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Boakye AS, Dzansi G, Ofosu-Poku R, Ansah MO, Owusu AK, Anyane G, Addai J, Dzaka AD, Salifu Y. Perspectives of Chronic Kidney Disease Patients on Readiness for Advance Care Planning at Komfo Anokye Teaching Hospital, Ghana. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:115-124. [PMID: 38947103 PMCID: PMC11202105 DOI: 10.59249/nzcs6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This study examined the impact of advance care planning (ACP) on the quality of life for patients with chronic kidney disease (CKD) at Komfo Anokye Teaching Hospital in Ghana. It specifically investigated patients' perspectives on their readiness for ACP. Utilizing a qualitative descriptive design, one-on-one interviews were conducted with CKD patients at the renal clinic, employing a semi-structured interview guide for thematic analysis of audio data. The findings revealed a gap in understanding among CKD patients, with participants acknowledging their vulnerability to renal failure, often linked to a medical history of diabetes and hypertension. Despite recognizing potential outcomes such as dialysis dependency or death, some patients retained hope for a cure, relying on faith. The initial kidney failure diagnosis induced shock and distress, leading many patients to prefer the comfort and familiarity of home-based care, including dialysis. Meanwhile, a minority favored hospital care to protect their children from psychological trauma. Most patients deemed legal preparations unnecessary, citing limited assets or a lack of concern for posthumous estate execution. These insights emphasize the necessity for targeted education and support in ACP to enhance patient outcomes in chronic kidney disease care and end-of-life planning.
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Affiliation(s)
- Abigail S. Boakye
- Family Medicine Department, Komfo Anokye Teaching
Hospital (KATH), Kumasi, Ghana
- Faculty of Palliative Care, Ghana College of Nurses and
Midwives, Accra, Ghana
| | - Gladys Dzansi
- Faculty of Palliative Care, Ghana College of Nurses and
Midwives, Accra, Ghana
| | - Rasheed Ofosu-Poku
- Family Medicine Department, Komfo Anokye Teaching
Hospital (KATH), Kumasi, Ghana
| | - Michael O. Ansah
- Family Medicine Department, Komfo Anokye Teaching
Hospital (KATH), Kumasi, Ghana
| | - Alfred K. Owusu
- Quality Assurance Unit, Komfo Anokye Teaching Hospital
(KATH), Kumasi, Ghana
| | - Gladys Anyane
- Family Medicine Department, Komfo Anokye Teaching
Hospital (KATH), Kumasi, Ghana
| | - Juliana Addai
- Family Medicine Department, Komfo Anokye Teaching
Hospital (KATH), Kumasi, Ghana
| | - Alberta D. Dzaka
- Family Medicine Department, Komfo Anokye Teaching
Hospital (KATH), Kumasi, Ghana
| | - Yakubu Salifu
- International Observatory on End of Life Care, Division
of Health Research, Lancaster University, Lancaster, UK
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152
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Janczewski LM, Chandrasekaran A, Abahuje E, Ko B, Slocum JD, Tesorero K, Nguyen MLT, Yang S, Strong EA, Bhakta K, Huml JP, Kruser JM, Johnson JK, Stey AM. Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study. Crit Care Med 2024; 52:e289-e298. [PMID: 38372629 PMCID: PMC11218910 DOI: 10.1097/ccm.0000000000006235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU. DESIGN Qualitative observational cross-sectional study. SETTING Seven ICUs across three hospitals in an integrated academic health system. SUBJECTS ICU clinicians (physicians [critical care, palliative care], advanced practice providers, nurses, social workers, chaplains). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In total, 27 semi-structured interviews were conducted, recorded, and transcribed. The research team reviewed all transcripts inductively to develop a codebook. Thematic analysis was conducted through coding, category formulation, and sorting for data reduction to identify central themes. Deductive reasoning facilitated data category formulation and thematic structuring anchored on the Systems Engineering Initiative for Patient Safety model identified that work systems (people, environment, tools, tasks) lead to processes and outcomes. Four themes were barriers or facilitators to end-of-life care. First, work system barriers delayed end-of-life care communication among clinicians as well as between clinicians and families. For example, over-reliance on palliative care people in handling end-of-life discussions prevented timely end-of-life care discussions with families. Second, clinician-level variability existed in end-of-life communication tasks. For example, end-of-life care discussions varied greatly in process and outcomes depending on the clinician leading the conversation. Third, clinician-family-patient priorities or treatment goals were misaligned. Conversely, regular discussion and joint decisions facilitated higher familial confidence in end-of-life care delivery process. These detailed discussions between care teams aligned priorities and led to fewer situations where patients/families received conflicting information. Fourth, clinician moral distress occurred from providing nonbeneficial care. Interviewees reported standardized end-of-life care discussion process incorporated by the people in the work system including patient, family, and clinicians were foundational to delivering end-of-life care that reduced both patient and family suffering, as well as clinician moral distress. CONCLUSIONS Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.
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Affiliation(s)
- Lauren M Janczewski
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Adithya Chandrasekaran
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Hospital Medicine, Division of Hospice and Palliative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medicine, Division of Critical Care Medicine, Northwestern Medicine Central DuPage Hospital, Winfield, IL
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bona Ko
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John D Slocum
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kaithlyn Tesorero
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - My L T Nguyen
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sohae Yang
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Erin A Strong
- Department of Hospital Medicine, Division of Hospice and Palliative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kunjan Bhakta
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jeffrey P Huml
- Department of Medicine, Division of Critical Care Medicine, Northwestern Medicine Central DuPage Hospital, Winfield, IL
| | - Jacqueline M Kruser
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Julie K Johnson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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153
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Friedman S, Noble R, Archer S, Gibson J, Hughes C. "It Helps Make the Fuzzy Go Away": Autistic Adults' Perspectives on Nature's Relationship with Well-being Through the Life Course. AUTISM IN ADULTHOOD 2024; 6:192-204. [PMID: 39139514 PMCID: PMC11317802 DOI: 10.1089/aut.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Background While previous work highlights the links between nature and various positive well-being-related outcomes, the experiences of autistic people in nature have received limited empirical research. Our study aimed at gathering autistic adults' perspectives on the relationship between nature and well-being in both childhood and adulthood. Methods We used an online survey to capture the views of 127 autistic adults across the United Kingdom. Using reflexive thematic analysis, we analyzed responses to three questions focused on nature experiences in childhood and adulthood and how the participants felt that nature was (or was not) related to well-being. Guided by self-determination theory, we used both inductive and deductive analysis. Results We developed three main themes to reflect the nature experiences of autistic adults: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. Compared with many other contexts, nature provides a non-judgmental space through which (in both childhood and adulthood) many, but not all, autistic individuals can meet individual needs and experience autonomy, relatedness, and competence. Conclusion This analysis of how autistic adults in the United Kingdom utilize nature to support well-being has implications for how nature can be used in social prescribing as well as in ensuring that existing outdoor spaces, organizations, and activities are supportive of autistic people.
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Affiliation(s)
- Samantha Friedman
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
| | - Roan Noble
- Independent Consultant, Edinburgh, United Kingdom
| | - Steph Archer
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Jenny Gibson
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
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154
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Adekunle OA, Schommer JC, Wang YS, Yunusa I, Fleming ML, Seoane-Vazquez E, Brown LM. Perceptions of metabolic syndrome management utilization in relation to patient experience and health-related quality of life. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100457. [PMID: 38868396 PMCID: PMC11168489 DOI: 10.1016/j.rcsop.2024.100457] [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: 04/16/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024] Open
Abstract
Background One factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes. Objectives The study explored the influence of PEwP and PMU on the health-related quality of life (HRQoL) of people with MetS. Methods Data on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square and ordinal regression tests were used to predict the association between PMU, PEwP, and HRQoL. Also, mediation analysis through Haye's model 4 explored the direct and indirect relationship of PMU and PEwP on HRQoL. Results A total of 706 completed surveys were collected and used for analyses. On average, respondents reported three comorbidities. Of the respondents, 72.0% had good PEwP, while 32.6% had good PMU. Comparatively, 38.4% of those with good PEwP had good PMU, compared to 17.3% of those with poor PEwP. Also, 47.0% of those with good PMU had good HRQoL compared to 35.3% with poor PMU. The odds of having fair or good PMU were nearly triple (OR = 2.97, p < 0.001) among those with good PEwP compared to those with poor PEwP. Also, respondents with good PMU had 58% (OR = 1.58, p = 0.008) higher odds of having fair or good HRQoL. Analysis through bootstrap indicated a significant relationship (BootCI = -0.072, -0.022) between PEwP and HRQoL via respondents' PMU. Conclusions MetS individuals with good experience and PMU were more likely to have good HRQoL. Prior experience with pharmacists influenced PMU and indirectly impacted HRQoL. Therefore, pharmacists must consider patients' experience and management utilization perceptions to promote health outcome among people with MetS, while implementing interventions.
