Comparing two sampling methods to engage hard-to-reach communities in research priority setting

Chronic Pain Self-Management Program for Low-Income Patients: Themes from a Qualitative Inquiry

OBJECTIVE

To examine factors influencing initial engagement, ongoing participation, learned behaviors, and subjective functional outcomes after a trial of the Living Better Beyond Pain (LBBP) chronic pain self-management program.

DESIGN

Qualitative study using the Grounded Theory approach.

SETTING

Two 60-minute focus groups and phone interviews in May 2017.

SUBJECTS

Focus groups with 18 participants who completed LBBP and six-month measures; telephone interviews with 17 participants who stopped attending.

METHODS

Study coordinators randomly selected program completers for focus groups and conducted phone interviews with noncompleters. Inductive thematic analysis was used to identify patterns in semantic content with a recursive process applied to focus group transcripts and interview transcriptions to codify into themes. Themes were categorized according to the Theory of Planned Behavior.

RESULTS

Focus group and telephone interview participants were primarily Hispanic and unemployed. Attitudes fostering participation in LBBP included dissatisfaction with the status quo, need to reduce pain medication, and lack of training and knowledge about chronic pain. Positive social norms from meeting others with chronic pain and support from the LBBP team encouraged attendance and adoption of behaviors. Transportation, pain, and competing activities were barriers, whereas adapting activities for the disabled was a facilitator. Maintaining behaviors and activities at home was challenging but ultimately rewarding due to improvement in daily function with less pain medication.

CONCLUSIONS

This qualitative study complements quantitative results showing clinically significant improvements in function after the LBBP program by adding practical insights into ways to increase participation and outcomes. Participants strongly endorsed the need for chronic pain self-management training.

Anxiety among dental professionals and its association with their dependency on social media for health information: insights from the COVID-19 pandemic

Background

Social media can play a detrimental role during a global health emergency. In this study, we aimed at assessing the impact social media has on the anxiety level of dental healthcare workers (DHCWs) whilst living through the COVID-19 pandemic.

Methods

An online questionnaire was disseminated to a cross-sectional sample of DHCWs from 19 countries using social media platforms. The questionnaire enquired about DHCWs’ frequency of using social media and their dependency on health-related information posted on those platforms. Anxiety was measured using General Anxiety Disorder scale (GAD-7).

Results

Four-hundred and three (403) DHCWs completed the online questionnaire. Sixty-eight percent (68%) frequently use social media for information on COVID-19. The frequency of social media use was higher among younger DHCWs, with shorter clinical experience, and holders of undergraduate qualifications (p = 0.009, p = 0.002, and p = 0.023, respectively). Almost one third of DHCWs had moderate to severe anxiety (31.7%), which was significantly associated with the frequency of social media use (p = 0.016). This association was adjusted for age, years of experience and qualification level (OR 1.75; 95% CI 1.05–2.93; p = 0.032).

Conclusion

COVID-19 social media infodemic has been adversely impacting the psychological wellbeing of DHCWs. More effective measures are needed to control the quality and spreadability of health information on social media platforms.

"An Undesired Life Event": A retrospective interview study of Swedish women's experiences of Caesarean Section in the 1970s and 1980s."

BACKGROUND

Giving birth is a transformative event. Memories of the birth often remain in a woman's mind for the rest of her life. Key aspects of a mother's overall birth experience include concerns about the safety and health of the baby, and the first contact the mother has with her child. To the best of our knowledge, research has not yet been published relating to the ways in which women undergoing caesarean sections in the 1970s and 1980s experienced the birth of their baby and whether or not their mode of delivery has affected their reproductive health and their relationship to their child.

OBJECTIVE

To describe women's experience of undergoing a caesarean section in the 1970s and 1980s in Sweden.

DESIGN

A qualitative method using semi-structured questions and content analysis.

PARTICIPANTS

Twenty-two women were interviewed who underwent caesarean section during the 1970s and 1980s in Sweden.

RESULTS

The overarching theme surrounding women's experience of having undergone a caesarean section 30-40 years ago is that it is described as "undesired life event". Four categories were established: vaginal birth as the norm; a total loss of control; acceptance and contact with the child.

CONCLUSION

Undergoing a caesarean section during the 1970s and 1980s was considered to be an undesired life events. The interlocuters who participated in this study had little knowledge about operative childbirth and were poorly prepared for a complicated birth and postpartum care. The women did not suffer any long-term physiological harm yet were harmed psychologically until they came to terms with their negative experience and reached acceptance of it.

Music Therapy Interventions for Stress Reduction in Adults With Mild Intellectual Disabilities: Perspectives From Clinical Practice

Stress is increasingly being recognized as one of the main factors that is negatively affecting our health, and therefore there is a need to regulate daily stress and prevent long-term stress. This need seems particularly important for adults with mild intellectual disabilities (MID) who have been shown to have more difficulties coping with stress than adults without intellectual disabilities. Hence, the development of music therapy interventions for stress reduction, particularly within populations where needs may be greater, is becoming increasingly important. In order to gain more insight into the practice-based knowledge on how music therapists lower stress levels of their patients with MID during music therapy sessions, we conducted focus group interviews with music therapists working with adults with MID (N = 13) from different countries and clinical institutions in Europe. Results provide an overview of the most-used interventions for stress reduction within and outside of music. Data-analysis resulted in the further specification of therapeutic goals, intervention techniques, the use of musical instruments, and related therapeutic change factors. The main findings indicate that music therapists used little to no receptive (e.g., music listening) interventions for stress reduction, but preferred to use active interventions, which were mainly based on musical improvisation. Results show that three therapy goals for stress relief could be distinguished. The goal of "synchronizing" can be seen as a sub goal because it often precedes working on the other two goals of "tension release" or "direct relaxation," which can also be seen as two ways of reaching stress reduction in adults with MID through music therapy interventions. Furthermore, the tempo and the dynamics of the music are considered as the most important musical components to reduce stress in adults with MID. Practical implications for stress-reducing music therapy interventions for adults with MID are discussed as well as recommendations for future research.

Physicians on the Frontlines: Understanding the Lived Experience of Physicians Working in Communities That Experienced a Mass Casualty Shooting

This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: (1) The psychological toll on physicians: "I wonder if I'm broken"; (2) the importance of and need for mass casualty shooting preparedness: "[We need to] recognize this as a public health concern and train physicians to manage it"; (3) massive media attention: "The media onslaught was unbelievable"; and (4) commitment to advocacy for a public health approach to firearm violence: "I want to do whatever I can to prevent some of these terrible events."

How individuals with spinal cord injury in the United States access and assess information about experimental therapies and clinical trials: results of a clinical survey

STUDY DESIGN

An internet-based survey.

OBJECTIVES

To determine how individuals with spinal cord injury (SCI) access information about experimental therapies and clinical trials. To understand which factors influence receipt of and perceived trustworthiness of that information.

SETTING

Two academic medical centers and an SCI organization.

