101
|
Cross‐racial interactions in the counselor education classroom: The impact of racial perception. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1002/jmcd.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
102
|
Dart J, Ash S, McCall L, Rees C. ‘We’re our own worst enemies’: A qualitative exploration of sociocultural factors in dietetic education influencing student-dietitian transitions. J Acad Nutr Diet 2022; 122:2036-2049.e4. [DOI: 10.1016/j.jand.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
|
103
|
Dart J, McCall L, Ash S, Rees C. Conceptualising professionalism in dietetics: an Australasian qualitative study. J Acad Nutr Diet 2022; 122:2087-2096.e7. [PMID: 35202846 DOI: 10.1016/j.jand.2022.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Professionalism is a vital aspect of healthcare and multidisciplinary teamwork. While there is substantive professionalism literature in medicine and an expanding healthcare professions literature, there is a significant gap in understanding professionalism in dietetics. There are very few research papers in the dietetics literature on this issue compared with other health professions. Given the multidisciplinary nature of healthcare, it is important to understand what professionalism means within each profession to develop shared understandings across healthcare teams. OBJECTIVE The study aim was to explore how dietetics professionalism is conceptualised by dietetic practitioners/preceptors, faculty and new graduates. DESIGN A constructionist exploratory qualitative interview study was conducted. PARTICIPANTS/SETTING One hundred participants (dietetic graduates, faculty and practitioners/preceptors), associated with 17 universities across Australia and New Zealand and from diverse geographical and work settings, participated in 27 group and 24 individual interviews from March 2018 to June 2019. ANALYSIS PERFORMED Thematic framework analysis was used to examine participants' understandings of professionalism. RESULTS Twenty-three dimensions of dietetics professionalism were identified, with the most common being communication and including four novel dimensions of professionalism (generational, emotion management, cultural capability and advocacy) not previously described in other professions. Professionalism as emotion management and generational adds new insights to the professionalism literature, expanding understandings of this vital aspect of healthcare. While high levels of consistency in professionalism understandings existed across the three stakeholder groups, some interesting differences were found. The profession of dietetics shares similarities with other professions in the ways professionalism is conceptualised. CONCLUSIONS Using these dimensions of professionalism as a framework for teaching and learning about professionalism will help in clarifying expectations and expand shared understandings about professionalism for dietitians, other health professions and across multidisciplinary teams.
Collapse
Affiliation(s)
- Janeane Dart
- Advanced Accredited Practicing Dietitian (AdvAPD), Dietitians Australia, Senior Lecturer / Doctoral Candidate, Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, AUSTRALIA.
| | - Louise McCall
- Adjunct Professor, Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, AUSTRALIA
| | - Susan Ash
- Master Health Planning, Postgrad Dip Nut & Diet., BSc, Fellow, Dietitians Australia, Adjunct Professor, Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, AUSTRALIA
| | - Charlotte Rees
- Professor, Head of School, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, AUSTRALIA, Adjunct Professor, Monash Centre for Scholarship in Health Education (MCSHE), 27 Rainforest Walk, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, 3800, AUSTRALIA
| |
Collapse
|
104
|
Elliott A, Lang S, Truby H, Brennan L, Gibson S. Tackling the challenge of treating obesity using design research methods: A scoping review. Obes Rev 2022; 23:e13360. [PMID: 34545669 DOI: 10.1111/obr.13360] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 01/10/2023]
Abstract
Design research methods, including user-centered design, human-centered design, and design thinking, are iterative processes and frameworks that engage stakeholders to inform the design of initiatives, programs, or research interventions. Design research methods are not yet widely applied in healthcare. To date, there is a limited understanding of how design research methodologies can be applied to develop client-centered weight loss interventions. This scoping review explores the extent, range, and nature of research projects that used design research methods to guide the development of an obesity treatment intervention. A systematic search of eight databases identified projects that used design research methods to develop a weight loss intervention or strategy. The method and practical application of design research processes for each eligible article were extracted and explored. Design research methods were used to generate ideas or guide the development of a mobile application (n = 6), mHealth device (n = 1), eHealth solution (n = 1), health promotion program (n = 1), or patient-clinician communication tools (n = 2). There was considerable variation in the application of design research processes between studies. Design research methods may provide an iterative, flexible framework to facilitate the development of client-centered, inclusive interventions and strategies. Design research methods may support research teams to move away from the one-size-fits-all approach to obesity treatment.
Collapse
Affiliation(s)
- Andrea Elliott
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Linda Brennan
- School of Media and Communication, RMIT University, Melbourne, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
105
|
McDonald F, Robinson K, Gallagher AL, Pettigrew J. Exploring the co-involvement of disabled adolescents in participatory action research; protocol for a critical interpretative synthesis. HRB Open Res 2022; 4:79. [PMID: 34988367 PMCID: PMC8689409 DOI: 10.12688/hrbopenres.13343.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Participatory action research (PAR) provides an opportunity for academic researchers and adolescents to co-conduct research within an area of shared interest. Reciprocal learning occurs as co-researchers acquire research skills and knowledge, and academic researchers gain understanding of the issue being examined, from the perspective of those with lived experience. All members of the research team have a shared responsibility for the research and decision-making processes. PAR has predominantly involved adults as co-researchers. However, in recent years more effort has been made to co-conduct research with adolescents. The aim of this review is to interrogate the practices of academic researchers employing a PAR approach when working along-side disabled adolescents. Methods/design: A critical interpretive synthesis (CIS) will be conducted, allowing for a diverse range of evidence to be drawn from. A systematic search of nine databases, from 1990 onwards, will be conducted first. Reference checking will occur to elicit further relevant data. Following screening, further purposive sampling will be completed to facilitate the development of concepts and theory in line with the on-going analysis and synthesis of findings. Data analysis will involve interpretation of included papers in relation to the principles of PAR and a ‘best-practice’ framework will be developed. During analysis particular emphasis will be given to the identification of potential social barriers to the participation of disabled adolescents in PAR. Discussion: PAR is widely employed but little is known about its use when working with disabled adolescents. This current CIS will critically question the current practices of academic researchers employing PAR when working along-side disabled adolescents and future research through the best practice framework we will develop.
Collapse
Affiliation(s)
- Fiona McDonald
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Robinson
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Aoife L Gallagher
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Judith Pettigrew
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| |
Collapse
|
106
|
Bevens W, Reece J, Jelinek PL, Weiland TJ, Nag N, Simpson-Yap S, Gray K, Jelinek GA, Neate SL. The feasibility of an online educational lifestyle program for people with multiple sclerosis: A qualitative analysis of participant semi-structured interviews. Digit Health 2022; 8:20552076221123713. [PMID: 36081754 PMCID: PMC9445470 DOI: 10.1177/20552076221123713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the feasibility of a randomised controlled trial of a multiple sclerosis online course (MSOC) via qualitative analysis of participant semi-structured interviews. Methods The MSOC was developed in two arms: intervention arm which contained evidence-based lifestyle modification recommendations, and standard-care arm which delivered information from MS websites reflecting standard advice. Participants were recruited via online advertisements, completed a baseline questionnaire, and randomised. Seven modules were delivered over six weeks. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, interviews were analysed using reflexive thematic analysis. Results Fourteen of the 17 course completers were interviewed: 86% (12/14) female; mean age 50 years; residing in Australia, New Zealand, and the USA, predominantly had relapsing-remitting MS, mean time from diagnosis 9.5 years, and patient-determined disease steps disability assessment distributed evenly across all three categories. Four themes were identified: 1) “Hearing our stories” (hope for the future, feeling represented, exploring the journey of others with MS, learning from diversity, and wanting to connect with others); 2) “Taking the plunge” (not wanting to be first, feelings of nervousness or reluctance and feeling confronted); 3) “The accessibility and safety of being online” (ease of access, going at your own pace, making it work and not letting others down); and 4) “unpacking the course” (ease of navigation, visuals, understandability, and length and timing). Conclusion Participants felt represented, found the course accessible and content was easy to understand. These experiences provide important insights and considerations for this digital health intervention.
Collapse
Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - J Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - PL Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - TJ Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Gray
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - GA Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - SL Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
107
|
Wishart D, Cruz Alvarez C, Ward C, Danner S, O'Brian CA, Simon M. Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review. Health Equity 2021; 5:554-568. [PMID: 34909522 PMCID: PMC8665802 DOI: 10.1089/heq.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.
Collapse
Affiliation(s)
- Danielle Wishart
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sankirtana Danner
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
108
|
Carvalho M, Dunne P, Kwasnicka D, Byrne M, McSharry J. Barriers and enablers to sustaining self-management behaviours after completing a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis. HRB Open Res 2021; 4:129. [DOI: 10.12688/hrbopenres.13466.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following completion of a self-management support intervention for type 2 diabetes. Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.