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Affiliation(s)
- Olajide A. Adekunle
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
| | - Jon C. Schommer
- Department of Pharmaceutical Care & Health Systems, University of Minnesota 7-155 Weaver-Densford Hall, Minneapolis, MN 55455, USA
| | - Yun S. Wang
- Department of Biomedical and Pharmaceutical Sciences School of Pharmacy, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, USA
| | - Ismaeel Yunusa
- Clinical Pharmacy and Outcomes Sciences (CPOS), College of Pharmacy, University of South Carolina, 715 Sumter Street, Suite 311L, Columbia, SC 29208, USA
| | - Marc L. Fleming
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
| | - Enrique Seoane-Vazquez
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
| | - Lawrence M. Brown
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
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155
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Coulaud PJ, Parent N, Stehr R, Salway T, Knight R. Acceptability of integrating mental health and substance use care within sexual health services among young sexual and gender minority men in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104459. [PMID: 38788388 DOI: 10.1016/j.drugpo.2024.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Despite well-established evidence showing that young sexual and gender minority (SGM) men experience disproportionate mental health and substance use inequities, few sexual health services provide mental health and substance use care. This qualitative study examined the experiences and perspectives about integrated care models within sexual health services among young SGM men experiencing mental health and substance use challenges. METHODS Semi-structured interviews were conducted with 50 SGM men aged 18-30 years who reported using substances with sex in Vancouver, Canada. Interviews were analyzed using thematic analysis. RESULTS Three themes were identified: 1) participants asserted that their sexual health, mental health and substance use-related health needs were interrelated and that not addressing all three concurrently could result in even more negative health outcomes. These concurrent health needs were described as stemming from the oppressive social conditions in which SGM men live. 2) Although sexual health clinics were considered a safe place to discuss sexual health needs, participants reported not being invited by health providers to engage in discussions about their mental health and substance use health-related needs. Participants also perceived how stigmas associated with mental health and substance use limited their ability to express and receive support. 3) Participants identified key characteristics they preferred and wanted within integrated care, including training for health providers on mental health and SGM men's health and connections (e.g., referral processes) between services. Participants also recommended integrating social support programs to help them address SGM-related social challenges. CONCLUSION Our findings highlight that SGM men's sexual health, mental health and substance use-related health needs and preferences are interrelated and should be addressed together. Tailored training and resources as well as structural adaptations to improve communication channels and collaborative connections between health providers are required to facilitate the development of integrated care for young SGM men.
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Affiliation(s)
- Pierre-Julien Coulaud
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
| | - Natasha Parent
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rodney Stehr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Rod Knight
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada; École de Santé Publique de l'Université de Montréal, Montréal, Québec, Canada; Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
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156
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Gray TF, Do KM, Amonoo HL, Sullivan L, Kelkar AH, Pirl WF, Hammer MJ, Tulsky JA, El-Jawahri A, Cutler CS, Partridge AH. Family Caregiver Experiences in the Inpatient and Outpatient Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Settings: A Qualitative Study. Transplant Cell Ther 2024; 30:610.e1-610.e16. [PMID: 37783339 DOI: 10.1016/j.jtct.2023.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
Caregivers (ie, family and friends) are essential in providing care and support for patients undergoing hematopoietic cell transplantation (HCT) and throughout their recovery. Traditionally delivered in the hospital, HCT is being increasingly provided in the outpatient setting, potentially heightening the burden on caregivers. Extensive work has examined the inpatient HCT caregiving experience, yet little is known about how caregiver experiences may differ based on whether the HCT was delivered on an inpatient or outpatient basis, particularly during the acute recovery period post-HCT. This study explored the similarities and differences in caregiver experiences in the inpatient and outpatient settings during the early recovery from reduced-intensity conditioning (RIC) allogeneic HCT. We conducted semistructured interviews (n = 15) with caregivers of adults undergoing RIC allogeneic HCT as either an inpatient (n = 7) or an outpatient (n = 8). We recruited caregivers using purposeful criterion sampling, based on the HCT setting, until thematic saturation occurred. Interview recordings were transcribed and coded through thematic analysis using Dedoose v.9.0. The study analysis was guided by the transactional model of stress and coping and the model of adaptation of family caregivers during the acute phase of BMT. Three themes emerged to describe similar experiences for HCT caregivers regardless of setting: (1) caregivers reported feeling like they were a necessary yet invisible part of the care team; (2) caregivers described learning to adapt to changing situations and varying patient needs; and (3) caregivers recounted how the uncertainty following HCT felt like existing between life and death while also maintaining a sense of gratitude and hope for the future. Caregivers also reported distinct experiences based on the transplantation setting and 4 themes emerged: (1) disrupted routines: inpatient caregivers reported disrupted routines when caring for the HCT recipient while simultaneously trying to manage non-caregiving responsibilities at home and work, and outpatient caregivers reported having to establish new routines that included frequent clinic visits with the patient while altering or pausing home and work responsibilities; (2) timing of caregiver involvement: inpatient caregivers felt more involved in care after the patient was discharged from the HCT hospitalization, whereas outpatient caregivers were already providing the majority of care earlier in the post-transplantation period; (3) fear of missing vital information: inpatient caregivers worried about missing vital information about the patient's care and progress if not physically present in the hospital, whereas outpatient caregivers feared overlooking vital information that may warrant contacting the care team as they monitored the patient at home; and (4) perceived adequacy of resources to meet psychosocial and practical needs: inpatient caregivers reported having adequate access to resources (ie, hospital-based services), whereas outpatient caregivers felt they had more limited access and needed to be resourceful in seeking out assistance. Inpatient and outpatient HCT caregivers described both similar and distinct experiences during the acute recovery period post-HCT. Specific interventions should address caregiver psychosocial needs (ie, distress, illness uncertainty, communication, and coping) and practical needs (ie, community resource referral, preparedness for home-based caregiving, and transplantation education) of HCT caregivers based on setting.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Khuyen M Do
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren Sullivan
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amar H Kelkar
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marilyn J Hammer
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Divison of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey S Cutler
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Wang X, Chen Y, Hu Y, Dong C. Exploring suicide resilience experiences in Chinese youth after self-poisoning: A qualitative study. Arch Psychiatr Nurs 2024; 50:67-73. [PMID: 38789236 DOI: 10.1016/j.apnu.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE This inquiry probes the suicide resilience experiences in suicide attempts by self-poisoning among Chinese youth. The study's goal is to provide healthcare professionals with critical insights to develop effective interventions that enhance suicide prevention measures and diminish the likelihood of subsequent attempts. METHODS Utilizing a qualitative phenomenological approach, we conducted semi-structured interviews with 12 youths (Mean age = 21.1 ± 2.8 years; n = 7 females) who survived suicide attempts by self-poisoning. Data analysis was performed using Colaizzi's seven-step method, a rigorous method entailing iterative reading for the extraction of key statements and the distillation of thematic essence. RESULTS Four primary themes with ten sub-themes were extracted: (1) New understanding of life (cherish life, and meaning of life), (2) Self-Reconciliation (self-acceptance, self-understanding, and self-openness), (3) Personal empowerment (increased self-reliance, increased responsibility, and increased emotional regulation), and (4) Life redesigning (faith in the future, and plan for the future). CONCLUSIONS The findings reveal a potential for psychological growth and beneficial transformation in youth following suicide attempts by self-poisoning. These insights advocate for the integration of positive psychology principles in therapeutic interventions for this demographic.
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Affiliation(s)
- Xinlu Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yifan Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiwen Hu
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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158
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Kılıç BŞ, Hiçdurmaz D, Ayhan Y, Saka E. Perspectives of Family Caregivers of People With Alzheimer's Disease on Caregiving Experience and Needs: A Qualitative Study. J Psychosoc Nurs Ment Health Serv 2024; 62:36-45. [PMID: 37956348 DOI: 10.3928/02793695-20231106-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The current study aimed to investigate the perspectives of family caregivers of people with Alzheimer's disease on caregiving experience and needs. A qualitative descriptive method was used with a sample of 23 family caregivers. Data were collected through in-depth, face-to-face interviews using a pilot-tested semi-structured interview guide. Data analysis was performed via content analysis. Three major themes emerged: (1) Stuck in Caregiving, (2) A Life in Metamorphosis, and (3) Needs. Findings revealed that caregivers struggled to manage the care process, adapt to life changes, and fulfill their needs. This study provides rich data to help create interventions to assist family caregivers. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 36-45.].
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159
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Rivera D, Henwood BF, Sussman S, Wenzel S, Dasgupta A, Campbell ANC, Wu E, Amaro H. Characterizing Multisystem Barriers to Women's Residential SUD Treatment: A Multisite Qualitative Analysis in Los Angeles. J Urban Health 2024; 101:653-667. [PMID: 38632159 PMCID: PMC11190110 DOI: 10.1007/s11524-024-00857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/19/2024]
Abstract
Residential substance use disorder (SUD) treatment programs are challenged by the differing values of the problem-solving court (PSC) and child welfare (CW) systems, along with communication barriers between staff. This study aimed to understand, from the viewpoints of SUD treatment providers, how divergent values and communication barriers adversely affect women's residential SUD treatment. We conducted qualitative semistructured interviews with 18 SUD treatment clinicians and six directors from four women's residential SUD treatment programs. Using a thematic analysis framework, we identified salient themes across specified codes. Analysis revealed six main themes, suggesting differing values and communication barriers across the SUD, PSC, and CW systems adversely affect the provision of SUD treatment. For differing values, three main themes emerged: (a) unaddressed trauma and fear of mental health treatment seeking; (b) perceptions of mothers with a SUD; and (c) the Adoption and Safe Families Act (ASFA) timeline as a barrier to SUD treatment provision. For communication barriers, three themes emerged: (a) inadequate communication and responsiveness with PSC and CW systems adversely affect treatment coordination, induce patient stress, and treatment disengagement; (b) lack of PSC and CW communication regarding child visitation planning adversely affects treatment motivation and retention; and (c) competing ASFA, PSC, and CW priorities and inadequate cross-system communication adversely affect treatment planning. Treatment providers face significant barriers in providing effective treatment to women simultaneously involved in the CW and PSC systems. Aligning values and addressing communication barriers, changes in policy, and enhanced cross-system training are crucial. Additionally, it is essential to reevaluate the ASFA timeline to align with the long-term treatment needs of mothers with a SUD. Further research should explore the viewpoints of patients, CW, and PSC staff to gain deeper insights into these SUD treatment barriers.