METHODS

Demographic information frequencies and percentages were calculated then analyzed using chi-square tests for independence. Fisher's exact test of independence was used to assess significance for contingency tables with categories containing expected counts below five.

RESULTS

Three hundred sixty four persons with SCI participated in the survey. Most felt confident in their ability to evaluate SCI-specific information from a variety of sources, though SCI organizations and the medical literature were deemed the most reliable. Information from SCI specialists was deemed more credible than that from non-SCI specialists, but only 53.6% of participants had access to them. Nearly all (89.0%) respondents who had sought information about experimental therapies had found it online, while 51.4% of those who had participated in a clinical trial had been contacted by a research team. Only 8.4% of participants felt their medical teams offered them sufficient information about experimental therapies and clinical trials. Wealthier and more educated respondents were more knowledgeable about health-related resources on the internet. Nearly all participants (96.9%) expressed interest in learning more about trials related to SCI.

CONCLUSIONS

There is an information deficit among people with SCI pertaining to experimental therapies and clinical trials. It is exacerbated by lack of income, education, and access to SCI specialists.

Obstetrical Unit Response to the COVID-19 Pandemic: OUR Study

OBJECTIVE

This study aimed to describe the response of labor and delivery (L&D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE).

STUDY DESIGN

A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through "snowballing." A single representative was asked to respond on behalf of each L&D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage.

RESULTS

A total of 301 surveys (estimated 51.5% response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31%), community teaching (45%) and nonteaching hospitals (24%). Sixteen percent of respondents were from states with high prevalence, defined as higher "deaths per million" rates compared with the national average. Universal laboratory testing for admissions was reported for 40% (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.23-2.42) and high prevalence states (aOR = 2.68, 95% CI: 1.37-5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33% and for cesarean delivery in 38% of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95% CI: 1.29-5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95% CI: 0.24-0.73).

CONCLUSION

Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely to recommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use.

KEY POINTS

· Heterogeneity is seen in institutional recommendations for viral testing and PPE.. · Universal laboratory testing for COVID-19 is more common at academic centers.. · N95 mask use during vaginal deliveries is less likely in places with universal testing..

Survivors of gun violence and the experience of recovery

BACKGROUND

Survivors of gun violence may develop significant mental health sequelae and are at higher risk for reinjury through repeat violence. Despite this, survivors of gun violence often return to the community where they were injured with suboptimal support for their mental health, emotional recovery, and well-being. The goal of this study was to characterize the posthospitalization recovery experience of survivors of gun violence.

METHODS

We conducted a qualitative research study with a community-based participatory research approach. In partnership with a community-based organization, we conducted in-depth one-on-one interviews and used snowball sampling to recruit survivors of gun violence. We applied the constant comparison method of qualitative analysis to catalogue interview transcript data by assigning conceptual codes and organizing them into a consensus list of themes. We presented the themes back to the participants and community members for confirmation.

RESULTS

We conducted 20 interviews with survivors of gun violence; all were black men, aged 20 years to 51 years. Five recurring themes emerged: (1) Isolation, physical and social restriction due to fear of surroundings; (2) Protection, feeling unsafe leading to the desire to carry a gun; (3) Aggression, willingness to use a firearm in an altercation; (4) Normalization, lack of reaction driven by the ubiquity of gun violence in the community; and (5) Distrust of health care providers, a barrier to mental health treatment.

CONCLUSION

Survivors of gun violence describe a disrupted sense of safety following their injury. As a result, they experience isolation, an increased need to carry a firearm, a normalization of gun violence, and barriers to mental health treatment. These maladaptive reactions suggest a mechanism for the violent recidivism seen among survivors of gun violence and offer potential targets to help this undertreated, high-risk population.

LEVEL OF EVIDENCE

Care management/Therapeutic V.

The Role of Perceived Unjust Treatment in Unmet Needs for Primary Care Among Finnish Roma Adults

The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods.

Self-Destigmatization Process? Experiences of Persons Living with Bipolar Disorder: A Qualitative Study

This qualitative study investigated subjective experiences of self-stigmatization and self-destigmatization among people living with bipolar disorder (BD). We conducted in-depth interviews focusing on self-stigmatization and self-destigmatization with 22 individuals living with BD. The interview transcripts were thematically analyzed using a mixed inductive and deductive approach. Thirty-six codes were extracted and organized into six themes: language, behaviors, relationships, personal experience, identity, and healthcare. Each theme was characterized by an evolution process, and the codes were distributed in a step-by-step order as landmarks. The process begins with the experience of self-stigmatization, and develops toward self-destigmatization. This study presents a new six-dimension process called the "self-destigmatization process" (SDP), a personal and interrelational process that deconstructs self-stigmatization. Clinicians can use the landmarks of the process for clinical assessment and therapeutic interventions to increase recovery orientation.

Factors associated with unsafe work behaviours in an Iranian petrochemical company: perspectives of workers, supervisors, and safety managers

BACKGROUND

The petrochemical industry is hazardous, in part because of the inherently dangerous nature of the work conducted, and incidents frequently result in significant financial and social losses. The most common immediate cause of incidents and injuries in this industry is unsafe worker behaviour. Identifying the factors encouraging unsafe work behaviours is the first step in taking action to discourage them. The aim of this study was to (a) explore workers', supervisors' and safety managers' attitudes and perceptions of safety in a petrochemical company in Iran, and (b) identify the factors that discourage safe work behaviours.

METHODS

A qualitative study was conducted by applying the steps described by Graneheim and Lundman (2004). Twenty participants were recruited from an Iranian petrochemical company using a multi-stage approach, with initial purposive sampling followed by snowball sampling to enhance recruitment. Individual face-to-face and semi-structured interviews were conducted to gain an in-depth understanding of factors acting as barriers to safe behaviour. The interviews were recorded and transcribed in Persian and then translated into English. Conventional content analysis was performed.

RESULTS

The main themes emerging from the interviews were: (i) poor direct safety management and supervision; (ii) unsafe workplace conditions; (iii) workers' perceptions, skills and training; and (iv) broader organisational factors.

CONCLUSIONS

The findings give insights into practical organisational measures that can be implemented by management to promote workers' commitment to safety and engage in safe behaviours in their workplace.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT20170515033981N2 . Retrospectively registered 19 June 2018.

Perceptions of radiography students toward problem-based learning almost two decades after its introduction at Makerere University, Uganda

Introduction

Problem-based learning (PBL) has been reported to be a valuable student-centred learning approach across the globe. In PBL students first encounter a problem, which triggers discussion, followed by student-centred inquiry. Makerere University College of Health Sciences has been using PBL for radiography students since 2002. Over the years, the learning landscape may have changed, including the significant disruption of learning by the coronavirus disease 2019 global pandemic. The study aimed at exploring the perceptions of undergraduate radiography students about the PBL curriculum at Makerere University almost two decades after its introduction.

Methods

This exploratory qualitative study involved 18 radiography students sampled purposively, from whom data were gathered using focus group discussions. Thematic analysis was subsequently used.