Collapse
|
109
|
The impact of excluded providers on Medicare beneficiaries’ mental health care. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
110
|
Kritz M, Thøgersen-Ntoumani C, Mullan B, Stathi A, Ntoumanis N. How can older peer leaders best support motivation for walking in physically inactive older adults? A self-determination theory perspective. Psychol Health 2021:1-22. [PMID: 34726967 DOI: 10.1080/08870446.2021.1994968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to determine what older adults perceive to be need-supportive behaviours of peer walk leaders, drawing primarily from Self-Determination Theory (SDT). DESIGN Experienced peer leaders (n = 13; Mage = 73.23, SD = 6.55) and walkers (n = 17; Mage = 72.88, SD = 5.79) were recruited from existing walking groups. Individuals who expressed an interest in becoming a peer leader (n = 18; Mage = 72.72, SD = 4.99) or walker (n = 20; Mage = 78.90, SD = 10.45) were recruited from retirement villages. MAIN OUTCOME MEASURES We conducted semi-structured interviews to identify leader behaviours that support autonomy, competence, and relatedness and analysed the data using framework analysis. RESULTS We identified eight main themes: eliciting walker interest, acknowledging and adapting to walkers' requirements, ensuring walkers feel comfortable, cared for, and socially integrated, supporting walker confidence, and promoting success experiences. Inexperienced leaders differed from other sub-groups in what they perceived to be supportive behaviours. CONCLUSION Future peer leaders could use the identified behaviours to help older adults feel motivated during group walks. New peer leaders can be educated about potential differences between what they describe as supportive and what walkers and experienced leaders perceive as need-supportive behaviours.
Collapse
Affiliation(s)
- Marlene Kritz
- Physical Activity and Wellbeing Research Group, Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Cecilie Thøgersen-Ntoumani
- Physical Activity and Wellbeing Research Group, Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Enable Institute, Curtin University, Australia
| | - Barbara Mullan
- Enable Institute, Curtin University, Australia.,WACPRU, Curtin University, Perth, Australia
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nikos Ntoumanis
- Physical Activity and Wellbeing Research Group, Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Enable Institute, Curtin University, Australia.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
| |
Collapse
|
111
|
Switzer S, Flicker S. Visualizing DEPICT: A Multistep Model for Participatory Analysis in Photovoice Research for Social Change. Health Promot Pract 2021; 22:50S-65S. [PMID: 34664518 PMCID: PMC8739615 DOI: 10.1177/15248399211045017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As a critical narrative intervention, photovoice invites community members to use photography to identify, document, and discuss issues in their communities. The method is often employed with projects that have a social change mandate. Photovoice may help participants express issues that are difficult to articulate, create tangible and meaningful research products for communities, and increase feelings of ownership. Despite being hailed as a promising participatory method, models for how to integrate diverse stakeholders feasibly, collaboratively, and rigorously into the analytic process are rare. The DEPICT model, originally developed to collaboratively analyze textual data, enhances rigor by including multiple stakeholders in the analysis process. We share lessons learned from Picturing Participation, a photovoice project exploring engagement in the HIV sector, to describe how we adapted DEPICT to collaboratively analyze participant-generated images and narratives across multiple sites. We highlight the following stages: dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, and collaborative analysis and translation, and we discuss how participatory analysis is compatible with creative, interactive dissemination outputs such as exhibitions, presentations, and workshops. The benefits of Visualizing DEPICT include feelings of increased ownership by community researchers and participants, enhanced rigor, and sophisticated knowledge translation approaches that honor multiple forms of knowing and community leadership. The potential challenges include navigating team capacity and resources, transparency and confidentiality, power dynamics, data overload, and streamlining "messy" analytic processes without losing complexity or involvement. Throughout, we offer recommendations for designing participatory visual analysis processes that are connected to critical narrative intervention and social change aims.
Collapse
Affiliation(s)
- Sarah Switzer
- University of Toronto, Toronto, Ontario, Canada
- Sarah Switzer, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, Ontario, M5S 1V6, Canada;
| | | |
Collapse
|
112
|
Werner NE, Rutkowski RA, Krause S, Barton HJ, Wust K, Hoonakker P, King B, Shah MN, Pulia MS, Brenny-Fitzpatrick M, Smith M, Carayon P. Disparate perspectives: Exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility. APPLIED ERGONOMICS 2021; 96:103509. [PMID: 34157478 PMCID: PMC8320066 DOI: 10.1016/j.apergo.2021.103509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/28/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. We explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF). We conducted a thematic analysis of interviews with ED and SNF healthcare professionals and identified three themes: 1) ED and SNF healthcare professionals had misaligned mental models regarding communication processes and tools used during care transitions, 2) ED and SNF healthcare professionals had misaligned mental models regarding healthcare system capability, and 3) Misalignments led to individual and organizational consequences. Overall, we found that SNF and ED healthcare professionals are part of the same process but have different perceptions of the process. Future work must take steps to redesign and realign these distinct work systems such that those involved conceptualize themselves as part of a joint process.
Collapse
Affiliation(s)
- Nicole E Werner
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States.
| | - Rachel A Rutkowski
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Sheryl Krause
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Hanna J Barton
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Kathryn Wust
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Peter Hoonakker
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Barbara King
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Manish N Shah
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Michael S Pulia
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Maria Brenny-Fitzpatrick
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Maureen Smith
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Pascale Carayon
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| |
Collapse
|
113
|
Mazur KM, Desmadryl M, VanAntwerp K, Ziegman C, Nemshak M, Shuman CJ. Implementing Evidence-Informed Discharge Preparedness Tools in the NICU: Parents' Perceptions. Adv Neonatal Care 2021; 21:E111-E119. [PMID: 33538497 DOI: 10.1097/anc.0000000000000836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies address preparing parents of neonatal intensive care unit (NICU) infants for infant discharge. Inadequate or ineffective parental preparedness for discharge can result in preventable emergency department and primary care visits. Parents' perceptions are needed to inform development and implementation of effective educational tools to improve parent discharge preparedness in the NICU. PURPOSE To describe the perceptions of parents of recently discharged NICU infants regarding discharge preparedness and implementation of the My Flight Plan for Home parent discharge preparedness tool. METHODS We used a qualitative descriptive design to collect individual interview data from 15 parents with infants discharged from a level 4 NICU in the Midwest. Individual interviews were conducted using a semistructured guide and were audio-recorded, transcribed verbatim, and thematically analyzed using the constant comparative method. RESULTS We identified 5 major themes: (1) family dynamics; (2) parenting in the NICU; (3) discharge preparedness; (4) engaging parents in infant care; and (5) implementation recommendations for the My Flight Plan for Home tool. Minor themes supported each of the major themes. IMPLICATIONS FOR PRACTICE To improve parents' confidence in caring for their infant after discharge, parents suggest nurses must engage parents in discharge education and infant care shortly following NICU admission and use parent-centered discharge preparedness tools. IMPLICATIONS FOR RESEARCH Future studies are needed to develop and test parent-tailored strategies for implementing parent discharge preparedness tools in the NICU.
Collapse
|
114
|
Atkinson MK, Singer SJ. Managing Organizational Constraints in Innovation Teams: A Qualitative Study Across Four Health Systems. Med Care Res Rev 2021; 78:521-536. [PMID: 32552540 PMCID: PMC8483614 DOI: 10.1177/1077558720925993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Though increasingly useful for developing complex healthcare innovations, interdisciplinary teams are prone to resistance and other organizational challenges. However, how teams are affected by and manage external constraints over the lifecycle of their innovation project is not well understood. We used a multimethod qualitative approach consisting of over 3 years of participant observation data to analyze how four interdisciplinary teams across different health systems experienced and managed constraints as they pursued process innovations. Specifically, we derived the constraint management process, which demonstrates how teams address constraints at different stages of innovation by applying various tactics. Our findings point to several practical implications concerning innovation processes in healthcare: (a) how conditions in the organizational context, or constraints, can impede team progress at different stages of innovation; and (2) the collective efforts, or tactics, teams use to manage or work around these constraints to further progress on their innovations.
Collapse
Affiliation(s)
- Mariam K. Atkinson
- Harvard University, T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 311, Boston, MA 02115
| | - Sara J. Singer
- Stanford University School of Medicine, 1265 Welch Road, Medical School Office Building, Room 328 Stanford, CA 94305
| |
Collapse
|
115
|
Zorbas C, Browne J, Chung A, Baker P, Palermo C, Reeve E, Peeters A, Backholer K. National nutrition policy in high-income countries: is health equity on the agenda? Nutr Rev 2021; 79:1100-1113. [PMID: 33230539 DOI: 10.1093/nutrit/nuaa120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Equity-oriented policy actions are a key public health principle. In this study, how equity and socioeconomic inequalities are represented in policy problematizations of population nutrition were examined. DATA SOURCES We retrieved a purposive sample of government nutrition-policy documents (n = 18) from high-income nations. DATA SYNTHESIS Thematic analysis of policy documents was informed by a multitheoretical understanding of equitable policies and Bacchi's "What's the Problem Represented to be?' analysis framework. Despite common rhetorical concerns about the existence of health inequalities, these concerns were often overshadowed by greater emphasis on lifestyle "problems" and reductionist policy actions. The notion that policy actions should be for all and reach everyone were seldom backed by specific actions. Rhetorical acknowledgements of the upstream drivers of health inequalities were also rarely problematized, as were government responsibilities for health equity and the role of policy and governance in reducing socioeconomic inequalities in nutrition. CONCLUSION To positively influence health equity outcomes, national nutrition policy will need to transition toward the prioritization of actions that uphold social justice and comprehensively address the upstream determinants of health.