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Affiliation(s)
- Dean Rivera
- Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA.
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 Street, MRF 214, Los Angeles, CA, 90089, USA
| | - Steve Sussman
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 Street, MRF 214, Los Angeles, CA, 90089, USA
| | - Anindita Dasgupta
- Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA
| | - Aimee N C Campbell
- Columbia University Irving Medical Center Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, Room 3719, New York, NY, 10032, USA
| | - Elwin Wu
- Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8Th Street, Miami, FL, 33199, USA
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Farhat H, Alinier G, Helou M, Galatis I, Bajow N, Jose D, Jouini S, Sezigen S, Hafi S, Mccabe S, Somrani N, Aifa KE, Chebbi H, Amor AB, Kerkeni Y, Al-Wathinani AM, Abdulla NM, Jairoun AA, Morris B, Castle N, Al-Sheikh L, Abougalala W, Dhiab MB, Laughton J. Perspectives on Preparedness for Chemical, Biological, Radiological, and Nuclear Threats in the Middle East and North Africa Region: Application of Artificial Intelligence Techniques. Health Secur 2024; 22:190-202. [PMID: 38335443 DOI: 10.1089/hs.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Over the past 3 decades, the diversity of ethnic, religious, and political backgrounds worldwide, particularly in countries of the Middle East and North Africa (MENA), has led to an increase in the number of intercountry conflicts and terrorist attacks, sometimes involving chemical and biological agents. This warrants moving toward a collaborative approach to strengthening preparedness in the region. In disaster medicine, artificial intelligence techniques have been increasingly utilized to allow a thorough analysis by revealing unseen patterns. In this study, the authors used text mining and machine learning techniques to analyze open-ended feedback from multidisciplinary experts in disaster medicine regarding the MENA region's preparedness for chemical, biological, radiological, and nuclear (CBRN) risks. Open-ended feedback from 29 international experts in disaster medicine, selected based on their organizational roles and contributions to the academic field, was collected using a modified interview method between October and December 2022. Machine learning clustering algorithms, natural language processing, and sentiment analysis were used to analyze the data gathered using R language accessed through the RStudio environment. Findings revealed negative and fearful sentiments about a lack of accessibility to preparedness information, as well as positive sentiments toward CBRN preparedness concepts raised by the modified interview method. The artificial intelligence analysis techniques revealed a common consensus among experts about the importance of having accessible and effective plans and improved health sector preparedness in MENA, especially for potential chemical and biological incidents. Findings from this study can inform policymakers in the region to converge their efforts to build collaborative initiatives to strengthen CBRN preparedness capabilities in the healthcare sector.
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Affiliation(s)
- Hassan Farhat
- Hassan Farhat, MRes, MSc, is a Quality Improvement Mentor, Quality Patient Safety and Risk Management, Ambulance Service Group, Hamad Medical Corporation, Doha, Qatar; PhD Candidate, Faculty of Medicine "Ibn El Jazzar," University of Sousse, Sousse, Tunisia; and PhD Candidate, Faculty of Sciences, University of Sfax, Sfax, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Guillaume Alinier
- Guillaume Alinier, PhD, MPhys (Hons), PGCert, SFHEA, NTF, is Director of Research, Ambulance Service, Hamad Medical Corporation, Doha, Qatar; Visiting Professor, School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Adjunct Professor, Weill Cornell Medicine-Qatar, Doha, Qatar; and Visiting Professor, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Mariana Helou
- Mariana Helou, MD, MSc DM, is a Clinical Assistant Professor and Clerkship Director of Emergency Room, Division Head of Emergency Medicine, Internal Medicine Department - Emergency, Medicine Gilbert and Rose-Marie Chagoury School of Medicine, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Ionnais Galatis
- Ionnais Galatis, Brigadier General (ret.), MD, MSc, MC, is an MD Consultant in Allergy & Clinical Immunology, Medical/Hospital/Ops CBRNE Planner/Instructor, Senior Asymmetric Threats Analyst, and Research Associate, Center for Security Studies (KEMEA), Athens, Greece; Manager, CBRN Knowledge Center, International CBRNE Institute, Brussels, Belgium; and Senior Advisor, Research Institute for European and American Studies, Alimos, Greece, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Nidaa Bajow
- Nidaa Bajow, MD, PhD, is Disaster Medicine Coordinator and Disaster Medicine Training Supervisor, Disaster Medicine Unit, Emergency Department Security Force Hospital Riyadh, Saudi Arabia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Denis Jose
- Denis Jose, Pharm D, PhD, is Colonel, Head, Pharmaceutical Services, and Technical Adviser on Toxicological and CBRNE Risk Management, Alpes-Maritimes Fire and Rescue Services, Paris, France, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Sarra Jouini
- Sarra Jouini, MD, is Emergency Coordinator, Emergency Department, Charles Nicolle Hospital, and an Associate Professor, EL Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Sermet Sezigen
- Sermet Sezigen, MD, PhD, is an Associate Professor, Department of Medical CBRN Defense, University of Health Sciences, Ankara, Turkey, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Samia Hafi
- Samia Hafi, MD, is Head of SAMU(EMS), Hospital of Gabes, Gabes, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Sheena Mccabe
- Sheena Mccabe, MSc, is a Consultant Lecture for BSc in Crisis and Emergency Management, Ras Laffan Emergency and Safety College, Ras Laffan, Qatar, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Naoufel Somrani
- Naoufel Somrani, MD, is General Director of Public Health Facilities, Ministry of Health, Tunis, Tunisia, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Kawther El Aifa
- Kawther El Aifa, MSc, is a Quality Management/Improvement Reviewer, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Henda Chebbi
- Henda Chebbi, MD, is Assistant Director of Emergency Medicine Unit, Strategic Health Operations Center (SHOCR Room), Emergency Medicine Directorate, Ministry of Health, Tunis, Tunisia, at King Saud University, Riyadh, Saudi Arabia
| | - Asma Ben Amor
- Asma Ben Amor, MRes, is a Paramedicine Professor, Higher School of Health Sciences and Technologies of Sousse, and a PhD Candidate, Faculty of Medicine "Ibn El Jazzar," University of Sousse, Sousse, Tunisia, at King Saud University, Riyadh, Saudi Arabia
| | - Yosra Kerkeni
- Yosra Kerkeni, MD, is Emergency Coordinator, Emergency Medicine, Ministry of Health, Tunis, Tunisia, at King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Al-Wathinani
- Ahmed M. Al-Wathinani, MHA, PhD, is Vice Dean of Academic Affairs, College of Applied, Business Administration; Chairman of the Emergency Medical Services Department; Associate Professor of Emergency and Disaster Management, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, at King Saud University, Riyadh, Saudi Arabia
| | - Nassem Mohammed Abdulla
- Nassem Mohammed Abdulla, PhD, is Head of Department, Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates, in Doha, Qatar
| | - Ammar Abdulrahman Jairoun
- Ammar Abdulrahman Jairoun, PhD, is Senior Consumables Material Inspection Officer, Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates; and Head of Department, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia, in Doha, Qatar
| | - Brendon Morris
- Brendon Morris, MRes, MTec, is Executive Director, Major Incident Planning and Resilience, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Nicholas Castle
- Nicholas Castle, PhD FIMC, is Interim Executive Director, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Loua Al-Sheikh
- Loua Al-Sheikh, MBChB, BSc(Hons), FRCA, is Medical Director, The Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Walid Abougalala
- Walid Abougalala, MBBS, EMDM, JMC(EM), MSc, MAo, MEdu, is a Consultant Emergency Preparedness and Response Department, Ministry of Public Health; Chairman, Corporate Facility Management and Safety Committee; and Consultant Emergency and Disaster Medicine, Hamad Medical Corporation, in Doha, Qatar
| | - Mohamed Ben Dhiab
- Mohamed Ben Dhiab, MD, is Vice Dean, Academic Affairs, Faculty of Medicine "Ibn El Jazzar," University of Sousse, and Professor of Forensic and Legal Medicine, Farhat Hached Academic Hospital, Sousse, Tunisia
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Hausmann LRM, Goodrich DE, Rodriguez KL, Beyer N, Michaels Z, Cantor G, Armstrong N, Eliacin J, Gurewich DA, Cohen AJ, Mor MK. Participation of Veterans Affairs Medical Centers in veteran-centric community-based service navigation networks: A mixed methods study. Health Serv Res 2024; 59:e14286. [PMID: 38258302 PMCID: PMC11063092 DOI: 10.1111/1475-6773.14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To understand the determinants and benefits of cross-sector partnerships between Veterans Affairs Medical Centers (VAMCs) and geographically affiliated AmericaServes Network coordination centers that address Veteran health-related social needs. DATA SOURCES AND SETTING Semi-structured interviews were conducted with AmericaServes and VAMC staff across seven regional networks. We matched administrative data to calculate the percentage of AmericaServes referrals that were successfully resolved (i.e., requested support was provided) in each network overall and stratified by whether clients were also VAMC patients. STUDY DESIGN Convergent parallel mixed-methods study guided by Himmelman's Developmental Continuum of Change Strategies (DCCS) for interorganizational collaboration. DATA COLLECTION Fourteen AmericaServes staff and 17 VAMC staff across seven networks were recruited using snowball sampling and interviewed between October 2021 and April 2022. Rapid qualitative analysis methods were used to characterize the extent and determinants of VAMC participation in networks. PRINCIPAL FINDINGS On the DCCS continuum of participation, three networks were classified as networking, two as coordinating, one as cooperating, and one as collaborating. Barriers to moving from networking to collaborating included bureaucratic resistance to change, VAMC leadership buy-in, and not having VAMCs staff use the shared technology platform. Facilitators included ongoing communication, a shared mission of serving Veterans, and having designated points-of-contact between organizations. The percentage of referrals that were successfully resolved was lowest in networks engaged in networking (65.3%) and highest in cooperating (85.6%) and collaborating (83.1%) networks. For coordinating, cooperating, and collaborating networks, successfully resolved referrals were more likely among Veterans who were also VAMC patients than among Veterans served only by AmericaServes. CONCLUSIONS VAMCs participate in AmericaServes Networks at varying levels. When partnerships are more advanced, successful resolution of referrals is more likely, especially among Veterans who are dually served by both organizations. Although challenges to establishing partnerships exist, this study highlights effective strategies to overcome them.