Results

Three key themes emerged from the data: (1) quality of teaching, (2) curriculum efficiency, and (3) curriculum expectations and rating. All students were generally positive about the curriculum. Most agreed that the curriculum was efficient to a greater extent and had met their expectations and desired objectives. Students, however, faced challenges; for example, with limited learning resources during the learning process.

Conclusion

This study highlights the significant role of PBL in enhancing student's problem-solving, critical thinking, literature search, and, most of all, their practical skills. Prioritization of teaching based on practical relevance and learning objectives is of great importance. The radiography students believed that their curriculum program was generally beneficial to them; however, it was affected by limited resources and limited availability of teaching personnel, which needs to be addressed.

Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa

BACKGROUND

Worldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers.

METHODS

The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method.

RESULTS

Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming 'spoilt'. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers' ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace.

CONCLUSION

Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support feeding and childcare if global nutrition and development goals are to be met.

Effect of REDD+ projects on local livelihood assets in Keo Seima and Oddar Meanchey, Cambodia

Climate-change mitigation projects are expected to improve local livelihoods in targeted areas. Several REDD+ projects aimed at reducing emissions from deforestation and forest degradation, conserving and enhancing forest carbon stocks, and sustainably managing forests have been implemented in Cambodia but few studies have examined the effects on local livelihoods before and during project implementation. Our study applies a sustainable livelihood framework to assess the livelihood assets of local communities in the Oddar Meanchey and Keo Seima REDD+ project sites in Cambodia before and during project implementation. Five capital assets, namely natural, physical, human, financial, and social capital, are assessed and scored on a 1-to-5 Likert scale. Data analysis collected through 252 interviews in Oddar Meanchey and Keo Seima reveals a slight increase in livelihood assets in both sites from project validation to implementation. Generally, the mean scores for local livelihood assets increased from 2.81 ± 0.07 (±is followed by the standard error) and 2.66 ± 0.06 to 3.07 ± 0.09 and 3.06 ± 0.08 in Oddar Meanchey and Keo Seima, respectively. Nevertheless, natural capital assets sharply declined from 3.50 and 3.32 to 2.09 and 2.25, respectively. Respondents mainly blamed illegal logging for the decline, suggesting that strict patrolling and enforcement must be implemented. Furthermore, the scarcity of carbon-credit buyers and the projects’ inability to generate carbon-based revenues has led to dissatisfaction among local communities, inducing avoidable illegal activities in pursuit of short-term benefits. A financial mechanism to ensure sufficient and sustained financial support regardless of carbon-market volatility is urgently needed.

Occupational noise induced hearing loss in the mining sector in South Africa: Perspectives from occupational health practitioners on how mineworkers are trained

Background

Historically, occupational health concerns associated with mining, particularly occupational noise-induced hearing loss (ONIHL), were ignored by the mining sector, policy-makers and academic researchers. As such, there is a dearth of literature related to ONIHL, especially in low- and middle-income countries such as South Africa. Consequently, mineworkers were not aware of the latent effects of excessive exposure to hazardous noise and the resultant hearing loss thereof.

Objectives

The aim of this study was to explore the perspectives of occupational health practitioners (OHPs) regarding education and training of mineworkers on occupational noise-induced hearing loss (ONIHL) and its impact on mineworkers’ health.

Method

Qualitative, in-depth telephonic and face-to-face interviews were conducted with 16 OHPs. Purposive and snowball sampling methods were utilised to recruit participants. Data were analysed using inductive thematic analysis.

Results

Three themes emerged from the data: ‘seeing is believing’, ‘not my department!’ and ‘barriers and facilitators to raising awareness’ with two subthemes: ‘blame it on the language and level of education’ and ‘compensation pay-outs’. Superficially, OHPs believe that mineworkers are aware of the impact of noise on health; however, the OHPs are not aware on how the mineworkers are educated on ONIHL and its latent consequences. Furthermore, language, low levels of education and literacy, as well as financial constraints, are the factors found to affect education and training of the mineworkers about the risks of ONIHL.

Conclusion

If the mining industry is committed in eliminating ONIHL, they should prioritise health literacy, and mines need to have an effective awareness-raising plan in place to eliminate ONIHL from every mine. This plan must consider diversity of workforce, including linguistic, as well as educational level diversity.

Information-Motivation-Behavioral Skills model of consistent condom use among transgender women in Shenyang, China

BACKGROUND

The Information-Motivation-Behavioral Skills (IMB) model has received consistent empirical support in the context of HIV prevention among various key populations, but not yet among transgender women (TGW). None effective interventions has been carried out among TGW so far to control their high prevalence of unprotected anal intercourse. The intent of the current study is to examine the application of the IMB model to clarifying the association between condom use correlates and condom use frequency among TGW in China.

METHODS

Using snowball sampling, we recruited 198 self-identified TGW in Shenyang, China from April 2017 to July 2017. Participants were required to complete a questionnaire assessing their background characteristics and IMB model constructs. Structural equation modeling (SEM) was conducted to demonstrate the utility of the IMB model.

RESULTS

The consistent condom use (CCU) rate was 47.0%. Results of SEM indicated that HIV-preventive motivation (comprising condom use attitude and subjective norms; β = 0.823, P <  0.001) and behavioral skills (including condom use skills and self-efficacy; β = 0.979, P = 0.004) were related to more frequent condom use, whereas HIV knowledge was unrelated to condom use (β = 0.052, P = 0.540).

CONCLUSIONS

The low CCU rate suggested that TGW in China were at high risk of HIV infection and transmission and a key intervention population. HIV-preventive interventions for this population should focus on enhancing motivation and strengthening behavioral skills to increase condom use frequency and reduce HIV infection.

The Canadian retinoblastoma research advisory board: a framework for patient engagement

PLAIN ENGLISH SUMMARY

Retinoblastoma is a rare eye cancer that occurs in one or both eyes of infants and young children as a result of errors in the RB1 gene. There are approximately 2000 retinoblastoma survivors in Canada. Those with the heritable form of the disease are at risk of passing the gene to the next generation and developing a second cancer. Many retinoblastoma survivors and families therefore interact with the healthcare system throughout their lives.The retinoblastoma community has a longstanding history of engaging patients in research, however without any formal process. The literature establishes benefits to patient engagement such as research results which are more applicable, credible, and transparent. Building on the established interest among stakeholders, the Canadian Retinoblastoma Research Advisory Board (CRRAB) was established in 2016 to foster sustainable and meaningful collaboration between patients (survivors and family members), advocacy groups, healthcare professionals, and researchers in the retinoblastoma community.The aim of this study was to evaluate the utility of CRRAB in fostering patient engagement in research. Members of CRRAB were surveyed to uncover their attitudes towards and experience with patient engagement in research. Participants perceived CRRAB to provide diverse and accessible opportunities for patient engagement in research and perceived their participation to have a meaningful impact. The results suggest that CRRAB promotes patient engagement in retinoblastoma research, and provides direction to sustain and enhance future patient engagement.