Collapse
Affiliation(s)
- Christina Zorbas
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Jennifer Browne
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Phillip Baker
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia
| | - Erica Reeve
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| |
Collapse
|
116
|
Ananth P, Mun S, Reffat N, Li R, Sedghi T, Avery M, Snaman J, Gross CP, Ma X, Wolfe J. A Stakeholder-Driven Qualitative Study to Define High Quality End-of-Life Care for Children With Cancer. J Pain Symptom Manage 2021; 62:492-502. [PMID: 33556497 PMCID: PMC8339188 DOI: 10.1016/j.jpainsymman.2021.01.134] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Among adults with cancer, measures for high quality end-of-life care (EOLC) include avoidance of hospitalizations near end of life. For children with cancer, no measures exist to evaluate or improve EOLC, and adult quality measures may not apply. OBJECTIVE We engaged key stakeholders to explore EOLC priorities for children with cancer and their families, and to examine relevance of existing adult EOLC quality measures for children with cancer. METHODS In a multicenter qualitative study, we conducted interviews and focus groups with: adolescents and young adults (AYAs) with advanced cancer, parents of children with advanced cancer, bereaved parents, and interdisciplinary healthcare professionals. We transcribed, coded, and employed thematic analysis to summarize findings. RESULTS We enrolled 54 stakeholders (25 parents [including 12 bereaved parents], 10 AYAs, and 19 healthcare professionals). Participants uniformly prioritized direct communication with children about preferences and prognosis, interdisciplinary care, symptom management, and honoring family preference for location of death. Many participants valued access to the emergency department or hospital for symptom management or supportive care, which diverges from measures for high quality EOLC in adults. Most wished to avoid mechanical ventilation and cardiopulmonary resuscitation. Notably, participants generally valued hospice; however, few understood hospice care or had utilized its services. CONCLUSION Childhood cancer stakeholders define high quality EOLC primarily through person-centered measures, characterizing half of existing adult-focused measures as limited in relevance to children. Future research should focus on developing techniques for person-centered quality measurement to capture attributes of greatest importance to children with cancer and their families.
Collapse
Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA.
| | - Sophia Mun
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Noora Reffat
- Biological Sciences Division, University of Chicago Medicine¸ Chicago, Illinois, USA
| | - Randall Li
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tannaz Sedghi
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Madeline Avery
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
117
|
Gillham J, Vassilev I, Band R. Rural influences on the social network dynamics of district nursing services: A qualitative meta-synthesis. Health Sci Rep 2021; 4:e336. [PMID: 34430710 PMCID: PMC8369946 DOI: 10.1002/hsr2.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS As demands on healthcare services grow, fiscal restrictions place increased emphasis on services outside of traditional healthcare settings. Previous research into long-term-conditions suggests that social network members (including weaker ties such as acquaintances, community groups, and healthcare professionals) play a key role in illness management. There is limited knowledge about the engagement of social networks in supporting people who are receiving medical interventions at home. This qualitative metasynthesis explores the work and the interactions between district nurses (DN) and informal network members supporting people who are receiving medical interventions at home and living in rural areas. METHODS A search was undertaken on CINAHL, Medline, and PsychINFO for qualitative research articles from 2009 to 2019. Studies that examined DN in rural locations and/or social network support in rural locations were eligible. Fourteen articles were selected. RESULTS Thematic analysis of results and discussion data from the studies resulted in four themes being developed: the development of both transactional and friend-like nurse-patient ties in rural localities, engagement of the wider network in the delivery of good care, blurring of professional boundaries in close community relationships, and issues accessing and navigating formal and informal support in the context of diminishing resources in rural areas.These findings suggest that DNs in rural localities work beyond professional specialties and experience to provide emotional support, help with daily tasks, and build links to communities. There was also evidence that nurses embedded within rural localities developed friend-like relationships with patients, and negotiated with existing support networks and communities to find support for the patient. CONCLUSIONS Findings indicated that developing strong links with patients and members of their networks does not automatically translate into positive outcomes for patients, and can be unsustainable, burdensome, and disruptive. DNs developing weak ties with patients and building awareness of the structure of individual networks and local sources of support offers avenues for sustainable and tailored community-based nursing support.
Collapse
Affiliation(s)
- Jack Gillham
- School of Health SciencesUniversity of SouthamptonSouthamptonEngland
| | - Ivaylo Vassilev
- School of Health SciencesUniversity of SouthamptonSouthamptonEngland
| | - Rebecca Band
- School of Health SciencesUniversity of SouthamptonSouthamptonEngland
| |
Collapse
|
118
|
Ottrey E, Rees CE, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study. MEDICAL EDUCATION 2021; 55:1078-1090. [PMID: 33617656 DOI: 10.1111/medu.14475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition. METHODS We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally. RESULTS We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3). DISCUSSION This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.
Collapse
Affiliation(s)
- Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- College of Science, Health, Engineering & Education, Murdoch University, Murdoch, WA, Australia
| | - Caitlin Kemp
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Tina P Brock
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Michelle Leech
- Medicine, Nursing & Health Sciences Medicine Course, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic, Australia
| | - Kayley Lyons
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Lynn V Monrouxe
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Julia Morphet
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
| |
Collapse
|
119
|
Kumar A, Sarkar M, Davis E, Morphet J, Maloney S, Ilic D, Palermo C. Impact of the COVID-19 pandemic on teaching and learning in health professional education: a mixed methods study protocol. BMC MEDICAL EDUCATION 2021; 21:439. [PMID: 34412603 PMCID: PMC8374410 DOI: 10.1186/s12909-021-02871-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/09/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Due to the complex nature of healthcare professionals' roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus. METHODS The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches. DISCUSSION The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature.
Collapse
Affiliation(s)
- Arunaz Kumar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Victoria 3168 Clayton, Australia
| | - Mahbub Sarkar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Victoria 3168 Clayton, Australia
| | - Elizabeth Davis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Victoria 3168 Clayton, Australia
| | - Julia Morphet
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula campus, Franskton, Victoria Australia
| | - Stephen Maloney
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Victoria 3168 Clayton, Australia
| | - Dragan Ilic
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Victoria 3168 Clayton, Australia
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Victoria 3168 Clayton, Australia
| |
Collapse
|
120
|
Mehrabi S, Muñoz JE, Basharat A, Boger J, Cao S, Barnett-Cowan M, Middleton LE. Immersive virtual reality exergames to promote well-being of community-dwelling older adults: a mixed-methods pilot study protocol (Preprint). JMIR Res Protoc 2021; 11:e32955. [PMID: 35700014 PMCID: PMC9237784 DOI: 10.2196/32955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/21/2022] [Accepted: 04/21/2022] [Indexed: 01/26/2023] Open
Abstract
Background Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults. Objective The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics). Methods The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults. Results The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ≥80%. Challenges associated with VR technology and the complexity of remote assessments are expected. Conclusions This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults’ well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults. International Registered Report Identifier (IRRID) DERR1-10.2196/32955
Collapse
Affiliation(s)
- Samira Mehrabi
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - John E Muñoz
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Aysha Basharat
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - Shi Cao
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| |
Collapse
|
121
|
Rees CE, Ottrey E, Barton P, Dix S, Griffiths D, Sarkar M, Brooks I. Materials matter: Understanding the importance of sociomaterial assemblages for OSCE candidate performance. MEDICAL EDUCATION 2021; 55:961-971. [PMID: 33651462 DOI: 10.1111/medu.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The OSCE is a sociomaterial assemblage-a meshing together of human and material components producing multiple effects. Materials matter because they shape candidate performance, with potentially calamitous career consequences if materials influence performance unjustly. Although the OSCE literature refers to materials, few papers study the sociomateriality of OSCEs. Therefore, we explored OSCE stakeholders' talk about sociomaterial assemblages to better understand their importance for candidate performance. METHODS We conducted 15 focus groups with OSCE candidates (n = 42), examiners (n = 20) and simulated patients (n = 17) after an Australian postgraduate nursing OSCE. Sociomateriality informed our team-based framework analysis of data. RESULTS Participants identified a multiplicity of OSCE materials (objects, technologies and spaces) thought to matter for candidate performance. Candidates' unfamiliarity with materials and missing or malfunctioning materials were reported to yield numerous negative impacts (eg cognitive overload, negative affect, time-wasting), thereby adversely affecting candidate performance. Both examiners and candidates made micro-adjustments to sociomaterial assemblages during the OSCE in order to make it work (eg candidates saying what they would do rather than doing it). Sometimes, such tinkering extended so far that sociomaterial assemblages were ruptured (eg examiners ignoring rubrics to help pass candidates), potentially influencing OSCE standardisation. DISCUSSION Our novel empirical study extends previous conceptual work by illustrating wide-ranging sociomaterial assemblages influencing OSCE candidate performance. Further research is now needed employing sociomaterial approaches to further elucidate sociomaterial entanglements in diverse OSCEs. We encourage OSCE stakeholders to become more attuned to the productive nature of materials within all stages of OSCE design and implementation.