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Affiliation(s)
- Leslie R. M. Hausmann
- Center for Health Equity Research and PromotionVeterans Affairs (VA) Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Division of General Internal Medicine, Department of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - David E. Goodrich
- Center for Health Equity Research and PromotionVeterans Affairs (VA) Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Keri L. Rodriguez
- Center for Health Equity Research and PromotionVeterans Affairs (VA) Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Nicole Beyer
- Center for Health Equity Research and PromotionVeterans Affairs (VA) Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Zachary Michaels
- Center for Health Equity Research and PromotionVeterans Affairs (VA) Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Gilly Cantor
- D'Aniello Institute for Veterans and Military FamiliesSyracuse UniversitySyracuseNew YorkUSA
| | - Nicholas Armstrong
- D'Aniello Institute for Veterans and Military FamiliesSyracuse UniversitySyracuseNew YorkUSA
| | - Johanne Eliacin
- National Center for PTSDVA Boston Healthcare SystemBostonMassachusettsUSA
- Center for Health Information and CommunicationRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
- Department of Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Deborah A. Gurewich
- Center for Healthcare Implementation and Research (CHOIR)VA Boston Health Care SystemBedfordMassachusettsUSA
- Section of Internal MedicineBoston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
| | - Alicia J. Cohen
- Center of Innovation in Long Term Services and Supports (LTSS‐COIN)VA Providence Healthcare SystemProvidenceRhode IslandUSA
- Department of Family MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Maria K. Mor
- Center for Health Equity Research and PromotionVeterans Affairs (VA) Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Graduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
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162
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Mason SJ, Brading LM, Kane K, Conaghan PG, Kingsbury SR, McHugh GA. Barriers and facilitators to engaging with a digital self-management programme for painful distal upper limb musculoskeletal disorders: A qualitative exploratory study. Health Expect 2024; 27:e14056. [PMID: 38858844 PMCID: PMC11164711 DOI: 10.1111/hex.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/01/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION People living with a painful distal upper limb musculoskeletal disorder (DUL-MSD) often experience pain, difficulty in doing everyday tasks and a reduced quality of life. Currently, there are challenges in the treatment of DUL-MSDs, highlighting the need to develop innovative approaches to rehabilitation. A potential solution is to develop and implement a digital self-management rehabilitation programme focussing on optimising recovery, improving function and reducing pain. Before developing this programme, we aimed to identify the barriers and facilitators to using a digital health intervention (DHI) for self-management of DUL-MSDs. OBJECTIVE This study aimed to investigate the potential barriers and facilitators to using a DHI with people living with DUL-MSDs and healthcare professionals (HCPs). METHODS A qualitative exploratory study was carried out with purposely selected participants consisting of 15 participants with DUL-MSDs and 13 HCPs. Three focus groups (FGs) and four semistructured interviews with DUL-MSD participants and semistructured interviews with 13 HCPs were conducted. FGs and interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. RESULTS To address challenges in the care and management of DUL-MSDs, both HCPs and people living with a DUL-MSD welcomed the development of a DHI. This study identified several barriers and facilitators that would influence engagement with a digital intervention. Findings suggest that in developing a DHI, attention needs to be paid to digital design features, usability, tailoring, personalisation and consideration of how well usual care could be replicated digitally without direct HCP involvement. CONCLUSION The identified digital design features of importance to participants will inform the design of a digital self-management rehabilitation programme for people living with DUL-MSDs. Addressing the barriers and facilitators to engagement with a DHI is essential in ensuring its relevance and acceptability to those who will use it. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement and Engagement (PPIE) was integral throughout the study. PPIE members contributed to the development and planning of this study, checked and confirmed the relevance of the findings and are involved in the dissemination plans.
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Affiliation(s)
- Samantha J. Mason
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | - Lucy M. Brading
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | - Kathleen Kane
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- Bone Cancer Research TrustLeedsUK
| | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
| | - Sarah R. Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
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163
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Kaitz J, Vimalananda VG, Charns MP, Fix GM. Multidisciplinary providers' perceptions of care delivery for sleep disorders: A qualitative case study. Sleep Health 2024; 10:342-347. [PMID: 38519364 DOI: 10.1016/j.sleh.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Sleep disorders are wide-ranging in their causes and impacts on other physical and mental health conditions. Thus, sleep disorders could benefit from a multidisciplinary approach to assessment and treatment. An integrated care model is often recommended but is costly to implement. We sought to understand how, in the absence of an established organizational structure for integrated sleep care, providers from different clinics work together to provide care for sleep disorders. METHODS A qualitative case study at one U.S. Department of Veterans Affairs (VA) medical center. We used a purposeful nested sampling strategy, combining maximum variation sampling and snowball sampling to recruit key staff involved in sleep care. RESULTS We interviewed providers (N = 10) from sleep medicine, primary care, and mental health services. Providers identified the ubiquity of sleep disorders and a concomitant need for multidisciplinary care. However, they described limited opportunities for multidisciplinary interactions and consequently a negative impact on clinical care. Providers described fragmentation in two areas: among sleep specialists and between sleep specialists and other referring and managing providers. CONCLUSIONS A range of interventions, based on setting and resources, could improve care coordination both among sleep specialists and between sleep and nonsleep providers. While integrated sleep specialist clinics could reduce care fragmentation, they may not directly impact coordination with referring providers, like primary care and general mental health, who are essential in managing chronic conditions. Future work should continue to explore improving care coordination for sleep problems to ensure patients receive high-quality, timely, patient-centered care.
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Affiliation(s)
- Jenesse Kaitz
- Sleep Medicine, VA Puget Sound Healthcare System, Seattle, Washington, USA.
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, USA
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164
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Santos A, Brito M, Silva E, Rocha F, Oliveira A, Dávila R, Gama H, Albuquerque J, Paiva M, Baía-Silva D, Sampaio V, Balieiro P, Rufatto R, Grewal Daumerie P, Peterka C, Edilson Lima F, Monteiro W, Arcanjo A, Silva R, Batista Pereira D, Lacerda M, Murta F. Perspectives of healthcare professionals on training for quantitative G6PD testing during implementation of tafenoquine in Brazil (QualiTRuST Study). PLoS Negl Trop Dis 2024; 18:e0012197. [PMID: 38837977 PMCID: PMC11152287 DOI: 10.1371/journal.pntd.0012197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system.
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Affiliation(s)
- Alicia Santos
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Evellyn Silva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Felipe Rocha
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Ana Oliveira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Rafaela Dávila
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Hiran Gama
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Mena Paiva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Brazil
| | | | | | | | - Wuelton Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Ana Arcanjo
- Fundação de Vigilância em Saúde, Manaus, Brazil
| | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
- University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Felipe Murta
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
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Mulcahy Symmons S, Drury A, De Brún A. Stakeholder perceptions of cervical screening accessibility and attendance in Ireland: a qualitative study. Health Promot Int 2024; 39:daae072. [PMID: 38943526 PMCID: PMC11214098 DOI: 10.1093/heapro/daae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024] Open
Abstract
Organized cervical screening programmes are commonplace in high-income countries. To provide an equitable cervical screening service, it is important to understand who is and is not attending screening and why. Promotion of screening and service improvement is not possible without recognition and identification of the barriers and needs of communities that are less engaged with screening. This study explored stakeholder perceptions of cervical screening attendance and accessibility in Ireland. Semi-structured interviews were conducted with 12 healthcare professionals, policymakers and academics. Interviews were conducted online in 2022. Reflexive thematic analysis was used inductively to generate themes, supported by NVivo. Three themes were developed: (i) getting the right information out the right way, (ii) acceptability and accessibility of screening and (iii) trying to identify and reach the non-attenders. Participants felt public knowledge of cervical screening and human papilloma virus was low and communication strategies were not adequate. Individual, cultural, structural and service-level factors influenced the accessibility and acceptability of screening. Identifying and reaching non-attenders was considered challenging and community outreach could support those less likely to attend screening. Stakeholder perspectives were valuable in understanding the complexities of screening accessibility and attendance from individual to service-level factors. Cultural competency training, inclusive language and visual cues in waiting rooms would support engagement with some populations who may be hesitant to attend screening. Collaboration with community organizations has opportunities to promote screening and understand the needs of those less likely to attend screening.