ABSTRACT

Background The Canadian Retinoblastoma Research Advisory Board (CRRAB) is a multidisciplinary group, including patients (survivors and family members), advocacy groups, healthcare professionals, and researchers, which aims to establish and sustain patient engagement in retinoblastoma research. The purpose of this study was to describe the development of CRRAB and to uncover members' understanding of and attitudes towards patient engagement in research. As well, to determine their level of engagement.Methods Retinoblastoma patients, healthcare professionals, and researchers provided leadership to co-develop CRRAB. CRRAB members were surveyed by pre- and post-test questionnaire at the 2016 Annual General Meeting to assess experience with, understanding of, and attitudes towards patient engagement in research. A second questionnaire was administered before the 2017 CRRAB meeting to assess awareness and perceived impact of CRRAB activities, and individual engagement in research. Data were analyzed by descriptive statistics and paired t-test (for pre/post-test). Thematic analysis of chart board discussions at both meetings revealed the joint goals of CRRAB and reasons for and barriers to patient engagement.Results In 2016, 21 individuals participated and self-identified as patients (11, 52%), healthcare professionals (6, 29%), and/or researchers (7, 33%) (participants could overlap stakeholder groups). Overall, participants believed that research is relevant to all stakeholders and that patients can have meaningful impact on research. In 2017, 35 individuals participated and identified as patients (21, 60%), healthcare professionals (9, 26%), and/or researchers (8, 23%). 94% of participants were aware of CRRAB initiatives and 67% had participated in at least one over the previous year. Participants perceived that CRRAB provides diverse opportunities and increases accessibility for patient engagement in research, and perceived patient engagement to have meaningful impact on retinoblastoma research. Chart board discussions revealed that participants wanted to be part of CRRAB to increase knowledge, support innovation and patient engagement, and be part of a community. Members most commonly faced barriers including time and cost restraints.Conclusions The results of this study suggest that CRRAB has supported the engagement needs of patients affected by retinoblastoma, and has provided an opportunity for engaging patients in retinoblastoma research. CRRAB will continue to be used as a framework for patient engagement, with improvements based on participant feedback.

The Swedish Version of the Electronic Health Literacy Scale: Prospective Psychometric Evaluation Study Including Thresholds Levels

Background

To enhance the efficacy of information and communication, health care has increasingly turned to digitalization. Electronic health (eHealth) is an important factor that influences the use and receipt of benefits from Web-based health resources. Consequently, the concept of eHealth literacy has emerged, and in 2006 Norman and Skinner developed an 8-item self-report instrument to measure these skills: the eHealth Literacy Scale (eHEALS). However, the eHEALS has not been tested for reliability and validity in the general Swedish population and no threshold values have been established.

Objective

The aim of this study was to translate and adapt eHEALS into a Swedish version; evaluate convergent validity and psychometric properties; and determine threshold levels for inadequate, problematic, and sufficient eHealth literacy.

Methods

Prospective psychometric evaluation study included 323 participants equally distributed between sexes with a mean age of 49 years recruited from 12 different arenas.

Results

There were some difficulties translating the English concept health resources. This resulted in this concept being translated as health information (ie, Hälsoinformation in Swedish). The eHEALS total score was 29.3 (SD 6.2), Cronbach alpha .94, Spearman-Brown coefficient .96, and response rate 94.6%. All a priori hypotheses were confirmed, supporting convergent validity. The test-retest reliability indicated an almost perfect agreement, .86 (P<.001). An exploratory factor analysis found one component explaining 64% of the total variance. No floor or ceiling effect was noted. Thresholds levels were set at 8 to 20 = inadequate, 21 to 26 = problematic, and 27 to 40 = sufficient, and there were no significant differences in distribution of the three levels between the Swedish version of eHEALS and the HLS-EU-Q16.

Conclusions

The Swedish version of eHEALS was assessed as being unidimensional with high internal consistency of the instrument, making the reliability adequate. Adapted threshold levels for inadequate, problematic, and sufficient levels of eHealth literacy seem to be relevant. However, there are some linguistic issues relating to the concept of health resources.

Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey

AIM

To describe the quality of life of persons with traumatic spinal cord injury (TSCI) in a rural area of a low-income country.

METHODS

This was a cross-sectional descriptive study in which snowballing was used to identify persons with TSCI in their homes. A Kiswahili version of the short version of the World Health Organization quality of life questionnaire was used for data collection. Data were analyzed descriptively and independent samples t-tests were used to calculate the difference in the mean scores between groups.

RESULTS

Eighty persons with TSCI with a mean age of 42.29 ± 11.4 years were identified, 68.8% of whom were males. The highest scoring domains were psychological (12.76 ± 2.55) and social relationships (12.62 ± 2.95). The lowest scores were for physical (11.48 ± 2.74) and environment (9.59 ± 2.68) domains. Significantly higher scores were associated with younger age in: physical (0.05), social relationships (0.01), and environment (0.02) domains (p value < 0.05).

CONCLUSIONS

Persons with TSCI in the Kilimanjaro rural area registered a relatively low quality of life in which the most affected domains are physical health and environment.Implications for rehabilitationQuality of life is the ultimate goal in the rehabilitation of persons with any irreversible disability such as spinal cord injury.It is important for rehabilitation professionals to know which domains of quality of life are most affected among persons with spinal cord injury.Rehabilitation professionals ought to understand and address physical health and environmental issues that affect persons with traumatic spinal cord injury in rural resource-constrained areas.Addressing physical health and environmental challenges for persons with spinal cord injury in resource-constrained rural areas require involvement of the family, rehabilitation personnel, policy makers, and the community.

Using Concept Mapping within a Community-Academic Partnership to Examine Obesity among Mexican Immigrants

Background

Weight gain is common following migration to a new country. Mexican immigrants have a disparate prevalence of overweight/obesity and food insecurity. Social stressors, such as unemployment, discrimination, and the threat of deportation, may fuel both food insecurity and weight gain in this population.

Objectives

We sought to (1) examine community-defined causes and correlates of obesity among Mexican-Americans; (2) determine how current social stressors, policies, and programs impact food insecurity and obesity; and (3) identify community-defined priorities for preventive interventions.

Methods

Group concept mapping (GCM) was used in a community-academic partnership (CAP) to describe the factors contributing to weight gain and obesity among Mexican immigrant families. Activities included community brainstorming, sorting and rating, multivariate statistical analysis, and community interpretation of results.

Results

Eighty statements were generated in the brainstorming sessions. These statements were sorted into nine clusters, which were organized into three regions: (1) intrapersonal factors; (2) community-level factors; and (3) social policy-related barriers. Statements reflecting the impact of immigration-related stressors were found in all three regions, addressing participants' fears of deportation, and the prioritization of resources away from healthy eating, resulting in food insecurity. Community members identified five priority areas for intervention planning: (1) lack of exercise; (2) lack of knowledge of a healthy diet; (3) expense of healthy foods; (4) "junk" food; and (5) stress management.

Conclusions

Results suggest high levels of social stress are contributing to food insecurity and obesity among Mexican immigrant families. Areas identified for intervention planning reflect the need for a multifaceted approach toward obesity prevention.