Collapse
Affiliation(s)
- Charlotte E Rees
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Peter Barton
- Medicine, Nursing and Health Sciences Faculty Office, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Samantha Dix
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Debra Griffiths
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Ingrid Brooks
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| |
Collapse
|
122
|
Kelly M, Steed L, Sohanpal R, Pinnock H, Barradell A, Dibao-Dina C, Mammoliti KM, Wileman V, Rowland V, Newton S, Moore A, Taylor S. The TANDEM trial: protocol for the process evaluation of a randomised trial of a complex intervention for anxiety and/or depression in people living with chronic obstructive pulmonary disease (COPD). Trials 2021; 22:495. [PMID: 34311766 PMCID: PMC8313120 DOI: 10.1186/s13063-021-05460-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 07/15/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND TANDEM is a randomised controlled trial of a complex healthcare intervention to improve the psychological and physical health of people living with chronic obstructive pulmonary disease (COPD) and anxiety and/or depression. Based on health psychology theory set out in a logic model, respiratory health professionals were recruited and trained to deliver a cognitive behavioural approach intervention (The TANDEM intervention) under the supervision of senior cognitive behavioural practitioners. Here, we describe the protocol for the process evaluation commissioned alongside the trial. A realist approach that includes attention to describing contexts and mechanisms has been adopted. METHODS We set up a multi-disciplinary team to develop and deliver the process evaluation. The mixed-methods design incorporates quantitative process data; monitoring of intervention fidelity; qualitative interviews with patients, carers, health professionals (facilitators) and clinical supervisors about their perspectives on acceptability of the intervention; and exploration with all stakeholders (including management/policy-makers) on future implementation. Normalisation process theory (NPT) will inform data collection and interpretation with a focus on implementation. Quantitative process data will be analysed descriptively. Qualitative interview data will be analysed before the trial outcomes are known using analytic induction and constant comparison to develop themes. Findings from the different elements will be reported separately and then integrated. CONCLUSION Detailed description and analysis of study processes in a research trial such as TANDEM enables research teams to describe study contexts and mechanisms and to examine the relationship with outcomes. In this way, learning from the trial goes beyond the randomised control trial (RCT) model where effectiveness is prioritised and makes it possible to explore issues arising for post-trial study implementation. TRIAL REGISTRATION ISRCTN ISRCTN59537391 . Registered on 20 March 2017. Trial protocol version 6.0, 22 April 2018. Process evaluation protocol version 4.0, 1 November 2020.
Collapse
Affiliation(s)
- Moira Kelly
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK.
| | - Liz Steed
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Ratna Sohanpal
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Amy Barradell
- Department of Respiratory Sciences, College of Life Sciences, NIHR Leicester Biomedical Research Centre- Respiratory Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP, UK
| | - Clarisse Dibao-Dina
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, 10 Boulevard Tonnellé, B.P. 3223, 37044, Tours, cedex 1, France
| | - Kristie-Marie Mammoliti
- Birmingham Clinical Trials Unit and WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Vari Wileman
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Vickie Rowland
- Department of Health & Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Sian Newton
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Anna Moore
- The Education Academy, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Stephanie Taylor
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| |
Collapse
|
123
|
Erdös T, de Haan E, Heusinkveld S. Coaching: client factors & contextual dynamics in the change process. COACHING: AN INTERNATIONAL JOURNAL OF THEORY, RESEARCH AND PRACTICE 2021. [DOI: 10.1080/17521882.2020.1791195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tünde Erdös
- Vrije Universiteit Amsterdam, Amsterdam Business Research Institute, Department of Management and Organisation, Amsterdam, The Netherlands
| | - Erik de Haan
- Vrije Universiteit Amsterdam, Amsterdam Business Research Institute, Department of Management and Organisation, Amsterdam, The Netherlands
- Ashridge Centre for Coaching, Berkhamsted, UK
| | - Stefan Heusinkveld
- Vrije Universiteit Amsterdam, Amsterdam Business Research Institute, Department of Management and Organisation, Amsterdam, The Netherlands
| |
Collapse
|
124
|
Bröer C, Veltkamp G, Bouw C, Vlaar N, Borst F, de Sauvage Nolting R. From Danger to Uncertainty: Changing Health Care Practices, Everyday Experiences, and Temporalities in Dealing With COVID-19 Policies in the Netherlands. QUALITATIVE HEALTH RESEARCH 2021; 31:1751-1763. [PMID: 34024194 DOI: 10.31235/osf.io/3ruz5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Based on ongoing longitudinal research in families with young children, we investigate parents' changing everyday experiences and health care practices of dealing with COVID-19 policies in the Netherlands from March to June 2020. We identify four key themes developing over time. In relation to evolving COVID-19 prevention policies, (a) the lockdown interrupted life and experiences of temporality. (b) Following the lockdown, risk management changed from fear to insecurities and (c) simultaneously, emotion management transitioned from solidarity to fragmentation. (d) Increasingly, pragmatic considerations allowed parents to tackle uncertainties and created room to normalize everyday life. We studied "change" by using a novel conceptual model for temporality and found distinct temporalities in parents' accounts. In sum, we interpret this as a shift from danger to uncertainty, induced by policy shifts and pragmatically translating those to the lifeworld.
Collapse
Affiliation(s)
| | | | | | - Noa Vlaar
- University of Amsterdam, Amsterdam, The Netherlands
| | - Femke Borst
- University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
125
|
Allen L, Ashford PA, Beeson E, Byford S, Chow J, Dalgleish T, Danese A, Finn J, Goodall B, Grainger L, Hammond M, Humphrey A, Mahoney-Davies G, Morant N, Shepstone L, Sims E, Smith P, Stallard P, Swanepoel A, Trickey D, Trigg K, Wilson J, Meiser-Stedman R. DECRYPT trial: study protocol for a phase II randomised controlled trial of cognitive therapy for post-traumatic stress disorder (PTSD) in youth exposed to multiple traumatic stressors. BMJ Open 2021; 11:e047600. [PMID: 34210731 PMCID: PMC8252885 DOI: 10.1136/bmjopen-2020-047600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a distressing and disabling condition that affects significant numbers of children and adolescents. Youth exposed to multiple traumas (eg, abuse, domestic violence) are at particular risk of developing PTSD. Cognitive therapy for PTSD (CT-PTSD), derived from adult work, is a theoretically informed, disorder-specific form of trauma-focused cognitive-behavioural therapy. While efficacious for child and adolescent single-event trauma samples, its effectiveness in routine settings with more complex, multiple trauma-exposed youth has not been established. The Delivery of Cognitive Therapy for Young People after Trauma randomised controlled trial (RCT) examines the effectiveness of CT-PTSD for treating PTSD following multiple trauma exposure in children and young people in comparison with treatment as usual (TAU). METHODS/DESIGN This protocol describes a two-arm, patient-level, single blind, superiority RCT comparing CT-PTSD (n=60) with TAU (n=60) in children and young people aged 8-17 years with a diagnosis of PTSD following multiple trauma exposure. The primary outcome is PTSD severity assessed using the Children's Revised Impact of Event Scale (8-item version) at post-treatment (ie, approximately 5 months post-randomisation). Secondary outcomes include structured interview assessment for PTSD, complex PTSD symptoms, depression and anxiety, overall functioning and parent-rated mental health. Mid-treatment and 11-month and 29-month post-randomisation assessments will also be completed. Process-outcome evaluation will consider which mechanisms underpin or moderate recovery. Qualitative interviews with the young people, their families and their therapists will be undertaken. Cost-effectiveness of CT-PTSD relative to TAU will be also be assessed. ETHICS AND DISSEMINATION This trial protocol has been approved by a UK Health Research Authority Research Ethics Committee (East of England-Cambridge South, 16/EE/0233). Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations and clinical workshops. TRIAL REGISTRATION ISRCTN12077707. Registered 24 October 2016 (http://www.isrctn.com/ISRCTN12077707). Trial recruitment commenced on 1 February 2017. It is anticipated that recruitment will continue until June 2021, with 11-month assessments being concluded in May 2022.
Collapse
Affiliation(s)
- Leila Allen
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Polly-Anna Ashford
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ella Beeson
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
| | - Jessica Chow
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Jack Finn
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ben Goodall
- North East London NHS Foundation Trust, Rainham, UK
| | - Lauren Grainger
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Matthew Hammond
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ayla Humphrey
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Nicola Morant
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Lee Shepstone
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Erika Sims
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Patrick Smith
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Annie Swanepoel
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - David Trickey
- Specialist Trauma and Maltreatment Service, Anna Freud National Centre for Children and Families, London, UK
| | - Katie Trigg
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| |
Collapse
|
126
|
Missouridou E, Zartaloudi A, Dafogianni C, Koutelekos J, Dousis E, Vlachou E, Evagelou E. Locked versus open ward environments and restrictive measures in acute psychiatry in Greece: Nursing students' attitudes and experiences. Perspect Psychiatr Care 2021; 57:1365-1375. [PMID: 33258139 DOI: 10.1111/ppc.12699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To examine student nurses' attitudes and experiences of door policies and restrictive measures in acute psychiatric care. METHODS A mixed-method study with 274 third-year students. RESULTS Participants' attitudes towards door locking and other containment measures appeared to be more a matter of custom, practice and tradition at particular units. The therapeutic benefits of open doors was the central organizing element in open units experiences while locked doors appeared to be "invisible" when the locked unit was perceived as a caring environment. PRACTICAL IMPLICATIONS Exploring student nurses' attitudes towards crucial and debatable aspects of mental health practice contributes in cultivating a critical and analytical attitude towards the service they provide necessary for supporting a recovery mental health model and building a strong professional identity.
Collapse
Affiliation(s)
- Evdokia Missouridou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Afroditi Zartaloudi
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Chrisoula Dafogianni
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - John Koutelekos
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Evangelos Dousis
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Eleni Evagelou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| |
Collapse
|
127
|
Bröer C, Veltkamp G, Bouw C, Vlaar N, Borst F, de Sauvage Nolting R. From Danger to Uncertainty: Changing Health Care Practices, Everyday Experiences, and Temporalities in Dealing With COVID-19 Policies in the Netherlands. QUALITATIVE HEALTH RESEARCH 2021; 31:1751-1763. [PMID: 34024194 PMCID: PMC8438783 DOI: 10.1177/10497323211005748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Based on ongoing longitudinal research in families with young children, we investigate parents' changing everyday experiences and health care practices of dealing with COVID-19 policies in the Netherlands from March to June 2020. We identify four key themes developing over time. In relation to evolving COVID-19 prevention policies, (a) the lockdown interrupted life and experiences of temporality. (b) Following the lockdown, risk management changed from fear to insecurities and (c) simultaneously, emotion management transitioned from solidarity to fragmentation. (d) Increasingly, pragmatic considerations allowed parents to tackle uncertainties and created room to normalize everyday life. We studied "change" by using a novel conceptual model for temporality and found distinct temporalities in parents' accounts. In sum, we interpret this as a shift from danger to uncertainty, induced by policy shifts and pragmatically translating those to the lifeworld.