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Affiliation(s)
- Sophie Mulcahy Symmons
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Centre, 4 Stillorgan Road, Belfield, Dublin 4, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Centre, 4 Stillorgan Road, Belfield, Dublin 4, Ireland
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Collins Ave Ext, Glasnevin, Dublin 9, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Centre, 4 Stillorgan Road, Belfield, Dublin 4, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Centre, 4 Stillorgan Road, Belfield, Dublin 4, Ireland
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Chiou YG, Chen SY, Wu LM, Lotus Shyu YI, Chiang YC, Hsiao CC, Wu HC, Tang WR. Experiences and preferences of truth-telling in families of children with cancer: A phenomenological study. Asia Pac J Oncol Nurs 2024; 11:100500. [PMID: 38933686 PMCID: PMC11203385 DOI: 10.1016/j.apjon.2024.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/27/2024] [Indexed: 06/28/2024] Open
Abstract
Objective The delivery of bad news is an unpleasant but necessary medical procedure. However, few studies have addressed the experiences and preferences of the families of school-aged children with cancer when they are informed of the children's condition. This study aimed to explore families of school-age children with cancer for their preferences and experiences of truth-telling. Methods This descriptive phenomenological qualitative research was conducted using focus group interviews and semistructured interview guidelines were adopted for in-depth interviews. Fifteen families participated in the study. The data were analyzed using Colaizzi's analysis. Data were collected from August 2019 to May 2020. Results The study identified two major themes: "caught in a dilemma" and "kind and comprehensive team support." The first major theme focused on families' experiences with cancer truth-telling. Three sub-themes emerged: (1) cultural aspects of cancer disclosure, (2) decision-making regarding informing pediatric patients about their illness, and (3) content of disclosure after weighing the pros and cons. The second major theme, which revealed families' preferences for delivering bad news, was classified into three sub-themes: (1) have integrity, (2) be realistic, and (3) be supportive. Conclusions This study underscores the dilemma encountered by the families of children with cancer after disclosure and their inclination toward receiving comprehensive information and continuous support. Health care personnel must improve their truth-telling ability in order to better address the needs of such families and to provide continuous support throughout the truth-telling process.
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Affiliation(s)
- Yen-Gan Chiou
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yea-Ing Lotus Shyu
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chien Chiang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chih-Cheng Hsiao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hui-Chuan Wu
- Department of Post Baccalaureate Nursing, College of Medicine, I-SHOU University, Kaohsiung, Taiwan
| | - Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Salah N, Cantoreggi N, Petignat P, Abdulcadir J. Understanding Professionals' Knowledge Regarding Factors Influencing Changes in Attitudes toward Female Genital Mutilation/Cutting in Post-Migration Communities in Geneva, Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:716. [PMID: 38928963 PMCID: PMC11203848 DOI: 10.3390/ijerph21060716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Female genital mutilation or cutting (FGM/C) is a practice involving the partial or complete removal of the external female genitalia for non-medical reasons. To facilitate attitude changes, the ecological model of behavior change considers multiple levels of influence and their relationships with environmental and behavioral factors. The combined effects of migration and cultural adaptation result in a transformative process that leads to decreased support for FGM/C. This qualitative study aimed to gain knowledge from FGM/C field professionals regarding the factors promoting behavioral changes in migrant communities in Geneva, Switzerland. Between September and October 2023, we conducted semi-structured interviews using a reflexive thematic analysis. Our qualitative research is reported in accordance with the COREQ criteria. A data analysis was performed using NVivo 14 software. Four influential dimensions were identified, each with associated factors. The first dimension, the social level, includes (1) the impact and implementation of anti-FGM/C laws. The second dimension, the community level, encompasses four factors such as (2) religion, (3) a multifaceted examination of social aspects, (4) navigating language barriers and raising awareness, and (5) cultural adaptation processes. The third dimension, the interpersonal level, includes factors such as (6) changing views on the marriage prerequisite. Finally, the fourth dimension, the personal level, is associated with (7) women's experiences and perspectives regarding FGM/C. The findings highlight seven environmental factors, both within and across dimensions of the ecological model, that interact with human behavior to enable an adaptive cultural process. This process influences changes in attitudes and behaviors regarding FGM/C.
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Affiliation(s)
- Nasteha Salah
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland;
| | - Nicola Cantoreggi
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland;
| | - Patrick Petignat
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - Jasmine Abdulcadir
- Division of Gynaecology, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, 1211 Geneva, Switzerland;
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Hu W, Yuan Q, Wang Y, Chen N. The influence factors of tour guides' professional identity and professional decision before and after the COVID-19 pandemic. Heliyon 2024; 10:e31588. [PMID: 38826715 PMCID: PMC11141458 DOI: 10.1016/j.heliyon.2024.e31588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
The COVID-19 pandemic has significantly impacted the tourism sector, particularly tour guides (TGs), affecting their professional identity (TGPI) and intentions to return to work. As China strives to revive its tourism industry, it is crucial to understand the current state of TGPI, its evolution, influencing factors, and its impact on TGs' return intentions. This study employed a quantitative approach, using comparative analysis and binary logistic regression, to investigate these issues among frontline TGs in China, pre- and post-pandemic. Cross-sectional surveys were conducted with 422 participants in 2019 and 398 in 2022, yielding 370 and 342 valid responses, respectively. The questionnaire utilized a five-point Likert scale. Findings reveal that (1) The overall TGPI level in 2022 post-pandemic is medium (3.93), showing a significant decrease from the pre-pandemic level in 2019 (4.15). (2) Influencing factors of TGPI are predominantly material, reflected in social insurance and income changes pre- and post-pandemic. (3) This study presents a novel definition and scale of TGPI, encompassing tour guides' professional value identity (TGPVI), emotion identity (TGPEI), relationship identity (TGPRI), and behavior tendency (TGPBT). (4) The two dimensions of the TGPI, TGPVI and TGPRI, income and education level, significantly influence TGs' return intentions. The study provides valuable academic and practical insights into TGPI and offers significant implications for enhancing TGs' return intentions and policymaking for post-pandemic tourism industry development.
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Affiliation(s)
- Wenwen Hu
- School of Management, Guangzhou College of Technology and Business, Guangzhou, 510850, China
| | - Qing Yuan
- School of Cultural Industry & Tourism Management, Henan University, Kaifeng, 475001, China
- Research Institute for Study Travel, Henan University, Kaifeng, 475001, China
| | - Yaxi Wang
- School of Cultural Industry & Tourism Management, Henan University, Kaifeng, 475001, China
- Research Institute for Study Travel, Henan University, Kaifeng, 475001, China
| | - Nan Chen
- School of Cultural Industry & Tourism Management, Henan University, Kaifeng, 475001, China
- Research Institute for Study Travel, Henan University, Kaifeng, 475001, China
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Njau T, Mwakawanga DL, Sunguya B, Minja A, Kaaya S, Fekadu A. Perceived barriers and opportunities for implementing an integrated psychological intervention for depression in adolescents living with HIV in Tanzania. BMC Health Serv Res 2024; 24:672. [PMID: 38807134 PMCID: PMC11134697 DOI: 10.1186/s12913-024-11118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Adolescents living with Human Immunodeficiency Virus (HIV) have an increased risk of depression, negatively affecting their adherence to antiretroviral therapy (ART) and treatment outcomes. Integrating mental health care in HIV care and treatment settings improves comprehensive care. However, integration remains challenging in Tanzania, like in other high-burden and low-resource settings. The overall objective of this work is to inform the development of a psychological intervention for depression in adolescents living with HIV (ALWHIV). We describe perceived barriers and opportunities for implementing an integrated, evidence-based psychological intervention to manage adolescent depression in HIV care and treatment centers (HIV-CTC) from the perspectives of adolescents, caregivers, and healthcare providers (HCPs) in Dar es Salaam, Tanzania. METHODS To inform intervention development and implementation, this study utilized a qualitative design through a phenomenological approach informed by the Consolidated Framework for Implementation Research (CFIR) to explore implementation barriers and facilitators in ALWHIV, HCPs, and caregivers. Forty-five in-depth interviews were conducted in three HIV-CTCs in Kinondoni Dar es Salaam. Audio records were transcribed verbatim and analyzed deductively through NVIVO software. RESULTS Barriers to implementing an integrated psychological intervention to address depression in ALWHIV included (A) poor mental health awareness among caregivers, adolescents, HCPs, and policy-makers, (B) high level of stigma against mental health care, (C) poor communication between adolescents and HCPs concerning mental health care, (D) lack of contextualized intervention of proven effectiveness and guidelines of mental health care, and (E) inadequate mental health care supportive supervision and mentorship. Facilitators for implementation included supportive infrastructure, positive pressure from HIV implementing partners, tension for change, and participant's perception of the advantage of a psychological intervention as compared to just usual HIV care and treatment counseling. CONCLUSION Despite several modifiable barriers to implementing a psychological intervention in HIV CTC, there were encouraging facilitators and opportunities for implementing an integrated, evidence-based psychological intervention to address depression in ALWHIV in Kinondoni Dar es Salaam, Tanzania.
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Affiliation(s)
- Tasiana Njau
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania, United Nations Road, Dar es Salaam, P.O Box 65001, Tanzania.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Dorkasi L Mwakawanga
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agape Minja
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania, United Nations Road, Dar es Salaam, P.O Box 65001, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania, United Nations Road, Dar es Salaam, P.O Box 65001, Tanzania
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
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170
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Bahrami M, Sebzari AR, Nasiri A. Caregivers' demands: caring atmosphere expected by cancer patients' caregivers-a qualitative content analysis. Support Care Cancer 2024; 32:389. [PMID: 38802620 DOI: 10.1007/s00520-024-08575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Family caregivers play a critical role in providing care for patients with cancer. However, the quality of their caregiving can be greatly impacted if the demands and expectations they experience are not identified. Therefore, this study aimed to explore the demands and perceived expectations of caregivers while caring for cancer patients. METHODS This qualitative study was conducted from June 2022 to September 2023. Face-to-face and in-depth semi-structured interviews were conducted to collect the experiences of 19 Iranian family caregivers of patients with cancer. Purposive sampling was used to select the participants. The interviews were analyzed using conventional content analysis and the rigor of the study was ensured by employing Lincoln and Guba's criteria. RESULTS Three main themes and six subthemes were identified through data analysis. The themes that emerged from the caregivers' experiences included the following: (1) ambiguity in the healthcare system, (2) need for empathetic communication, and (3) forgotten caregivers in the healthcare system. CONCLUSION Caregivers often feel overlooked, resulting in unfulfilled needs and expectations. It is imperative to explore potential solutions that provide caregivers information, empathetic communication, and support. Nurses, as key members of the healthcare team, should play a significant role in addressing this problem.