Musculoskeletal pain stakeholder engagement and partnership development: determining patient-centered research priorities

BACKGROUND

Musculoskeletal (MSK) pain is a global public health problem with increased societal burden. Increased attention has focused toward patient and other stakeholder perspectives when determining future MSK pain research priorities, however infrastructure and capacity building within the community are needed for individuals and organizations to participate in patient-centered outcomes research. The purpose of this manuscript is to describe our collaborative experiences with several MSK pain stakeholders and processes to identify a top priority research topic.

METHODS

Lunch meetings and formalized workshops were used to develop infrastructure for engaging patients and other stakeholders with early capacity building for partners to identify MSK pain research ideas based on their personal experiences. Additional capacity building and engagement through literature searching further prepared partners to contribute informed decisions about MSK pain research topics and subsequent selection of an important research question.

RESULTS

Several key deliverables (e.g., Governance Document, Communication Plan) were developed and completed over the course of this project to provide partnership structure. Other key deliverables included a list of preliminary comparative effectiveness research ideas (n = 8) and selection of shared decision making for MSK pain as the top priority research topic with patient partners identifying pain self-efficacy as an important outcome domain.

CONCLUSIONS

Our patient partners provided the catalyst for identifying shared decision making as a high priority research topic based on a wide spectrum of stakeholder perspectives and unique experiences. Patient partners were primarily identified using a single rehabilitation health system and clinician partners were heavily weighted by physical therapists which may have introduced selection bias.

Differential Mental Health Impact Six Months After Extensive River Flooding in Rural Australia: A Cross-Sectional Analysis Through an Equity Lens

Background: Northern New South Wales in Australia is a “hotspot” for natural disaster declarations with recent extensive flooding in early 2017. With limited knowledge about how climate change affects mental health and resilience, robust local assessments are required to better understand long-term impact, particularly in communities prone to extreme weather events.

Methods: Six months post-flood, a cross-sectional survey of adults living in the region during the flood was conducted to quantify associations between flood impact and psychological morbidity (post-traumatic stress (PTSD), anxiety, depression, suicidal ideation) for different exposure scenarios, and respondent groups. We adopted a community-academic partnership approach and purposive recruitment to increase participation from marginalized groups.

Results: Of 2,180 respondents, almost all (91%) were affected by some degree of flood-related exposure at an individual and community level (ranging from suburb damage to home or business inundated). Socio-economically marginalized respondents were more likely to have their homes inundated and to be displaced. Mental health risk was significantly elevated for respondents: whose home/business/farm was inundated [e.g., home inundation: PTSD adjusted odds ratio (AOR) 13.72 (99% CI 4.53–41.56)]; who reported multiple exposures [e.g., three exposures: PTSD AOR 6.43 (99% CI 2.11–19.60)]; and who were still displaced after 6 months [e.g., PTSD AOR 24.43 (99% CI 7.05–84.69)].

Conclusion: The 2017 flood had profound impact, particularly for respondents still displaced and for socio-economically marginalized groups. Our community-academic partnership approach builds community cohesion, informs targeted mental health disaster preparedness and response policies for different sectors of the community and longer-term interventions aimed at improving community adaptability to climate change.

Feelings of Entrapment and Defeat Mediate the Association Between Self-Esteem and Depression Among Transgender Women Sex Workers in China

BACKGROUND

Transgender women sex workers have a high prevalence of depression. Low self-esteem and subsequent involuntary subordination (characterized by feelings of defeat and entrapment) are well-documented risk factors for depression. The object of the present study was to investigate the mediating effect of feelings of entrapment and defeat on the relationship between self-esteem and depression among transgender women sex workers in China.

METHODS

A cross-sectional study was conducted in Shenyang and Guangzhou in 2017. Participants were 198 transgender women sex workers who completed a structured questionnaire assessing background characteristics, self-esteem, feelings of entrapment and defeat, and depression. Linear regression was used to test the mediation hypotheses.

RESULTS

Of participants, 25.25% exhibited high levels of depression. Self-esteem scores were negatively correlated with depression scores (r = -0.54, p < 0.05, R 2 adj = 0.23), defeat scores (r = -1.68, p < 0.05, R 2 adj = 0.31), and entrapment scores (r = -1.67, p < 0.05, R 2 adj = 0.25). In the mediation hypothesis model, entrapment (r = 0.21, p < 0.05) and defeat (r = 0.08, p < 0.05) had a complete mediating effect on the relationship between self-esteem (Spearman's r = -0.06, p = 0.36) and depression (R 2 adj = 0.61).

CONCLUSION

Feelings of entrapment and defeat mediated the association between self-esteem and depression. More focus is needed on monitoring feelings of defeat and entrapment among transgender women sex workers to mitigate the risk of depression.

Perspectives on health examination for asylum seekers in relation to health literacy - focus group discussions with Arabic and Somali speaking participants

BACKGROUND

Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework.

METHODS

Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis.

RESULTS

One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level."

CONCLUSION

The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered.

Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol

INTRODUCTION

Equity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual's knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers' Health literacy and eHealth literacy levels in Sweden.

METHODS AND ANALYSIS

This is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ² and Fisher's exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed.

ETHICS AND DISSEMINATION

The project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.

A Core Outcome Set to Evaluate Physical Activity Interventions for People Living With Dementia

Background and Objectives

A core outcome set (COS) to evaluate physical activity (PA) interventions for people living with dementia is needed, as the development of guidelines is currently limited by important heterogeneity in this field of research. Development of COS often includes Delphi surveys, but people living with dementia are often excluded. This study aimed to reach consensus on this COS using a modified Delphi survey to enable the participation of people living with dementia.

Research Design and Methods

Two stakeholders groups took part in a Delphi survey (Group 1: people living with dementia and family caregivers; Group 2: professionals from different backgrounds, including physiotherapists, occupational therapists, and researchers). Caregivers and professionals completed the survey remotely. Participants living with dementia took part face-to-face, using a card sorting strategy. The consensus process was finalized with a consensus meeting.

Results

Ninety-five participants of both groups completed the modified Delphi. Of those, 11 attended the consensus meeting. The card sorting strategy was successful at including people living with dementia. Seven outcomes reached consensus: preventing falls; doing what you can do; staying healthy and fit; walking better, being able to stand up and climb stairs; feeling brighter; enjoying the moment; and, feeling useful and having a purpose.

Discussion and Implications

Robust and innovative methodological strategies were used to reach a consensus on a COS (what to measure) to evaluate PA for people living with dementia. Future work will focus on the selection of the most appropriate tools to measure these outcomes (how to measure).

