematology support group. Findings highlight the need to conduct periodic readiness assessments, provide opportunities and scaffolding to learn skills based on readiness level, and help build social support networks to encourage and facilitate learning.

Components of Effective Cognitive-Behavioral Therapy for Pediatric Headache: A Mixed Methods Approach

Internet-delivered treatment has the potential to expand access to evidence-based cognitive-behavioral therapy (CBT) for pediatric headache, and has demonstrated efficacy in small trials for some youth with headache. We used a mixed methods approach to identify effective components of CBT for this population. In Study 1, component profile analysis identified common interventions delivered in published RCTs of effective CBT protocols for pediatric headache delivered face-to-face or via the Internet. We identified a core set of three treatment components that were common across face-to-face and Internet protocols: 1) headache education, 2) relaxation training, and 3) cognitive interventions. Biofeedback was identified as an additional core treatment component delivered in face-to-face protocols only. In Study 2, we conducted qualitative interviews to describe the perspectives of youth with headache and their parents on successful components of an Internet CBT intervention. Eleven themes emerged from the qualitative data analysis, which broadly focused on patient experiences using the treatment components and suggestions for new treatment components. In the Discussion, these mixed methods findings are integrated to inform the adaptation of an Internet CBT protocol for youth with headache.

Stakeholders' Perceptions Sought to Inform the Development of a Low-Cost Mobile Robot for Older Adults: A Qualitative Descriptive Study

Creative solutions are needed to support community-dwelling older adults residing in a variety of settings including their house, apartment, or Supportive Apartment Living (SAL) to promote independence and reduce the risk of nursing home replacement. The objective of this study was to gain an understanding of older adults' needs for physical, mental, and social activities to support the design and functionality of a low-cost mobile assistive robot. A qualitative descriptive study was designed which included three stakeholder focus groups (caregivers, clinicians, and older adults). We held three focus groups with a total of 19 participants: one with paid caregivers ( n = 6), one with interdisciplinary clinicians ( n = 8), and one with older adults residing in SAL ( n = 5). Conventional content analysis was the analytical technique. Four themes emerged: (a) Accomplishing Everyday Tasks: activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were important from the perspectives of all three groups for the older adults to accomplish daily, as well as the "use it or lose it" attitude of the older adults; (b) Personal Connections and Meaningful Activities: for the older adults, it was important for them to engage in socialization and leisure activities, and for the caregivers and clinicians, they work to build personal relationships with the older adults; (c) Cognitive Interventions: the clinicians provided cognitive tools (including reminders, routine and designing interventions) to older adults so they can remain as safe and independent as possible in the SAL; and (d) Safety Measures: encompassed clinicians addressing safety and injury prevention and the caregivers checking in on the older adults in their SAL apartments. This work contributed to the design and functionality specifications for an autonomous low-cost mobile robot for deployment to increase the independence of older adults.

Patient Perspectives on Gene Transfer Therapy for Sickle Cell Disease

INTRODUCTION

Sickle cell disease (SCD) is a chronic genetic disease with high morbidity and early mortality; it affects nearly 100,000 individuals in the USA. Bone marrow transplantation, the only curative treatment, is available to less than 20% of patients because of a number of access barriers. Gene transfer therapy (GTT) has been shown to be curative in animal models and is approved for use in humans for early-phase studies at a few centers. GTT would offer a more accessible treatment option available to all patients. It is important to understand patient perspectives on GTT to help ensure human clinical trial success.

METHODS

Two focus groups were conducted with younger (18-30 years) and older (31 years and older) adults with SCD to obtain data on patient knowledge and beliefs about GTT. Data from these two focus groups was used to develop a GTT educational brochure. A third focus group was conducted to obtain participant feedback on acceptability and feasibility of education and the brochure.

RESULTS

Most adults, especially young adults, had little knowledge about GTT and expressed fear and uncertainty about the side effects of chemotherapy (e.g., hair loss, infertility), use of a human immunodeficiency virus (HIV)-derived viral vector, and potential for cancer risk. Participants wanted full transparency in educational materials, but advised researchers not to share the vector's relation to HIV because of cultural stigma and no HIV virus is used for the GTT vector.

CONCLUSION

Older adults had more desire to participate in human clinical GTT trials than younger participants. When recruiting for trials, researchers should develop GTT educational materials that address participant lack of trust in the healthcare system, cultural beliefs, fears related to side effects, and include visual illustrations. Use of such materials will provide adults with SCD the information they need to fully evaluate GTT.

Caregiver perspectives on the social competence of pediatric brain tumor survivors

ᅟ: Pediatric brain tumor survivors are at risk for significant difficulties related to social competence. Little research has examined factors that contribute to survivor social problems.

PURPOSE

The current study is grounded in a model of social competence for youth with brain disorder and used qualitative and quantitative methods to obtain caregiver perspectives on survivor social competence and identify pertinent risk and resistance factors.

METHODS

The study occurred in two phases, including focus groups with 36 caregivers of 24 survivors and confirmatory interviews with 12 caregivers of 12 survivors.

RESULTS

Qualitative content analyses resulted in three themes that were illustrative of the model of social competence. Themes included (1) the impact of survivor sequelae on social function; (2) the role of family in evaluating and promoting survivor social development; and (3) the match between the survivor's social context and developmental needs. Quantitative data supported the associations between survivor social skills, survivor executive function, and family functioning.