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Affiliation(s)
- Mahnaz Bahrami
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Reza Sebzari
- Department of Internal Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Nasiri
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Birjand University of Medical Sciences, Birjand, Iran.
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171
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Rehman N, Edkins V, Ogrinc N. Is Sustainable Consumption a Sufficient Motivator for Consumers to Adopt Meat Alternatives? A Consumer Perspective on Plant-Based, Cell-Culture-Derived, and Insect-Based Alternatives. Foods 2024; 13:1627. [PMID: 38890856 PMCID: PMC11171576 DOI: 10.3390/foods13111627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
This study investigates consumer preference and acceptance of three meat alternatives-plant-based, lab-grown, and insect-based-as sustainable choices to meet the demands of a growing population and evolving food systems. Insights were gathered from European consumers regarding their perceptions and consumption patterns using a mixed-methods approach. The approach employed a questionnaire followed by focus group discussions conducted in Slovenia and the UK to understand the motivations and barriers behind their responses. The UK and Slovenia were chosen as they provided the highest response rates to the questionnaire and they have differing legislation. The results show that plant-based alternatives are the most familiar and accepted option, while lab-grown meat and insect-based products are less familiar and have lower acceptance rates. Moreover, they show that although sustainability factors are important to consumers, they are not their only concern; health and nutrition are the primary motivators for choosing meat alternatives. These are followed closely by sensory appeal, pricing, and a preference for natural, minimally processed options. Based on insights from the focus groups, strategies to overcome the barriers to the acceptance of meat alternatives should include targeted product categorisation and placement, educational campaigns, effective use of media, and greater transparency in product information.
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Affiliation(s)
- Nayyer Rehman
- WRG Europe Ltd., 26-28 Southernhay East, Exeter EX1 1NS, UK
- Jožef Stefan International Postgraduate School, Jamova 39, 1000 Ljubljana, Slovenia
| | | | - Nives Ogrinc
- Jožef Stefan International Postgraduate School, Jamova 39, 1000 Ljubljana, Slovenia
- Department of Environmental Sciences, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia
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172
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Ahlstedt Karlsson S, Myrin Westesson L, Hansson E, Paganini A. Women's experiences of health care providers when choosing flat closure after breast cancer: An interview study. Eur J Oncol Nurs 2024; 70:102613. [PMID: 38795447 DOI: 10.1016/j.ejon.2024.102613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE The purpose of this study was to explore women's experiences with healthcare providers previous to a flat closure after breast cancer. METHODS Data was collected using individual semi-structured interviews by telephone or teleconferencing systems with 18 women who shared their experience with health care before and during flat closure operation after breast cancer or a breast gene mutation. The interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS The analysis generated three specific themes: (1) Striving to be recognized as a person, (2) Barriers to shared decision making and (3) A need to be empowered, indicating that women's views are not always illuminated and enquired about by health care providers. The care agenda was also more often regulated by norms and standard care than the individual women's intended goals. Furthermore, when the agenda for surgery had been previously set, the women were not presented with viable options to choose from for the upcoming surgery. For these women to influence the reality they face, they have to seek support outside of healthcare. This indicates the important role of patient networks and relatives in empowering the individual women to stand up for their choice and body. CONCLUSION In order to offer feasible surgery for women diagnosed with breast cancer or a breast mutation gene, the women's wishes regarding flat closure and what matters to her in her life must be identified. Also emphasized is the need for a more systematic approach in involving the affected women in shared decision-making.
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Affiliation(s)
- Susanne Ahlstedt Karlsson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Linda Myrin Westesson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Gothenburg, Sweden
| | - Emma Hansson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Paganini
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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173
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Mouchaers I, Buma LE, Verbeek H, Zwakhalen S, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care. Sci Rep 2024; 14:11391. [PMID: 38762551 PMCID: PMC11102453 DOI: 10.1038/s41598-024-62047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
| | - Lise E Buma
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Cicero Zorggroep, Brunssum, The Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Sandra Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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174
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Wake E, Ranse J, Campbell D, Gabbe B, Marshall AP. Follow-up after major traumatic injury: a survey of services in Australian and New Zealand public hospitals. BMC Health Serv Res 2024; 24:630. [PMID: 38750458 PMCID: PMC11097478 DOI: 10.1186/s12913-024-11105-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Increased survival from traumatic injury has led to a higher demand for follow-up care when patients are discharged from hospital. It is currently unclear how follow-up care following major trauma is provided to patients, and how, when, and to whom follow-up services are delivered. The aim of this study was to describe the current follow-up care provided to patients and their families who have experienced major traumatic injury in Australia and New Zealand (ANZ). METHODS Informed by Donabedian's 'Evaluating the Quality of Medical Care' model and the Institute of Medicine's Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre. RESULTS Data were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up. CONCLUSION Follow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations.
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Affiliation(s)
- Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia.
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Don Campbell
- Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Belinda Gabbe
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
- Midwifery Education and Research Unit, Gold Coast University Hospital, Nursing, QLD, Australia
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175
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Liang M, Ho GWK, Christensen M. Living in fear at the unpredictability of mental health issues in the classroom: a phenomenological study of secondary school teachers in encountering students with mental health issues. Front Psychiatry 2024; 15:1367660. [PMID: 38812481 PMCID: PMC11135124 DOI: 10.3389/fpsyt.2024.1367660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Background The prevalence of mental health issues among secondary school students is on the rise. Secondary school teachers, outside the home environment, are often in a prime position to identify adolescents facing mental health challenges. Limited knowledge regarding the experiences and perspectives of secondary school teachers when encountering this particular group of students, particularly in Asian countries. Objectives This study aimed to describe the lived experiences of secondary school teachers exposed to students with mental health issues in the classroom in a Chinese context. Methods A descriptive phenomenological approach within the tradition of Husserl was used. A purposive sampling method was used to collect the participants in Changsha, Hunan, China. Sixteen secondary school teachers participated in this study. Individual, face-to-face interviews were conducted, tape-recorded, and transcripted. Colaizzi's seven-step descriptive phenomenological method was used to do the data analysis. Results One Central theme: Living in fear at the unpredictability of mental health issues in the classroom and four sub-themes emerged: (1) Worried and anxious by the uncertainty of student mental health issues; (2) Scared and afraid by students' unpredictable behaviors; (3) Afraid of students' failure and its potential outcome; (4) Students having mental health issues are dangerous. Conclusions and implications The teachers in this study found managing the unpredictability of mental health issues in the classroom deeply distressing and challenging. A comprehensive approach to address the cultural, social, and educational factors influencing secondary school teachers' experiences is encouraged.
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Affiliation(s)
- Mining Liang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- The Interdisciplinary Centre for Qualitative Research, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Martin Christensen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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176
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Schwab-Reese L, Short C, Jacobs L, Fingerman M. Rapport Building in Written Crisis Services: Qualitative Content Analysis. J Med Internet Res 2024; 26:e42049. [PMID: 38748472 PMCID: PMC11137431 DOI: 10.2196/42049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 08/21/2023] [Accepted: 03/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.
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Affiliation(s)
- Laura Schwab-Reese
- Department of Public Health, Purdue University, West Lafayette, IN, United States
| | - Caitlyn Short
- Department of Public Health, Purdue University, West Lafayette, IN, United States
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Oyinlola M, Kolade O, Okoya SA, Ajala O, Adefila A, Adediji A, Babaremu K, Tijani B, Adejuwon J, Wambui F, Akinlabi ET. Entrepreneurship and innovation in Nigerian universities: Trends, challenges and opportunities. Heliyon 2024; 10:e29940. [PMID: 38711656 PMCID: PMC11070808 DOI: 10.1016/j.heliyon.2024.e29940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024] Open
Abstract
In a bid to improve entrepreneurial outcomes of graduates from Nigerian universities, the Nigerian government has launched a range of interventions, including a 2004 national policy mandating compulsory inclusion of entrepreneurship education in the curriculum, and support for the establishment and implementation of entrepreneurship development activities by university departments. However, not much is known about the operational nuances, challenges and impact cases that characterise the implementation of this national policy in such a vast, culturally diverse country as Nigeria. To address this lacuna, this study draws on qualitative data from five focus groups, crystalised with quantitative data from 151 students across four Nigerian Universities, to explicate the current trends, successes, and challenges of entrepreneurship development and innovation support in Nigerian universities. The paper offers recommendations on how the current policy on entrepreneurship education in Nigeria can be enhanced to improve student entrepreneurial aspirations and outcomes. It also signposts innovative pedagogic activities which could be deployed to achieve this.