Saving water for the future: Public awareness of water usage and water quality

Fresh water is a limited resource under anthropogenic threat. Europeans are using an average of 3550 L per capita per day and this amount is increasing steadily as incomes rise. Water saving options are being actively promoted, but these intensified measures do not yet come close to saving enough water to prevent water shortages that may seriously affect our way of life in the near future. With projected increases in demands for good quality fresh water, educating the public about sustainable personal water use and water quality threats becomes an absolute necessity. One way to achieve this is through engaging citizens in water issues, e.g. through citizen science projects. Using snowball convenience sampling, we distributed a questionnaire among 498 people in 23 countries to investigate whether people were aware of how much water they used, what they perceived as threats to water quality and whether they would like to help improve water quality. Our results showed that the amount of daily water use was greatly underestimated among respondents, especially indirect use of water for the production of goods and services. Furthermore, the effects of climate change and detrimental habits such as feeding ducks were underestimated, presumably because of environmental illiteracy. However, eighty-five percent (85%) of our participants indicated an interest in directly working together with scientists to understand and improve their local water quality. Involving citizens in improving local lake quality promotes both environmental and scientific literacy, and can therefore result in a reduction in daily personal water use. The next iteration of the Water Framework Directive legislation will be launched shortly, requiring water managers to include citizens in their monitoring schemes. Engaging citizens will not only help improve surface water quality, and educate about cause and effect chains in water quality, but will also reduce the personal fresh water usage.

Reaching the "Hard-to-Reach": Recruitment of Rural-Dwelling Adults With Disabilities

Introduction: There are 46 million individuals living in rural America that require unique consideration for rural health research. Recruitment of research participants from disparity groups can be difficult as these groups can be hard-to-reach. In particular, strategies for reaching rural-dwelling Americans with disabilities are not well-documented. Furthermore, researchers sometimes underestimate the time and effort needed to recruit participants from hard-to-reach populations. The purpose of this article is to report the methods used to recruit 12 rural-dwelling adults with disabilities into a qualitative study. Method: The recruitment strategies discussed in this article were used in a grounded theory study. Results: Fifty percent of the sample in this study was recruited via a community gatekeeper, 33% responded to a classified advertisement, and 17% were recruited via the researchers' professional networks. Discussion: Lessons learned yield insights as to effective recruitment methods for rural dwellers as well as other hard-to-reach populations.

Physical activity counselling among GPs: a qualitative study from Thailand

BACKGROUND

Physical activity (PA) counselling is an intervention to promote PA among patients in primary care, yet it remains limited in this clinical setting. This study aimed to explore PA counselling practices among general practitioners (GPs), as well as barriers to and recommendations for improving PA counselling.

METHODS

This qualitative study employed a descriptive approach. Data were collected by in-depth interviews and analysed by thematic analysis. The study was conducted in district hospitals in Nakhon Si Thammarat, Thailand, from February 2017 to February 2018. The study participants were GPs who worked at district hospitals.

RESULTS

Seventeen GPs (6 males and 11 females, mean age 29.8 ± 3.4 years) from 6 district hospitals were interviewed. Their clinical experience ranged from 2 to 12 years (mean 4.7 ± 2.9). The GPs saw 30-80 outpatients/day (mean 56.2 ± 14.1) and spent 1-8 min (mean 3.8 ± 1.8) with each patient. They emphasised PA in patients with poorly controlled non-communicable diseases (NCDs) using the word 'exercise' in the Thai language as well as discussing time and frequency of exercise. PA was considered a non-pharmacological treatment in the management of NCDs, which improved patient health and quality of life. Barriers to PA counselling among GPs included time constraints, insufficient knowledge, and lack of opportunities to follow-up previously counselled patients. GPs suggested that training in PA counselling was required.

CONCLUSIONS

GPs concurred that PA counselling is essential in the treatment of NCDs. Physicians' recommendations to improve the quality of PA counselling in primary care include 3 Ts: training in PA counselling, tools for prescribing PA, and teams of healthcare professionals. Implementing use of written PA prescriptions may encourage patients to increase PA. Multidisciplinary teams should be developed to support PA counselling in the clinical setting. Further studies should focus on appropriate techniques to implement PA counselling and overcome existing barriers.

VA Provider Perspectives on Coordinating COPD Care Across Health Systems

BACKGROUND

More and more Veterans are receiving care from community providers, increasing the need for effective coordination across health systems. For Veterans with chronic obstructive pulmonary disease (COPD), this need is intensified by complex comorbidity patterns that often include multiple providers co-managing patient care.

OBJECTIVES

We sought to understand how VA providers perceive coordination with community providers for Veterans with COPD.

DESIGN

Qualitative study of VA providers.

METHODS

We selected six geographically diverse VA sites and conducted semi-structured telephone interviews with providers practicing in inpatient and/or outpatient settings who care for Veterans with COPD.

MAIN MEASURES

Interviews focused on communication with community providers about discharge information and clinic management. We analyzed responses according to the principles of conventional content analysis, allowing inductive themes to emerge.

KEY RESULTS

We interviewed 25 providers during the period of June to October 2017. Qualitative data analysis yielded five themes: (1) VA providers perceive communication challenges between VA and community providers, including difficult, inadequate, and delayed communication; (2) communication is facilitated by personal relationships across health systems; (3) the lack of electronic health record (EHR) interoperability impairs communication, resulting in transmission of unstructured data; (4) poor communication leads to duplicative efforts and wasted resources; and (5) providers frequently rely on patients to communicate about care taking place in the community.

CONCLUSIONS

VA providers described major challenges in coordinating with community providers, leading to perceptions of delayed, missed, or duplicative care and jeopardizing the overall quality, safety, and efficiency of Veteran care. Our study highlights the need for system-level solutions to support coordination across health systems for Veterans with COPD and may have implications for other conditions that lead to recurrent hospitalization and/or care in the community.

The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change

Background

Wearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse.

Objective

The aim of this study was to investigate older adults’ perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage.

Methods

Data for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type).

Results

The results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior.

Conclusions

The results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology’s limitations and gaining awareness of one’s physical activity without changing the physical activity level itself.

A genetic counseling needs assessment of Mexico

BACKGROUND

While genetic counseling has expanded globally, Mexico has not adopted it as a separate profession. Given the rapid expansion of genetic and genomic services, understanding the current genetic counseling landscape in Mexico is crucial to improving healthcare outcomes.

METHODS

Our needs assessment strategy has two components. First, we gathered quantitative data about genetics education and medical geneticists' geographic distribution through an exhaustive compilation of available information across several medical schools and public databases. Second, we conducted semi-structured interviews of 19 key-informants from 10 Mexican states remotely with digital recording and transcription.

RESULTS

Across 32 states, ~54% of enrolled medical students receive no medical genetics training, and only Mexico City averages at least one medical geneticist per 100,000 people. Barriers to genetic counseling services include: geographic distribution of medical geneticists, lack of access to diagnostic tools, patient health literacy and cultural beliefs, and education in medical genetics/genetic counseling. Participants reported generally positive attitudes towards a genetic counseling profession; concerns regarding a current shortage of available jobs for medical geneticists persisted.

CONCLUSION

To create a foundation that can support a genetic counseling profession in Mexico, the clinical significance of medical genetics must be promoted nationwide. Potential approaches include: requiring medical genetics coursework, developing community genetics services, and increasing jobs for medical geneticists.