Collapse
Affiliation(s)
| | | | | | - Noa Vlaar
- University of Amsterdam, Amsterdam, The Netherlands
| | - Femke Borst
- University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
128
|
Ramanadhan S, Revette AC, Lee RM, Aveling EL. Pragmatic approaches to analyzing qualitative data for implementation science: an introduction. Implement Sci Commun 2021; 2:70. [PMID: 34187595 PMCID: PMC8243847 DOI: 10.1186/s43058-021-00174-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Qualitative methods are critical for implementation science as they generate opportunities to examine complexity and include a diversity of perspectives. However, it can be a challenge to identify the approach that will provide the best fit for achieving a given set of practice-driven research needs. After all, implementation scientists must find a balance between speed and rigor, reliance on existing frameworks and new discoveries, and inclusion of insider and outsider perspectives. This paper offers guidance on taking a pragmatic approach to analysis, which entails strategically combining and borrowing from established qualitative approaches to meet a study's needs, typically with guidance from an existing framework and with explicit research and practice change goals.Section 1 offers a series of practical questions to guide the development of a pragmatic analytic approach. These include examining the balance of inductive and deductive procedures, the extent to which insider or outsider perspectives are privileged, study requirements related to data and products that support scientific advancement and practice change, and strategic resource allocation. This is followed by an introduction to three approaches commonly considered for implementation science projects: grounded theory, framework analysis, and interpretive phenomenological analysis, highlighting core analytic procedures that may be borrowed for a pragmatic approach. Section 2 addresses opportunities to ensure and communicate rigor of pragmatic analytic approaches. Section 3 provides an illustrative example from the team's work, highlighting how a pragmatic analytic approach was designed and executed and the diversity of research and practice products generated.As qualitative inquiry gains prominence in implementation science, it is critical to take advantage of qualitative methods' diversity and flexibility. This paper furthers the conversation regarding how to strategically mix and match components of established qualitative approaches to meet the analytic needs of implementation science projects, thereby supporting high-impact research and improved opportunities to create practice change.
Collapse
Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Anna C Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Emma L Aveling
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| |
Collapse
|
129
|
Wand T, Collett G, Cutten A, Buchanan-Hagen S, Stack A, White K. Patient and staff experience with a new model of emergency department based mental health nursing care implemented in two rural settings. Int Emerg Nurs 2021; 57:101013. [PMID: 34134083 DOI: 10.1016/j.ienj.2021.101013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As part of a larger multi-site translational research project this study explored patient and staff experiences, perspectives and recommendations in relation to a mental health liaison nursing (MHLN) service implemented in the emergency department (ED) of two rural hospitals in New South Wales, Australia. METHODS Semi-structured interviews were conducted across the two sites with a sample of ED patients (n = 32), ED nurses (n = 14), ED medical officers (n = 11) and psychiatrists (n = 3). Data were analysed thematically. FINDINGS Patients highlighted the therapeutic benefits of the MHLNs, particularly being listened to and understood. Patients appreciated being seen promptly and having effective follow-up. Some negative experiences were encountered. Staff recognized that embedding the new model of care in the ED impacted positively on ED culture and practice. A nurse practitioner position as clinical lead instituted at one site made the most substantial contribution to integrating mental health care within the ED. Room for improvement was also noted. CONCLUSIONS Findings from this study indicate that an ED-based model of MHLN care developed in a metropolitan setting was successfully translated to two rural EDs. While translating a model of care from one context to another is not without its challenges, adherence to the key principles of this model of MHLN care was associated with the most positive outcome.
Collapse
Affiliation(s)
- Timothy Wand
- University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Gemma Collett
- Translational Research Manager, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Alexa Cutten
- Translational Research Manager, Hunter New England Local Health District, Australia.
| | - Sally Buchanan-Hagen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Amanda Stack
- Translational Research Manager, Western NSW Local Health District, Australia.
| | - Kathryn White
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia.
| |
Collapse
|
130
|
Ansar N, Hjeltnes A, Stige SH, Binder PE, Stiegler JR. Parenthood-Lost and Found: Exploring Parents' Experiences of Receiving a Program in Emotion Focused Skills Training. Front Psychol 2021; 12:559188. [PMID: 34149488 PMCID: PMC8209250 DOI: 10.3389/fpsyg.2021.559188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 04/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background Parents play a crucial role in the development, maintenance, and deterioration of child difficulties. Emotion focused skills training (EFST) targets parents’ capacity to provide their child with emotion-oriented skills in order to promote good child mental health. Few qualitative studies have specifically investigated parents’ experiences of receiving such programs. Objective This study aimed to explore how parents experience working with their own and their child’s emotions undergoing a short-term program in EFST; in particular, changes in their experience of being a parent and in everyday life are reported. Method Semi-structured in-depth qualitative interviews were conducted with 14 parents who had completed a short-term EFST program (2-day group training and 6 h of supervision). Interview transcripts were analyzed using a reflexive thematic analysis approach. Results A total of 14 parents (40% men, four couples, Mage = 39.5, SD = 4.4) participated in the study. Our analysis resulted in the following three themes: (1) “Coming home” as a parent, with the following subthemes: (a) New ways of being with their child and (b) Parents’ painful inner world; (2) Reclaiming parenthood—applying new tools and learning in challenging situations; and (3) This is us—changing the heart of the story. The first theme was related to the descriptions of the changes that emerged in parents’ inner lives, the second revolved around the employment of their skills intuitively and creatively based on what was required by the challenging situations, and the third theme referred to new discoveries on family dynamics. Conclusion Parents’ experiences of having wisdom and calmness inside them (being) and doing parenting differently, as well as the changed perspectives of the family (living), resonate with the theoretical ground of emotion-focused therapy (EFT). The findings also indicate that therapists should be aware of potential parental distress when working in view of changing unpleasant emotions in such skill-based programs.
Collapse
Affiliation(s)
- Nadia Ansar
- Norwegian Institute of Emotion-Focused Therapy, Bergen, Norway.,Department of Research and Development, University of Oslo, Oslo, Norway
| | - Aslak Hjeltnes
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Signe Hjelen Stige
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Per-Einar Binder
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | |
Collapse
|
131
|
Hemming L, Pratt D, Bhatti P, Shaw J, Haddock G. Involving an individual with lived-experience in a co-analysis of qualitative data. Health Expect 2021; 24:766-775. [PMID: 33788373 PMCID: PMC8235892 DOI: 10.1111/hex.13188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/18/2020] [Accepted: 12/10/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND People with lived-experience of the phenomenon under investigation are seldom involved in the analysis of qualitative data, and there exists little guidance for those wishing to involve contributors at this stage of research. AIMS To critically reflect on the process of involving people with lived-experience in a thematic analysis and to offer direction to other researchers. METHODS An individual with lived-experience of residing in prison contributed to a co-analysis of qualitative data using thematic analysis. This paper reports on involvement at each stage of a thematic analysis and follows an established reporting checklist. RESULTS A number of challenges and benefits were encountered in the process of co-analysing the data. These are discussed in relation to previous research and how to overcome the challenges encountered. CONCLUSIONS The paper concludes by giving recommendations and guidance for future researchers wishing to involve people with lived-experience in qualitative data analysis.
Collapse
Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences CentreManchesterUK
| | - Daniel Pratt
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences CentreManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Peer Bhatti
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Jennifer Shaw
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences CentreManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Gillian Haddock
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences CentreManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| |
Collapse
|
132
|
Rankl F, Johnson GA, Vindrola-Padros C. Examining What We Know in Relation to How We Know It: A Team-Based Reflexivity Model for Rapid Qualitative Health Research. QUALITATIVE HEALTH RESEARCH 2021; 31:1358-1370. [PMID: 33745367 PMCID: PMC8182295 DOI: 10.1177/1049732321998062] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Reflexivity constitutes a core component of qualitative research and has been actively integrated into long-term and "lone ranger" approaches to qualitative research. However, its application to team-based approaches and particularly to rapid qualitative team-based approaches continues to lag behind. In this article, we introduce a reflexivity model we developed for teams undertaking rapid qualitative studies. Utilizing our most recent application of this model to a rapid qualitative appraisal of health care workers' experiences delivering care during the COVID-19 pandemic as a case study, we identify the steps to put this model into practice and its main outcomes. Our application of the model revealed that the team's practices could be grouped along four dimensions: design assumptions, data collection and analysis processes, multidisciplinary collaboration, and responsible dissemination. Reflexivity can improve the relations within the team and the quality of the research output, if it is implemented as a continuous and iterative process.