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Affiliation(s)
- Muyiwa Oyinlola
- Institute of Energy and Sustainable Development, De Montfort University, Leicester, LE 1 9BH, UK
| | - Oluwaseun Kolade
- Sheffield Business School, Sheffield Hallam University, Sheffield, UK
| | - Silifat Abimbola Okoya
- Institute of Energy and Sustainable Development, De Montfort University, Leicester, LE 1 9BH, UK
| | - Olubunmi Ajala
- School of Economics, Finance and Accounting, Coventry University, CV1 5DL, UK
| | - Arinola Adefila
- Staffordshire Centre for Learning and Pedagogic Practice, ST4 2DE, UK
| | - Adedapo Adediji
- Directorate of Pan African University Life and Earth Sciences Institute (PAULESI), Ibadan, Oyo State, Nigeria
| | - Kunle Babaremu
- Directorate of Pan African University Life and Earth Sciences Institute (PAULESI), Ibadan, Oyo State, Nigeria
| | - Bosun Tijani
- Co Creation Hub, 294 Herbert Macaulay Way, Yaba, Lagos, Nigeria
| | - Jude Adejuwon
- Co Creation Hub, 294 Herbert Macaulay Way, Yaba, Lagos, Nigeria
| | | | - Esther Titilayo Akinlabi
- Department of Mechanical and Construction Engineering, University of Northumbria, Newcastle Upon Tyne, UK
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Brown RT, Zamora K, Rizzo A, Spar MJ, Fung KZ, Santiago L, Campbell A, Nicosia FM. Improving measurement of functional status among older adults in primary care: A pilot study. PLoS One 2024; 19:e0303402. [PMID: 38739582 PMCID: PMC11090365 DOI: 10.1371/journal.pone.0303402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.
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Affiliation(s)
- Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathy Z. Fung
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lea Santiago
- San Francisco VA Health Care System, San Francisco, California, United States of America
| | - Annie Campbell
- Martinez VA Medical Center, Martinez, California, United States of America
| | - Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, United States of America
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Lee K, Etherton-Beer C, Johnson J, Lobo E, Wang K, Ailabouni N, Mavaddat N, Clifford RM, Page AT. Utilising a 'Community of Practice' to support pharmacists to work in residential aged care: protocol for a longitudinal evaluation. BMJ Open 2024; 14:e076856. [PMID: 38740504 PMCID: PMC11097797 DOI: 10.1136/bmjopen-2023-076856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION A Community of Practice is briefly defined as a group of people with a shared interest in a given area of practice who work collaboratively to grow collective knowledge. Communities of Practice have been used to facilitate knowledge exchange and improve evidence-based practice. Knowledge translation within the residential aged care sector is lacking, with barriers such as inadequate staffing and knowledge gaps commonly cited. In Australia, a Federal inquiry into residential aged care practices led to a recommendation to embed pharmacists within residential aged care facilities. Onsite practice in aged care is a new role for pharmacists in Australia. Thus, support is needed to enable pharmacists to practice in this role.The primary aim is to evaluate the processes and outcomes of a Community of Practice designed to support pharmacists to work in aged care. METHODS AND ANALYSIS A longitudinal, single-group, pretest-post-test design in which the intervention is a Community of Practice. The Community of Practice will be established and made available for 3 years to all Australian pharmacists interested in, new to or established in aged care roles. The Community of Practice will be hosted on online discussion platforms, with additional virtual meetings and annual symposia. The following data will be collected from all members of the Community of Practice: self-evaluation of the processes and outcomes of the Community of Practice (via the CoPeval scale) and confidence in evidence-based practice (EPIC scale), collected via online questionnaires annually; and discussion platform usage statistics and discussion transcripts. A subset of members will be invited to participate in annual semi-structured individual interviews.Data from the online questionnaire will be analysed descriptively. Discussion transcripts will be analysed using topic modelling and content analysis to identify the common topics discussed and their frequencies. Qualitative data from individual interviews will be thematically analysed to explore perceptions and experiences with the intervention for information/knowledge exchange, impact on practice, and sharing/promoting/implementing evidence-based practice. ETHICS AND DISSEMINATION Human ethics approval has been granted by the University of Western Australia's Human Ethics Committee (2023/ET000000). No personal information will be included in any publications and reports to funding bodies.Findings will be disseminated to all members of the Community of Practice, professional organisations, social and mass media, peer-review journals, research and professional conferences and annual reports to the funding body.
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Affiliation(s)
- Kenneth Lee
- Pharmacy, School of Allied Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta Johnson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Elton Lobo
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Kate Wang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Nagham Ailabouni
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Nahal Mavaddat
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Rhonda Marise Clifford
- School of Allied Health, Univeristy of Western Australia, Perth, Western Australia, Australia
| | - Amy Theresa Page
- School of Allied Health, Univeristy of Western Australia, Perth, Western Australia, Australia
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Rys M, Schollaert E, Van Hoye G. Living the employer brand during a crisis? A qualitative study on internal employer branding in times of the COVID-19 pandemic. PLoS One 2024; 19:e0303361. [PMID: 38739576 PMCID: PMC11090342 DOI: 10.1371/journal.pone.0303361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Employer branding has emerged as a strategic imperative in the quest for talent. However, existing research has predominantly explored stable periods, overlooking the possible transformative impact of crises and the crucial role that HR managers play in crafting internal employer branding strategies. As such, this research addresses this by scrutinizing internal employer branding during the COVID-19 pandemic. Conducting in-depth interviews with 37 Belgian HR managers, we delve into the perceived challenges and opportunities that the COVID-19 crisis presented with respect to internal employer branding and its touchpoints-internal communication and leadership. A subsequent member and employee check with six HR managers and six employees validated our findings. The results unveiled organizations' heightened concern for employer branding during crises, emphasizing the strategic reflection invested. Remarkably, despite facing organizational/operational constraints/risks imposed by the crisis, the attention and efforts remain steadfastly centered on the experienced internal employer brand in crisis situations. Additionally, a contextual analysis suggests that various employer brand types face similar challenges in crises, however, the employer brand serves as a defining factor that shapes how an organization responds to both external uncertainties and internal dynamics brought about by the crisis. This study contributes to a nuanced understanding of internal employer branding dynamics during crises, shedding light on the strategic considerations of HR managers.
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Affiliation(s)
- Marthe Rys
- Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
| | - Eveline Schollaert
- Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
| | - Greet Van Hoye
- Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
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Lamb R, Kougiali ZG. Women and shame: narratives of recovery from alcohol dependence. Psychol Health 2024:1-38. [PMID: 38736242 DOI: 10.1080/08870446.2024.2352191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Existing literature indicates distinct pathways and the key role of shame and stigma into alcohol dependence (AD) and recovery for women. Internationally, there is a paucity of research exploring these factors from women's perspectives. METHODS AND MEASURES Taking a critical realist epistemological position, unstructured life story interviews were analysed via narrative analysis to explore how seven women from the UK, storied shame in their recovery from AD. RESULTS Shame followed a common trajectory across participants' stories, appearing as a reoccurring factor throughout AD and recovery. Participants narrated shame as gendered, contributing to a loss of personal control in defining a valued personal identity. Drinking began as a shame-management strategy but evolved into a source of shame, compounded by fears of being labelled an 'alcoholic woman'. Recovery involved reclaiming the self through de-shaming a shame-based identity and developing a positive, non-drinking identity. By evaluating 'shaming' recovery frameworks, sharing stories and reconstructing their own, participants were able to work through shame, resist pathologising identity labels and internalise esteemed 'sober' identities. CONCLUSION This research provides important insights into the intersection between shame, identity, gender and culture in women's recovery from AD. Implications for clinical practice, future research and policy are considered.
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Affiliation(s)
- Robin Lamb
- Department of Psychology, University of East London, London, UK
| | - Zetta G Kougiali
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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182
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Schröder H, Mataboge P, McMahon SA, Gómez-Olivé FX, Schatz EJ, Bärnighausen T, De Neve JW. "I am adhering to HIV treatment so that I can live to support her": A qualitative study of upward intergenerational support in South Africa. J Glob Health 2024; 14:04083. [PMID: 38726557 PMCID: PMC11082624 DOI: 10.7189/jogh.14.04083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Intergenerational family care, which was upended by the HIV epidemic in sub-Saharan Africa (SSA), may return to a pre-HIV era arrangement as access to antiretroviral therapy (ART) expands and treated adults can once again provide support for older household members. Empirical research has demonstrated positive 'spillover effects' of ART uptake from treated adults to younger generations, yet much less is known about the nature and breadth of such effects to older generations. This study explores the role and lived experiences among adults who take up ART and those of an older generation with whom they live. Methods We conducted a qualitative study consisting of semi-structured interviews (n = 46) embedded in the Agincourt Health and Demographic Surveillance System (HDSS) in rural South Africa, between July and September 2022. We purposefully sampled two respondent categories: (i) young or middle-aged adults on ART (aged 18-59 years old); and (ii) older adults (aged ≥60 years old) who were affiliated with a young or middle-aged adult on ART. We used thematic content analysis to extract, code, and categorise relevant text by types of upward spillover effects from ART in younger adults to older adults. Quantitative data was extracted from the existing Agincourt HDSS database and matched to qualitative interview data based on Clinic link unique identifiers of study participants. Results Mean age was 41 years among young or middle-aged adults (n = 29) and 72 years among older adults (n = 17). Among younger adults, time on ART ranged from five months to more than 21 years. Both young or middle-aged adults on ART and older adults reported positive spillover effects for older adults across five main tiers: caregiving, financial support, physical and mental health, living arrangements and household relationships, and stigma and reputation. Spillover challenges included financial costs and caregiving responsibilities following ART initiation of young or middle-aged adults, although these additional caregiving responsibilities were generally not perceived as particularly burdensome. Conclusions ART is likely to benefit older adults in South Africa whose families are affected by HIV. This study identified a wide range of perceived spillover effects from ART in younger adults to older adults, including improvements to upward intergenerational support. These qualitative findings offer a guide to researchers, policymakers, and donors to capitalise on the broader societal effects of a large-scale health intervention to further support family structures and meet the needs of a growing older population.