CONCLUSIONS

Overall, findings underscore the influence of risk and resistance factors across different systems on survivor social competence and suggest directions for future research and intervention efforts.

Diabetes care provider perceptions on family challenges of pediatric type 1 diabetes

Pediatric healthcare providers' perspectives on barriers to diabetes self-management among youth with type 1 diabetes and strategies to overcome them were explored qualitatively. Family conflict about diabetes care was viewed as a common problem, addressable by behavioral interventions to improve communication and promote family teamwork in diabetes management responsibilities.

A Single-Arm Feasibility Trial of Problem-Solving Skills Training for Parents of Children with Idiopathic Chronic Pain Conditions Receiving Intensive Pain Rehabilitation

Objective

To adapt problem-solving skills training (PSST) for parents of children receiving intensive pain rehabilitation and evaluate treatment feasibility, acceptability, and satisfaction.

Methods

Using a prospective single-arm case series design, we evaluated the feasibility of delivering PSST to 26 parents (84.6% female) from one of three pediatric pain rehabilitation programs.

Results

Parents completed four to six sessions of PSST delivered during a 2-4-week period. A mixed-methods approach was used to assess treatment acceptability and satisfaction. We also assessed changes in parent mental health and behavior outcomes from pretreatment to immediate posttreatment and 3-month follow-up. Parents demonstrated excellent treatment adherence and rated the intervention as highly acceptable and satisfactory. Preliminary analyses indicated improvements in domains of mental health, parenting behaviors, health status, and problem-solving skills.

Conclusions

Findings demonstrate the potential role of psychological interventions directed at reducing parent distress in the context of intensive pediatric pain rehabilitation.

Long-Term Pain and Recovery After Major Pediatric Surgery: A Qualitative Study With Teens, Parents, and Perioperative Care Providers

Research developing targeted treatment focused on coping with children's long-term pain after surgery is needed because of the high prevalence of chronic pain after surgery. This qualitative study aimed to: 1) understand the child's and family's experiences of pain over the course of their surgical experience, and 2) gather stakeholder input regarding potential barriers and facilitators of perioperative intervention delivery. Fifteen children ages 10 to 18 years who underwent recent major surgery, their primary caregivers, and 17 perioperative health care providers were interviewed. Interviews were coded using semantic thematic analysis. The perioperative period presented emotional challenges for families. Families felt unprepared for surgery and pain. Recovery and regaining physical functioning at home was challenging. Families struggled to return to valued activities. Families reported interest in a perioperative psychosocial intervention. Providers endorsed that families would benefit from enhanced coping skills. They emphasized that families would benefit from more detailed preparatory information. Providers suggested that flexible intervention delivery at home would be ideal. Research developing interventions addressing pain and anxiety in children undergoing major surgery is critically needed. The findings of the present study can inform intervention development with the aim of improving short- as well as long-term recovery in children undergoing major surgery.

PERSPECTIVE

This qualitative study examined children and their parents' experience of long-term pain and recovery after major surgery, identifying barriers and facilitators of perioperative intervention delivery. Families experienced surgery as stressful, and felt underprepared for pain and recovery. Families and health care providers expressed interest in a preoperative intervention teaching coping skills.

Patient outcomes after critical illness: a systematic review of qualitative studies following hospital discharge

BACKGROUND

There is growing interest in patient outcomes following critical illness, with an increasing number and different types of studies conducted, and a need for synthesis of existing findings to help inform the field. For this purpose we conducted a systematic review of qualitative studies evaluating patient outcomes after hospital discharge for survivors of critical illness.

METHODS

We searched the PubMed, EMBASE, CINAHL, PsycINFO, and CENTRAL databases from inception to June 2015. Studies were eligible for inclusion if the study population was >50 % adults discharged from the ICU, with qualitative evaluation of patient outcomes. Studies were excluded if they focused on specific ICU patient populations or specialty ICUs. Citations were screened in duplicate, and two reviewers extracted data sequentially for each eligible article. Themes related to patient outcome domains were coded and categorized based on the main domains of the Patient Reported Outcomes Measurement Information System (PROMIS) framework.

RESULTS

A total of 2735 citations were screened, and 22 full-text articles were eligible, with year of publication ranging from 1995 to 2015. All of the qualitative themes were extracted from eligible studies and then categorized using PROMIS descriptors: satisfaction with life (16 studies), including positive outlook, acceptance, gratitude, independence, boredom, loneliness, and wishing they had not lived; mental health (15 articles), including symptoms of post-traumatic stress disorder, anxiety, depression, and irritability/anger; physical health (14 articles), including mobility, activities of daily living, fatigue, appetite, sensory changes, muscle weakness, and sleep disturbances; social health (seven articles), including changes in friends/family relationships; and ability to participate in social roles and activities (six articles), including hobbies and disability.

CONCLUSION

ICU survivors may experience positive emotions and life satisfaction; however, a wide range of mental, physical, social, and functional sequelae occur after hospital discharge. These findings are important for understanding patient-centered outcomes in critical care and providing focus for future interventional studies aimed at improving outcomes of importance to ICU survivors.

Characteristics of Qualitative Descriptive Studies: A Systematic Review

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, although there were some inconsistencies, most articles included characteristics consistent with the limited available QD definitions and descriptions. Next, flexibility or variability of methods was common and effective for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD studies so that readers can determine whether the methods used were reasonable and effective in producing useful findings. © 2016 Wiley Periodicals, Inc.