Collapse
Affiliation(s)
- Felicia Rankl
- University College London, London,
United Kingdom
- Nuffield College, University of
Oxford, Oxford, United Kingdom
- Felicia Rankl, Nuffield College,
University of Oxford, New Road, Oxford OX1 1NF, UK.
| | | | | |
Collapse
|
133
|
Bogle A, Rhodes P, Hunt C. Cultural humility and decolonial practice: narratives of therapists’ lives. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1924655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ashley Bogle
- School of Psychology, University of Sydney, Sydney, Australia
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, Australia
| |
Collapse
|
134
|
King O. Two sets of qualitative research reporting guidelines: An analysis of the shortfalls. Res Nurs Health 2021; 44:715-723. [PMID: 34018217 DOI: 10.1002/nur.22157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/19/2021] [Accepted: 05/08/2021] [Indexed: 11/11/2022]
Abstract
Findings from qualitative research may make valuable contributions to the evidence informing healthcare practice. Qualitative research methodologies and methods, however, are less familiar to health researchers and research consumers when compared with quantitative methods. Qualitative research reporting guidelines and their merit have been hotly debated for at least two decades. Herein I discuss two sets of qualitative research reporting guidelines endorsed by many high tiered health research journals: Consolidated criteria for reporting qualitative research and Standards for reporting qualitative research. Six aspects of the two sets of guidelines are compared. The first aspect is the focus of the guidelines. The latter five aspects are items included in the guidelines: reflexivity, participant sampling and saturation, data collection, member checking, and data analysis. Except for reflexivity, these items were selected for comparison as they include features of, or strategies to, enhance the rigor of qualitative research that are applicable within some but not all qualitative methodologies. Reflexivity, a central feature of rigor within all qualitative research, is discussed for its suboptimal representation in both sets of reporting guidelines. Without regular and critical review of reporting guidelines, efforts to promote the design, conduct, and reporting of rigorous qualitative health research to support evidence-informed practice may be undermined. Moreover, for qualitative research reporting guidelines to be useful, they must be applied appropriately and in a flexible manner by researchers and reviewers. This paper has implications for researchers, journal editors, reviewers, and research consumers.
Collapse
Affiliation(s)
- Olivia King
- Allied Health, University Hospital, Geelong, Australia.,Allied Health, South West Healthcare, Warrnambool, Australia.,Faculty of Medicine, Nursing & Health Sciences, Monash Centre for Scholarship in Health Education, Melbourne, Australia
| |
Collapse
|
135
|
Barton HJ, Coller RJ, Loganathar S, Singhe N, Ehlenbach ML, Katz B, Warner G, Kelly MM, Werner NE. Medical Device Workarounds in Providing Care for Children With Medical Complexity in the Home. Pediatrics 2021; 147:peds.2020-019513. [PMID: 33926988 PMCID: PMC8085995 DOI: 10.1542/peds.2020-019513] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children with medical complexity (CMC) are commonly assisted by medical devices, which family caregivers are responsible for managing and troubleshooting in the home. Optimizing device use by maximizing the benefits and minimizing the complications is a critical goal for CMC but is relatively unexplored. In this study, we sought to identify and describe workarounds families have developed to optimize medical device use for their needs. METHODS We conducted 30 contextual inquiry interviews with families of CMC in homes. Interviews were recorded, transcribed, and analyzed for barriers and workarounds specific to medical device usage through a directed content analysis. We used observation notes and photographs to confirm and elaborate on interview findings. RESULTS We identified 4 barriers to using medical devices in the home: (1) the quantity and type of devices allotted do not meet family needs, (2) the device is not designed to be used in locations families require, (3) device use is physically or organizationally disruptive to the home, and (4) the device is not designed to fit the user. We also identified 11 categories of workarounds to the barriers. CONCLUSIONS Families face many barriers in using medical devices to care for CMC. Our findings offer rich narrative and photographic data revealing the ways in which caregivers work around these barriers. Future researchers should explore the downstream effects of these ubiquitous, necessary workarounds on CMC outcomes toward developing interventions that optimize device use for families.
Collapse
Affiliation(s)
| | - Ryan J. Coller
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Nawang Singhe
- Departments of Industrial and Systems Engineering and
| | - Mary L. Ehlenbach
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Gemma Warner
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | - Michelle M. Kelly
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | |
Collapse
|
136
|
Lang S, Gibson S, Ng KW, Truby H. Understanding children and young people's experiences pursuing weight loss maintenance using the Socio-ecological Model: A qualitative systematic literature review. Obes Rev 2021; 22:e13172. [PMID: 33331090 DOI: 10.1111/obr.13172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023]
Abstract
Developing a broader understanding of children and young people's experiences of long-term attempts of weight management may provide insight into both enablers and barriers to successful weight loss maintenance. This review aims to explore children and young people's perceptions of long-term attempts of weight management. Six databases were searched for qualitative studies describing young participants (<25 years, previously or currently above a healthy weight) experiences of weight management for >6 months following intentional weight loss. A thematic synthesis was undertaken. Themes were interpreted using the Socio-ecological Model. Factors supporting attempts to maintain weight loss included having clear motivation for change; developing personal skills to manage the challenges of change; family support/dynamics that encourage healthy lifestyles; and health-promoting cultures in schools/workplaces, communities, and the broader living environment. Conversely, ambivalence, difficulty coping with changes, peer pressure, challenging family dynamics, limited professional support, and unhealthy living environments were barriers to maintaining behavior change. These facilitators and barriers at each level of the Socio-ecological Model informed a model of weight loss maintenance for children and young people. Supporting children, young people, and families to develop the skills to manage the individual, social, and environmental challenges that shape attempts of long-term weight management will help to support their ability to manage their weight long term.
Collapse
Affiliation(s)
- Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Ker Wei Ng
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
137
|
Mendonça AB, Pereira ER, Magnago C, Medeiros AYBBV, Silva RMCRA, Martins ADO, Meira KC. Suffering experiences of people with cancer undergoing chemotherapy: A meta-ethnographic study. Nurs Health Sci 2021; 23:586-610. [PMID: 33817939 DOI: 10.1111/nhs.12839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.
Collapse
Affiliation(s)
- Angelo Braga Mendonça
- Healthcare Sciences Program, School of Nursing, Universidade Federal Fluminense, Niterói, Brazil
| | - Eliane Ramos Pereira
- Healthcare Sciences Program, School of Nursing, Universidade Federal Fluminense, Niterói, Brazil
| | - Carinne Magnago
- Public Health Faculty, Universidade de São Paulo, Niterói, Brazil
| | | | | | | | - Karina Cardoso Meira
- Health Sciences School, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
138
|
Behman A, Feldman B, Doria A, Fusco C, Wright J. Functional limitations caused by simple bone cysts. J Child Orthop 2021; 15:178-182. [PMID: 34040665 PMCID: PMC8138791 DOI: 10.1302/1863-2548.15.200169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Relatively little is known about the impact of benign bone lesions on function. The aim of this study was to create a more complete understanding of the impact of functional disability from simple bone cysts (SBCs) by combining qualitative and quantitative methods. METHODS This study followed a convergent parallel mixed methods design. The quantitative arm included 130 children with SBC and used the Activities Scale for Kids (ASK) to measure physical function. In the qualitative arm ten children and their parents participated in interviews related to activity participation and interactions with their physical and social environments. The two data sets were analyzed independently and then the results were integrated. RESULTS The ASK demonstrated 35% of children achieving the maximum score. In total, 65% of children responded "I had no medical needs" confirming that SBC, while being present throughout childhood, is largely perceived as not a chronic illness. Qualitatively most children reported minimal or no changes in activity participation but reported thinking about being more cautious during play, confirming that SBC affects effort not participation in play. CONCLUSION The diagnosis of SBC did not have a significant impact on physical function, but did alter children's thoughts about physical activity participation. This finding suggests that physical function scores may have unappreciated ceiling effects. Outcome tools that combine both illness perceptions and physical function may help to better assess functional outcomes of SBC. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Amy Behman
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Orthopaedic Surgery, Toronto Hospital for Sick Children, Toronto, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,Correspondence should be sent to Amy Behman, Toronto Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada. E-mail:
| | - Brian Feldman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,Division of Rheumatology, Department of Paediatrics and Medicine, University of Toronto, Toronto, Canada
| | - Andrea Doria
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Caroline Fusco
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - James Wright
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
139
|
Shamba D, Day LT, Zaman SB, Sunny AK, Tarimo MN, Peven K, Khan J, Thakur N, Talha MTUS, K C A, Haider R, Ruysen H, Mazumder T, Rahman MH, Shaikh MZH, Sæbø JI, Hanson C, Singh NS, Schellenberg J, Vaz LME, Requejo J, Lawn JE. Barriers and enablers to routine register data collection for newborns and mothers: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:233. [PMID: 33765963 PMCID: PMC7995573 DOI: 10.1186/s12884-020-03517-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Policymakers need regular high-quality coverage data on care around the time of birth to accelerate progress for ending preventable maternal and newborn deaths and stillbirths. With increasing facility births, routine Health Management Information System (HMIS) data have potential to track coverage. Identifying barriers and enablers faced by frontline health workers recording HMIS source data in registers is important to improve data for use. METHODS The EN-BIRTH study was a mixed-methods observational study in five hospitals in Bangladesh, Nepal and Tanzania to assess measurement validity for selected Every Newborn coverage indicators. We described data elements required in labour ward registers to track these indicators. To evaluate barriers and enablers for correct recording of data in registers, we designed three interview tools: a) semi-structured in-depth interview (IDI) guide b) semi-structured focus group discussion (FGD) guide, and c) checklist assessing care-to-documentation. We interviewed two groups of respondents (January 2018-March 2019): hospital nurse-midwives and doctors who fill ward registers after birth (n = 40 IDI and n = 5 FGD); and data collectors (n = 65). Qualitative data were analysed thematically by categorising pre-identified codes. Common emerging themes of barriers or enablers across all five hospitals were identified relating to three conceptual framework categories. RESULTS Similar themes emerged as both barriers and enablers. First, register design was recognised as crucial, yet perceived as complex, and not always standardised for necessary data elements. Second, register filling was performed by over-stretched nurse-midwives with variable training, limited supervision, and availability of logistical resources. Documentation complexity across parallel documents was time-consuming and delayed because of low staff numbers. Complete data were valued more than correct data. Third, use of register data included clinical handover and monthly reporting, but little feedback was given from data users. CONCLUSION Health workers invest major time recording register data for maternal and newborn core health indicators. Improving data quality requires standardised register designs streamlined to capture only necessary data elements. Consistent implementation processes are also needed. Two-way feedback between HMIS levels is critical to improve performance and accurately track progress towards agreed health goals.