Recruiting, integrating, and sustaining stakeholder participation in environmental management: A case study from the Great Lakes Areas of Concern

Stakeholder participation is now widely viewed as an essential component of environmental management projects, but limited research investigates how practitioners perceive the major challenges and strategies for implementing high-quality participation. In order to address this gap, we present findings from a survey and interviews conducted with managers and advisory committee leaders in a case study of United States and binational (US and Canada) Great Lakes Areas of Concern. Our findings suggest that recruiting and integrating participants and sustaining participation over the long term present distinctive ongoing challenges that are not fully recognized in existing conceptualizations of the process of implementing participation. For example, it can be difficult to recruit active stakeholders to fill vacant "slots," to integrate distinctive interests and perspectives in decision-making processes, and to keep participants involved when activity is low and less visible. We present strategies that emerged in the survey and interviews for addressing these challenges, emphasizing the building and leveraging of relationships among stakeholders themselves. Such strategies include balancing tight networks with an openness to new members, supplementing formal hearings with social gatherings, making participation socially meaningful, and dividing labor between managers and advisory committees.

Personality, Work-Life Balance, Hardiness, and Vocation: A Typology of Nurses and Nursing Values in a Special Sample of English Hospital Nurses

This initial report of a longitudinal study of 192 English hospital nurses measured Nursing Values (the 6Cs of nursing); Personality, Self-Esteem and Depression; Burnout Potential; Work-Life Balance Stress; “Hardy Personality”; and Intention to Leave Nursing. Correlational, component, and cluster analysis identified four groups: “The Soldiers” (N = 79), with medium scores on most measures, who bravely “soldier on” in their nursing roles, in the face of numerous financial cuts to the National Health Service, and worsening nurse–patient ratios; “Cheerful Professionals” (N = 54), coping successfully with nursing roles, and a variety of challenges, in upwardly mobile careers; “High Achievers” (N = 39), senior nurses with strong profiles of a “hardy personality”, and commitment to fundamental nursing values; and “Highly Stressed, Potential Leavers” (N = 20), with indicators of significant psychological distress, and difficulty in coping with nursing role challenges. We have initiated a program of co-counselling and social support for this distressed group, by nurses who are coping more successfully with multiple challenges. We discuss the role of nurse educators in fostering nursing values, developing and supporting a “hardy personality” and emotional resilience in recruits to nursing. This study is framed within the disciplinary approach of Critical Realism, which identifies the value basis for research and dialogue in developing strategies for social change. The importance of this research is that: (a) it is part of the new thrust in nursing research, applying Critical Realist theory and methodology to research on nursing stress; (b) it has established, through network sampling, a group of nurses who can be supportive of each other in their stressful careers; (c) it establishes the reliability and potential validity of a measure of core nursing values; (d) it is among the first studies in research on nursing stress, to use the humanizing methodology of moving from data analysis (description of “things”), to describing a typology of nursing stress and career progress (description of individuals).

The latent structure of major depressive symptoms and its relationship with somatic disorder symptoms among Filipino female domestic workers in China

Emerging research have investigated the factor structure of major depressive disorder (MDD) symptoms based on DSM-5 nomenclature. However, to date, results have been inconsistent on what symptom-structure best represent MDD. This study examines the best fitting MDD among four competing models in a sample of overseas Filipino domestic helpers (N = 232). The results show that a two-factor model (Model 2b; Krause et al., 2010) provided the best fit. The model consist of two factors: somatic and non-somatic/affective symptoms. Somatic component includes sleep difficulties, fatigue, appetite changes, concentration difficulties, and psychomotor agitation/retardation while non-somatic/affective component covers anhedonia, depressed mood, feelings of worthlessness, and thoughts of death. Further, the results reveal a pattern where PHQ-15 somatic symptom-items have a higher significant relationship with MDD's somatic symptoms than with the MDD's non-somatic/affective symptoms. These findings suggest that the items of model 2b are appropriately embedded in their respective factors. Differentiating MDD factors have important clinical implications, particularly in the diagnosis and treatment of depression among overseas Filipino domestic helpers.

"I don't think we've quite got there yet": The experience of allyship for mental health consumer researchers

WHAT IS KNOWN OF THE SUBJECT

Consumer participation in mental health services is an expectation articulated through mental health policy. Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers. Researchers from the health disciplines find value in consumer involvement in mental health research. These researchers can support and facilitate consumer research by being allies to consumer researchers.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers. Involving consumers in mental health research is likely to lead to improved practice.

ABSTRACT

Introduction Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer-led research, extending connections and partnerships, and desire to do better. Discussion Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role.

Serial album validation for promotion of infant body weight control

Objective:

to validate the content and appearance of a serial album for children aged from 7 to 10 years addressing the topic of prevention and control of body weight.

Method:

methodological study with descriptive nature. The validation process was attended by 33 specialists in educational technologies and/or in excess of infantile weight. The agreement index of 80% was the minimum considered to guarantee the validation of the material.

Results:

most of the specialists had a doctoral degree and a graduate degree in nursing. Regarding content, illustrations, layout and relevance, all items were validated and 69.7% of the experts considered the album as great. The overall agreement validation index for the educational technology was 0.88. Only the script-sheet 3 did not reach the cutoff point of the content validation index. Changes were made to the material, such as title change, inclusion of the school context and insertion of nutritionist and physical educator in the story narrated in the album.

Conclusion:

the proposed serial album was considered valid by experts regarding content and appearance, suggesting that this technology has the potential to contribute in health education by promoting healthy weight in the age group of 7 to 10 years.

Patient-centered prioritization of bladder cancer research

BACKGROUND

Patient-centered research requires the meaningful involvement of patients and caregivers throughout the research process. The objective of this study was to create a process for sustainable engagement for research prioritization within oncology.

METHODS

From December 2014 to 2016, a network of engaged patients for research prioritization was created in partnership with the Bladder Cancer Advocacy Network (BCAN): the BCAN Patient Survey Network (PSN). The PSN leveraged an online bladder cancer community with additional recruitment through print advertisements and social media campaigns. Prioritized research questions were developed through a modified Delphi process and were iterated through multidisciplinary working groups and a repeat survey.

RESULTS

In year 1 of the PSN, 354 patients and caregivers responded to the research prioritization survey; the number of responses increased to 1034 in year 2. The majority of respondents had non-muscle-invasive bladder cancer (NMIBC), and the mean time since diagnosis was 5 years. Stakeholder-identified questions for noninvasive, invasive, and metastatic disease were prioritized by the PSN. Free-text questions were sorted with thematic mapping. Several questions submitted by respondents were among the prioritized research questions. A final prioritized list of research questions was disseminated to various funding agencies, and a highly ranked NMIBC research question was included as a priority area in the 2017 Patient-Centered Outcomes Research Institute announcement of pragmatic trial funding.