Collapse
Affiliation(s)
- Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK.
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Menna Narcis Tarimo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Taqbir Us Samad Talha
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rajib Haider
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ziaul Haque Shaikh
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Claudia Hanson
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Neha S Singh
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Joanna Schellenberg
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - Lara M E Vaz
- International Programs, Population Reference Bureau, Washington DC, USA
| | | | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| |
Collapse
|
140
|
Gertner AK, Franklin J, Roth I, Cruden GH, Haley AD, Finley EP, Hamilton AB, Palinkas LA, Powell BJ. A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34056611 PMCID: PMC8153409 DOI: 10.1177/2633489521992743] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Researchers have argued for the value of ethnographic approaches to implementation science (IS). The contested meanings of ethnography pose challenges and possibilities to its use in IS. The goal of this study was to identify sources of commonality and variation, and to distill a set of recommendations for reporting ethnographic approaches in IS. Methods: We included in our scoping review English-language academic journal articles meeting two criteria: (1) IS articles in the healthcare field and (2) articles that described their approach as ethnographic. In March 2019, we implemented our search criteria in four academic databases and one academic journal. Abstracts were screened for inclusion by at least two authors. We iteratively develop a codebook for full-text analysis and double-coded included articles. We summarized the findings and developed reporting recommendations through discussion. Results: Of the 210 articles whose abstracts were screened, 73 were included in full-text analysis. The number of articles increased in recent years. Ethnographic approaches were used within a wide variety of theoretical approaches and research designs. Articles primarily described using interviews and observational methods as part of their ethnographic approaches, though numerous other methods were also employed. The most cited rationales for using ethnographic approaches were to capture context-specific phenomena, understand insiders’ perspective, and study complex interactions. In reporting on ethnographic approaches, we recommend that researchers provide information on researcher training and position, reflect on researchers’ positionality, describe observational methods in detail, and report results from all the methods used. Conclusion: The number of IS studies using ethnography has increased in recent years. Ethnography holds great potential for contributing further to IS, particularly to studying implementation strategy mechanisms and understanding complex adaptive systems. Researchers have proposed that ethnographic methods may be valuable to implementation research and practice. Ethnographic approaches have their roots in the field of anthropology, but they are now used in many fields. These approaches often involve a researcher spending time in “real-world” settings, conducting interviews and observation to understand a group of people. That said, researchers disagree on the meaning of ethnography, which presents a challenge to its use in implementation science (IS). We searched for articles in the field of IS that described their methods as ethnographic. We then reviewed the articles, looking for similarities and differences in how and why ethnographic approaches were used. Many of these articles said they used ethnographic methods because they were interested in issues like context, research participants’ views, and complex interactions. We found a large amount of variation in how ethnographic methods were used. We developed recommendations for describing ethnographic methods in a way that readers can clearly understand. We also made several observations of the value ethnographic approaches can bring to IS. Ethnographic methods may be especially useful to studying unplanned and unexpected changes that take place during implementation. These recommendations and observations could be helpful to implementation researchers wishing to use ethnographic methods.
Collapse
Affiliation(s)
- Alex K Gertner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua Franklin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | | | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin P Finley
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, University of Southern California, Los Angeles, CA, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
141
|
Morant N, Davidson M, Wackett J, Lamb D, Pinfold V, Smith D, Johnson S, Lloyd-Evans B, Osborn DPJ. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC Psychiatry 2021; 21:146. [PMID: 33691668 PMCID: PMC7944597 DOI: 10.1186/s12888-021-03140-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. METHODS We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. RESULTS Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. CONCLUSIONS Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
Collapse
Affiliation(s)
- Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael Davidson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Wackett
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Danielle Lamb
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Deb Smith
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - David P J Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
142
|
Participant Perspectives on the Contributions of Physical, Psychological, and Sociological Fidelity to Learning in Interprofessional Mental Health Simulation. Simul Healthc 2021; 15:141-146. [PMID: 32218087 DOI: 10.1097/sih.0000000000000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation has been identified as a key training modality to enhance interprofessional care for patients with co-occurring physical and mental illnesses. Fidelity is an important instructional design consideration for interprofessional simulation; however, research examining the contribution of physical, psychological, and sociological fidelity in achieving learning outcomes remains limited. This qualitative study explored the relationship between fidelity and learning from the perspective of interprofessional simulation course participants. METHODS Semistructured interviews were conducted with participants from the Interprofessional Simulations of Patient Experiences Across the Care Continuum - Child and Youth course. Consistent with grounded theory, data collection and analysis proceeded in an iterative fashion and emergent themes were identified by the research team through a process of constant comparative analysis. RESULTS Data saturation was reached after 10 interviews. High psychological fidelity allowed participants to engage in the simulation scenarios in ways that were congruent with their professional roles, which supported individual practice change. Tasks that were too closely aligned with their clinical experiences sometimes, however, limited new learning opportunities. Selective manipulations of sociological fidelity seemed to support learning outcomes related to understanding and appreciating the roles and responsibilities of other health professionals. Physical fidelity was less essential. CONCLUSIONS Psychological and sociological fidelity were perceived by participants as being most critical to learning in interprofessional mental health simulation. Improving our understanding of how simulation works in this context is important to effectively direct the efforts of learners, instructors, and designers toward maximizing the benefit of simulation-based learning in a cost-efficient manner.
Collapse
|
143
|
Gooden A, Keys CB, Back L, McMahon SD, Morgan M. Organizational empowerment: A framework examining historical and systemic domains in school settings. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:516-532. [PMID: 33190279 DOI: 10.1002/jcop.22476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/26/2020] [Accepted: 10/28/2020] [Indexed: 06/11/2023]
Abstract
Organizational empowerment (OE) is a key construct in community psychology. We build on current understandings of OE by exploring history and systemic relationships as important aspects of OE. We conducted interviews with 20 school leaders from 16 schools that went through a district-wide transition of students with disabilities into general education schools and asked these leaders about their preparation and service provision during this transition. We utilized a grounded theory approach to analyze the data, and two domains of OE emerged: historical and systemic, each with multiple dimensions. The historical domain refers to schools' functioning before the transition, and the systemic domain reflects interactions between schools and the School District Office for Students with Disabilities during the transition. We provide a nuanced understanding of these domains of organizational empowerment and their interaction, as well as implications for empowerment theory and practice.
Collapse
Affiliation(s)
- Adia Gooden
- The Family Institute at Northwestern University, Northwestern University, Evanston, Illinois, USA
| | - Christopher B Keys
- Psychology Department, DePaul University, DePaul University, Chicago, Illinois, USA
| | - Lindsey Back
- Psychology Department, DePaul University, DePaul University, Chicago, Illinois, USA
- Undergraduate Affairs, University of Illinois at Chicago, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Susan D McMahon
- Psychology Department, DePaul University, DePaul University, Chicago, Illinois, USA
| | - Michele Morgan
- Psychology Department, DePaul University, DePaul University, Chicago, Illinois, USA
| |
Collapse
|
144
|
Stephens GC, Rees CE, Lazarus MD. Exploring the impact of education on preclinical medical students' tolerance of uncertainty: a qualitative longitudinal study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:53-77. [PMID: 32378150 DOI: 10.1007/s10459-020-09971-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/27/2020] [Indexed: 05/27/2023]
Abstract
Tolerance of uncertainty, a construct describing individuals' responses to perceived uncertainty, has relevancy across healthcare systems, yet little work explores the impact of education on medical students' tolerance of uncertainty. While debate remains as to whether tolerance of uncertainty is changeable or static, the prevailing conceptual healthcare tolerance of uncertainty model (Hillen et al. in Soc Sci Med 180:62-75, 2017) suggests that individuals' tolerance of uncertainty is influenced by so-called moderators. Evidence regarding education's role as a moderator of tolerance of uncertainty is, however, lacking. Preliminary work exploring medical students' professional identity formation within anatomy learning identified tolerance of uncertainty as a theme warranting further exploration. Extending from this work, our research question was: How does the anatomy education learning environment impact medical students' tolerance of uncertainty? To address this question, qualitative data were collected longitudinally across two successive cohorts through online discussion forums during semester and end of semester interviews. Framework analysis identified five stimuli of uncertainty, four moderators of uncertainty, and cognitive, emotional and behavioral responses to uncertainty with variable valency (positive and/or negative). Longitudinal data analyses indicated changes in stimuli, moderators and responses to uncertainty over time, suggesting that tolerance of uncertainty is changeable rather than static. While our findings support the Hillen et al. (Soc Sci Med 180:62-75, 2017) model in parts, our data extend this model and the previous literature. Although further research is needed about students' development of tolerance of uncertainty in the clinical learning environment, we encourage medical educators to incorporate aspects of tolerance of uncertainty into curricular and learning environments.
Collapse
Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Monash University, Room 168, 10 Chancellors Walk, Clayton, VIC, 3800, Australia
| | - Charlotte E Rees
- College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, WA, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Monash University, Room 168, 10 Chancellors Walk, Clayton, VIC, 3800, Australia.
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
| |
Collapse
|
145
|
King A, Leider H, Herman D, Malinowski AK, D'Souza R. Patient- and Health-Care-Provider-Reported Outcomes to Consider in Research on Pregnancy-Associated Venous Thromboembolism. Thromb Haemost 2021; 121:1228-1236. [PMID: 33567461 DOI: 10.1055/s-0041-1722855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) in pregnancy can have numerous adverse impacts on patients and health care systems. Ongoing research aimed at improving maternal and fetal/neonatal outcomes is hampered by the lack of patient perspective in determining which outcomes are considered important to assess the effectiveness of interventions. OBJECTIVES The objective of this study was to elicit outcomes from those who experienced or were at risk for pregnancy-associated VTE (health service users, HSUs) and health care providers (HCPs) involved in their care. METHODS Canadian HSUs and HCPs were recruited using convenience and purposive sampling, respectively. Individual, semistructured interviews aimed specifically at eliciting pregnancy-related outcomes were conducted until data saturation was attained. Interviews were audio-recorded and transcribed verbatim. Written transcripts were de-identified and interpretatively analyzed in duplicate to obtain outcomes related to participant experiences. Outcomes were grouped based on a taxonomy developed for medical research and compared between and across interviews with patients and HCPs, and with those obtained through a systematic review of the published literature. RESULTS AND CONCLUSION We interviewed 10 HSUs and eight HCPs and elicited 52 outcomes, 21 of which have not been reported in the literature. Although the majority of elicited outcomes were in the clinical/physiological core outcome area, both HSUs and HCPs highlighted the importance of outcomes related to functioning/life impact and general wellbeing of mother and baby. These outcomes representing the perspectives of HSUs and HCPs should be considered while conducting trials on pregnancy-associated VTE.
Collapse
Affiliation(s)
- Alexandria King
- Institute of Medical Science, University of Toronto, Canada.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Haley Leider
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Dylan Herman
- Institute of Medical Science, University of Toronto, Canada.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Rohan D'Souza
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
146
|
Varpio L, O'Brien B, Rees CE, Monrouxe L, Ajjawi R, Paradis E. The applicability of generalisability and bias to health professions education's research. MEDICAL EDUCATION 2021; 55:167-173. [PMID: 32779251 DOI: 10.1111/medu.14348] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/29/2020] [Accepted: 08/05/2020] [Indexed: 05/27/2023]
Abstract
CONTEXT Research in health professions education (HPE) spans an array of topics and draws from a diversity of research domains , which brings richness to our understanding of complex phenomena and challenges us to appreciate different approaches to studying them. To fully appreciate and benefit from this diversity, scholars in HPE must be savvy to the hallmarks of rigour that differ across research approaches. In the absence of such recognition, the valuable contributions of many high-quality studies risk being undermined. METHODS In this article, we delve into two constructs---generalisability and bias--that are commonly invoked in discussions of rigour in health professions education research. We inspect the meaning and applicability of these constructs to research conducted from different paradigms (i.e., positivist and constructivist) and orientations (i.e., objectivist and subjectivist) and then describe how scholars can demonstrate rigour when these constructs do not align with the assumptions underpinning their research. CONCLUSIONS A one-size-fits-all approach to evaluating the rigour of HPE research disadvantages some approaches and threatens to reduce the diversity of research in our field. Generalisability and bias are two examples of problematic constructs within paradigms that embrace subjectivity; others are equally problematic. As a way forward, we encourage HPE scholars to inspect their assumptions about the nature and purpose of research-both to defend research rigour in their own studies and to ensure they apply standards of rigour that align with research they read and review.
Collapse
Affiliation(s)
- Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bridget O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
| | - Charlotte E Rees
- College of Science, Health, and Education (SHEE), Murdoch University, Murdoch, WA, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Clayton, Vic, Australia
| | - Lynn Monrouxe
- Faculty of Medicine and Health, University of Syndey, Sydney, NSW, Australia
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Vic., Australia
| | | |
Collapse
|
147
|
Griffiths J, Schultz K, Han H, Dalgarno N. Feedback on feedback: a two-way street between residents and preceptors. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:e32-e45. [PMID: 33680229 PMCID: PMC7931483 DOI: 10.36834/cmej.69913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Workplace-based assessment (WBA), foundational to competency-based medical education, relies on preceptors providing feedback to residents. Preceptors however get little timely, formative, specific, actionable feedback on the effectiveness of that feedback. Our study aimed to identify useful qualities of feedback for family medicine residents and to inform improving feedback-giving skills for preceptors in PGME training program. METHODS This study employed a two-phase exploratory design. Phase 1 collected qualitative data from preceptor feedback given to residents through Field Notes (FNs) and quantitative data from residents who provided feedback to preceptor about the quality of the feedback given. Phase 2 employed focus groups to explore ways in which residents are willing to provide preceptors with constructive feedback about the quality of the feedback they receive. Descriptive statistics and a thematic approach were used for data analysis. FINDINGS We collected 22 FNs identified by residents as being impactful to their learning; analysis of these FNs resulted in five themes. Functionality was then added to the electronic FNs allowing residents to indicate impactful feedback with a "Thumbs Up" icon. Over one year, 895 out of 8,496 FNs (11%) had a "Thumbs up" added, divided into reasons of: confirmation of learning (28.6%), practice improvement (21.2%), new learning (18.8%), motivation (17.7%), and evoking reflection (13.7%). Two focus groups (12 residents, convenience sampling) explored residents' perception of constructive feedback and willingness to also provide constructive feedback to preceptors. CONCLUSION Adding constructive feedback to existing positive feedback choices will provide preceptors with holistic information about the impact of their feedback on learners, which, in turn, should allow them to provide more effective feedback to learners. However, power differential, relationship impact, and institutional support were concerns for residents that would need to be addressed for this to be optimally operationalized.
Collapse
Affiliation(s)
- Jane Griffiths
- Department of Family Medicine, Queen's University, Ontario, Canada
| | - Karen Schultz
- Department of Family Medicine, Queen's University, Ontario, Canada
| | - Han Han
- Department of Family Medicine, Queen's University, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, Ontario, Canada
| |
Collapse
|
148
|
McDonald JA, Lai CJ, Lin MYC, O'Sullivan PS, Hauer KE. "There Is a Lot of Change Afoot": A Qualitative Study of Faculty Adaptation to Elimination of Tiered Grades With Increased Emphasis on Feedback in Core Clerkships. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:263-270. [PMID: 32909998 DOI: 10.1097/acm.0000000000003730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Medical schools responding to challenges with fairness, equity, learning environments, and student wellness have reconsidered clerkship grades. This study used the Concerns-Based Adoption Model (CBAM) to explore how faculty responded to a change in the approach to assessment from focus on grades toward focus on feedback. METHOD This qualitative study used an inductive approach to analyze data from semistructured interviews with teaching faculty and education leaders at University of California, San Francisco, School of Medicine 6 months following the elimination of traditional tiered clerkship grades. Participants were recruited in 2019 using purposive sampling. Interview questions addressed participants' perceptions of the new approach to assessment and grading that emphasizes assessment for learning, including advantages and concerns. The authors analyzed data using thematic analysis informed by sensitizing concepts from CBAM. RESULTS Nineteen faculty participated (11 medicine, 8 surgery). Faculty expressed optimism about the impact of the change on their clinical educator roles and sought faculty development to enhance feedback and assessment skills. Perceived benefits to students addressed learning and wellness, with concern for students' motivation and professional development. Faculty shared uncertainty about their roles and larger systemic consequences involving the residency match and institutional reputation. Participants acknowledged that traditional grading is imperfect, yet felt a departure from this system represented significant culture change. CONCLUSIONS Faculty perceptions of the assessment and grade change in 2 large departments demonstrated tensions around grading. Their descriptions of change as an ongoing process aligned with CBAM and required them to consider new approaches and perspectives. While discourse about assessment and grading frequently focuses on learners, these findings support institutional consideration of the impact of changes in assessment on teaching faculty.
Collapse
MESH Headings
- Clinical Clerkship/standards
- Clinical Clerkship/statistics & numerical data
- Clinical Competence/statistics & numerical data
- Education, Medical/standards
- Education, Medical/statistics & numerical data
- Education, Medical, Undergraduate/standards
- Education, Medical, Undergraduate/statistics & numerical data
- Educational Measurement/methods
- Faculty, Medical/statistics & numerical data
- Faculty, Medical/trends
- Feedback
- Female
- Humans
- Leadership
- Learning/physiology
- Male
- Perception
- Qualitative Research
- San Francisco/epidemiology
- Schools, Medical/organization & administration
- Students, Medical/psychology
- Surveys and Questionnaires
- Thematic Apperception Test/statistics & numerical data
- Universities/organization & administration
Collapse
Affiliation(s)
- Jordan A McDonald
- J.A. McDonald is a third-year medical student, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Cindy J Lai
- C.J. Lai is director of internal medicine clerkships and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Matthew Y C Lin
- M.Y.C. Lin is director of surgery clerkships and associate professor, Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Patricia S O'Sullivan
- P.S. O'Sullivan is director of research and development in medical education and professor, Department of Medicine and Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| |
Collapse
|
149
|
Eschmann R, Groshek J, Li S, Toraif N, Thompson JG. Bigger than sports: Identity politics, Colin Kaepernick, and concession making in #BoycottNike. COMPUTERS IN HUMAN BEHAVIOR 2021. [DOI: 10.1016/j.chb.2020.106583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
150
|
Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
Collapse
Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| |
Collapse
|