CONCLUSIONS

Patient engagement is needed to identify high-priority research questions in oncology. The BCAN PSN provides a successful example of an engagement infrastructure for annual research prioritization in bladder cancer. The creation of an engagement network sets the groundwork for additional phases of engagement, including design, conduct, and dissemination. Cancer 2018. © 2018 American Cancer Society.

Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients

BACKGROUND

Patients with chronic pain often lack the skills and resources necessary to manage this disease.

OBJECTIVE

To develop a chronic pain self-management program reflecting community stakeholders' priorities and to compare functional outcomes from training in two settings.

DESIGN

A parallel-group randomized trial.

PARTICIPANTS

Eligible subjects were 35-70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics.

INTERVENTIONS

In one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library.

MAIN MEASURES

Five times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol-Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses.

KEY RESULTS

Among 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (-4.9 s, P = 0.001) and improved scores on Borg Effort (-1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events.

CONCLUSIONS

In low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.

Involving citizens in priority setting for public health research: Implementation in infection research

BACKGROUND

Public sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research.

METHOD

A scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool.

RESULTS

188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of "non-experts" as decision makers were expressed.

CONCLUSION

Voting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats.

Psychometric properties of the Arabic version of the 12-item diabetes fatalism scale

Background

There are widespread fatalistic beliefs in Arab countries, especially among individuals with diabetes. However, there is no tool to assess diabetes fatalism in this population. This study describes the processes used to create an Arabic version of the Diabetes Fatalism Scale (DFS) and examine its psychometric properties.

Methods

A descriptive correlational design was used with a convenience sample of Lebanese adults (N = 274) with type 2 diabetes recruited from a major hospital in Beirut, Lebanon and by snowball sampling. The 12- item Diabetes Fatalism Scale- Arabic (12-item DFS-Ar) was back-translated from the original version, pilot tested on 22 adults with type 2 diabetes and then administered to 274 patients to assess the validity and reliability of the scale. Confirmatory factor analysis (CFA) was used to test the hypothesized factor structure. Cronbach’s alpha was used to test for reliability.

Results

CFA supported the existence of the three factor hypothesis of the original DFS scale. The five items measuring “emotional distress” loaded under Factor 1, the four items measuring “spiritual coping” loaded under factor 2 and the last three items measuring “perceived self-efficacy” of the original scale loaded under Factor 3 (p <0.001 for all three subscales). Goodness of fit indices confirmed adequateness of the CFA model (CFI = 0.97, TLI = 0.96, RMSEA = 0.067 and pclose = 0.05). The 12-item DFS-Ar showed good reliability (Cronbach’s alpha of 0.86) and significantly predicted HbA1c (β = 0.20, p < 0.01). After adjusting for the demographic characteristics and the number of diabetes comorbid conditions, the 12-item DFS-Ar score was independently associated with HbA1c in a multivariable model (β = 0.16, p < 0.05).

Conclusions

The 12-item DFS-Ar demonstrated good psychometric properties that are comparable to the original scale. It is a valid and reliable measure of diabetes fatalism. Further testing with larger and non-Lebanese Arabic population is needed.

Caregiver burden in owners of a sick companion animal: a cross-sectional observational study

Much recent work has focused on occupational stress in veterinary medicine, although little is known about the possible contribution of client-based factors. Clients providing care for a companion animal with protracted illness are likely to experience 'caregiver burden' and reduced psychosocial functioning, which may ultimately lead to increased veterinarian stress. This cross-sectional observational study assessed caregiver burden and psychosocial function in 238 owners of a dog or cat, comparing owners of an animal with chronic or terminal diseases (n=119) with healthy controls blindly matched for owner age/sex and animal species (n=119). Results showed greater burden, stress and symptoms of depression/anxiety, as well as poorer quality of life, in owners of companion animals with chronic or terminal disease (p<0.001 for all). Higher burden was correlated with reduced psychosocial function (p<0.001 for all). Owners of a sick companion animal exhibit elevated caregiver burden, which is linked to poorer psychosocial functioning. This knowledge may help veterinarians understand and more effectively handle client distress in the context of managing the challenges of sick companion animal caregiving. Future work is needed to determine whether clients with this presentation impact veterinarian stress and how burden in this population might be reduced.

Evidence of the paradoxical effect of social network support: A study among Filipino domestic workers in China

Labor migrants are at an increased risk for poor mental health. Post-migration stressors contribute significantly to this risk. Social network supports are vitally important to protect health but little is known about the role of social network supports among labor migrants. The current study evaluated the role of migration stressors on poor mental health among Filipino female domestic workers (FDW) and whether family and friend social network support (SNS) modified this relationship. Data were collected from 261 FDWs in Macau, China from May to September 2013. Hierarchical multiple regression was conducted to test for direct and moderating effects of social networks on psychological distress. Post-migration stress was associated with increased anxiety, depression, somatization, and post-traumatic stress disorder symptoms. SNS from family was not associated with the four psychological symptoms nor did it modify the association between stress and these symptoms. SNS from friends was positively associated with these symptoms, and significantly moderated the relationship between stress and these symptoms. Counterintuitive to the known buffering effects of SNS, greater SNS was associated with greater psychological symptoms among FDWs exposed to post-migration stressors. The present findings suggest that reliance on SNS to cope with post-migration stressors may worsen psychological distress.

Prioritizing the patient voice in the development of urologic oncology research

Prioritization of patient and stakeholder engagement in the research process has been realized through increased funding and policy directives at the government level. Particularly, patient engagement in the preparatory research stage has driven development of patient-prioritized research questions. In this article, a successful example of patient-centered research prioritization is reviewed, and effective strategies and opportunities for patient engagement in urologic oncology research are described.

Less Exercise and More Drugs: How a Low-Income Population Manages Chronic Pain

OBJECTIVES

To evaluate chronic pain management in a multistate, low-income Hispanic population, and to examine predictors of exercising and prescription pain medication (PPM) use.

DESIGN

Online survey administered to a representative sample of Hispanic adults in June 2015.

SETTING

Five southwestern states.

PARTICIPANTS

Among all online panel members who were Hispanic (N=1007), aged 35 to 75 years from 5 states, representing 11,016,135 persons, the survey was completed by 516 members (51%). Among these, 102 participants were identified with chronic noncancer pain representing 1,140,170 persons.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Exercising or using PPM for chronic pain in past year.

RESULTS

Most participants reported using PPM (58%) and exercise (54%) to manage pain. Compared with annual household incomes >$75,000, adjusted odds ratios [AORs] for exercising were .20 for <$10,000 (P=.12); .40 for $10,000 to $34,999 (P=.22); and .15 for $35,000 to $74,999 (P=.015). Conversely, AORs for PPM were over 4-fold higher for lower-income groups as follows: 14.2, 4.79, and 4.85, respectively (all P<.065). PPM users rated the importance of accessing a gym to manage pain lower (P=.01), while exercisers rated the feasibility of gym access to manage pain higher (P=.001).

CONCLUSIONS

In a Hispanic population-based sample with chronic pain, lower-income groups tended to exercise less but use PPM more. Barriers to gym access and use may play a role in these disparities.