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Affiliation(s)
- Henning Schröder
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Palesa Mataboge
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Enid J Schatz
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health, College of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
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Babarczy B, Hajdu Á, Benko R, Matuz M, Papp R, Antoniou P, Kandelaki K, Lo Fo Wong D, Warsi SK. Hungarian general practice paediatricians' antibiotic prescribing behaviour for suspected respiratory tract infections: a qualitative study. BMJ Open 2024; 14:e081574. [PMID: 38729758 PMCID: PMC11097800 DOI: 10.1136/bmjopen-2023-081574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Inappropriate antibiotic prescribing is a major cause of antimicrobial resistance (AMR). The aim of this study was to explore paediatric general practitioners' (GP Peds) antibiotic prescription practice in suspected respiratory tract infections (RTIs), using the capability-opportunity-motivation-behaviour framework. DESIGN The design is a qualitative study based on individual, semistructured telephone or virtual interviews. SETTING Paediatric general practice in Hungary. We applied stratified maximum variation sampling to cover the categories of age, sex and geographical location of participants. PARTICIPANTS We interviewed 22 GP Peds. Nine were male and 13 were female: 2 of them were less than 40 years old, 14 were between 40 and 60 years, and 6 were above 60 years. 10 worked in low-antibiotic prescription areas, 5 in areas with medium levels of antibiotic prescription, 3 in high-antibiotic prescription areas, and 4 in and around the capital city. RESULTS Study participants had varying antibiotic prescription preferences. Personal experience and physical examination play a central role in GP Peds' diagnostic and treatment practice. Participants emphasised the need to treat children in their entirety, taking their personal medical record, social background and sometimes parents' preferences into account, besides the acute clinical manifestation of RTI. Most respondents were confident they apply the most effective therapy even if, in some cases, this meant prescribing medicines with a higher chance of contributing to the development of AMR. Some participants felt antibiotic prescription frequency has decreased in recent years. CONCLUSIONS Our findings suggest that a more prudent attitude toward antibiotic prescribing may have become more common but also highlight relevant gaps in both physicians' and public knowledge of antibiotics and AMR. To reinforce awareness and close remaining gaps, Hungary should adopt its national AMR National Action Plan and further increase its efforts towards active professional communication and feedback for primary care physicians.
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Affiliation(s)
- Balázs Babarczy
- Syreon Research Institute, Budapest, Hungary
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Ágnes Hajdu
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Ria Benko
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Renáta Papp
- Centre of Science & Innovation Vice-rector and Business Development, Semmelweis University, Budapest, Hungary
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Murungi T, Kunihira I, Oyella P, Mugerwa M, Gift P, Aceng MJ, Abolo L, Puleh SS. Knowledge and perceptions of religious leaders toward HIV prevention among young people in a resource-limited setting: A qualitative study. RESEARCH SQUARE 2024:rs.3.rs-3442966. [PMID: 38766076 PMCID: PMC11100868 DOI: 10.21203/rs.3.rs-3442966/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Currently, 410,000 new HIV infections among youth occur worldwide, which is a significant public health issue. Members of the clergy can be trustworthy allies in the reduction of HIV infections among the youth. However, little is known regarding their knowledge as well as the perceptions they hold towards HIV prevention among young people. Thus, we explored the knowledge and perceptions of religious leaders regarding HIV prevention among young people (15-24 years) in Lira district. Methods This was a cross-sectional qualitative study conducted among 20 religious leaders in March 2021 in Lira district. Religious leaders were sampled purposively and recruited from modern religions (beliefs influenced by Christianity or Islam) in Lira district. Guides for key informant interviews were utilized to gather information. Each interview was audio recorded, transcribed, and entered into NVivo version 12 software, and the data was then ready for analysis. The main themes were determined using thematic analysis. Results Although a few individuals had some misconceptions, the majority of participants had good knowledge about the transmission and prevention of HIV. Participants knew awareness creation, abstinence, and faithfulness in marriage as HIV prevention strategies and held positive perceptions. Perceived barriers to HIV prevention involvement were lack of knowledge and training, and inadequate resources whereas motivating factors were; being respected, and trusted, and having easy access to young people. Conclusion In conclusion, religious leaders show limited HIV prevention knowledge due to religious beliefs, but understand the importance of measures like abstinence. Despite challenges, their involvement is crucial. Addressing knowledge gaps and providing support is vital. Future efforts should emphasize both behavioral measures and interventions like condom use, Post Exposure Prophylaxis, and Pre-Exposure Prophylaxis.
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Walker SC, Ahrens KR, Owens MD, Parnes M, Langley J, Ackerley C, Purtle J, Saldana L, Aarons GA, Hogue A, Palinkas LA. Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol. Implement Sci Commun 2024; 5:54. [PMID: 38720398 PMCID: PMC11077850 DOI: 10.1186/s43058-024-00583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study. METHODS This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA. DISCUSSION This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA.
| | - Kym R Ahrens
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Mandy D Owens
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - McKenna Parnes
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Joe Langley
- Lab For Living, Sheffield Hallam University, Sheffield, UK
| | - Christine Ackerley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, Global Center for Implementation Science, New York University, New York City, USA
| | - Lisa Saldana
- Chestnut Health Systems, Lighthouse Institute, Eugene, OR, USA
| | - Gregory A Aarons
- Department of Psychiatry, UC San Diego ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Aaron Hogue
- Partnership to End Addiction, New York, NY, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Kihagi GW, Hansen LS, Agure E, Muok EMO, Mank I, Danquah I, Sorgho R. 'Counselling is not just providing information': perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya. BMC Health Serv Res 2024; 24:597. [PMID: 38715044 PMCID: PMC11077832 DOI: 10.1186/s12913-024-10872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 03/14/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Globally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs. OBJECTIVE For the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling. DESIGN We employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo. SETTING Health and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya. PARTICIPANTS We interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya. RESULTS Nutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers. CONCLUSION There is a disconnect between the caregivers' preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.
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Affiliation(s)
- Grace Wothaya Kihagi
- Heidelberg Institute for Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany.
| | - Lea-Sophie Hansen
- Heidelberg Institute for Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Erick Agure
- Heidelberg Institute for Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | | | - Isabel Mank
- Heidelberg Institute for Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- German Institute for Development Evaluation (DEval), Bonn, Germany
| | - Ina Danquah
- Heidelberg Institute for Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Hertz-Chair Innovation for Planetary Health and Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Raissa Sorgho
- Heidelberg Institute for Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Centre for Wellness and Nutrition, Public Health Institute, Sacramento, CA, USA
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Nevedal AL, Widerquist MAO, Reardon CM, Arasim M, Jackson GL, White B, Burns M, Fix GM, DeLaughter K, Cutrona SL, Gifford AL, Jasuja GK, Hogan TP, King HA, Henderson B, Damschroder LJ. Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration. Implement Sci 2024; 19:34. [PMID: 38715094 PMCID: PMC11075255 DOI: 10.1186/s13012-024-01361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility. METHODS A longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.'s factors influencing sustainment. RESULTS After approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a "liminal" stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support. CONCLUSIONS We identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA.
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Affiliation(s)
- Andrea L Nevedal
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Marilla A Opra Widerquist
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - Caitlin M Reardon
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - Maria Arasim
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Madison Burns
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Division of General Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Allen L Gifford
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Timothy P Hogan
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Blake Henderson
- Innovation Ecosystem, United States Veterans Health Administration, Washington, DC, USA
| | - Laura J Damschroder
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
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Viphonephom P, Kounnavong S, Reinharz D. Decentralization and immunization program in a single-party state: the case of the Lao People's Democratic Republic. Trop Med Health 2024; 52:35. [PMID: 38715093 PMCID: PMC11075326 DOI: 10.1186/s41182-024-00601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The Lao People's Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied. METHODS A case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents. RESULTS The Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change. CONCLUSION Unprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program.
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Affiliation(s)
- Phonevilay Viphonephom
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute (Lao TPHI), Ministry of Health, Vientiane, Lao PDR
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
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Eyre A, Cohen J, Funnell S, James L, Guglani S, Abi Haidar H, Samson L, Ward M, Jetty R, Harrison M, Lyons JS, Fraser-Roberts L, Bennett S, Archibald D, Khorsand S, Audcent T. Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool. BMC Pediatr 2024; 24:300. [PMID: 38702643 PMCID: PMC11067211 DOI: 10.1186/s12887-024-04759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings. METHODS The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility. RESULTS Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%). INTERPRETATION Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study's findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.
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Affiliation(s)
- Alison Eyre
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Centretown Community Health Centre, Ottawa, ON, Canada.
| | - Janice Cohen
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sarah Funnell
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, Queen's University, Kingston, ON, Canada
- Centre for Indigenous Health Research and Education, University of Ottawa, Ottawa, ON, Canada
| | - Lynsey James
- Centretown Community Health Centre, Ottawa, ON, Canada
| | - Sheena Guglani
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Hounaida Abi Haidar
- Department of Family Medicine, Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Lindy Samson
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michelle Ward
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Radha Jetty
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Megan Harrison
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - John S Lyons
- Centre for Innovation in Population Health, University of Kentucky, Lexington, KY, USA
| | - Leigh Fraser-Roberts
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Susan Bennett
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Soha Khorsand
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tobey Audcent
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Clarke L, O'Neill N, Patel B, Steeman S, Segal G, Merrell SB, Gisondi MA. Trainee advocacy for medical education on the care of people with intellectual and/or developmental disabilities: a sequential mixed methods analysis. BMC MEDICAL EDUCATION 2024; 24:491. [PMID: 38702741 PMCID: PMC11067383 DOI: 10.1186/s12909-024-05449-4] [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: 06/28/2023] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Medical trainees (medical students, residents, and fellows) are playing an active role in the development of new curricular initiatives; however, examinations of their advocacy efforts are rarely reported. The purpose of this study was to understand the experiences of trainees advocating for improved medical education on the care of people with intellectual and/or developmental disabilities. METHODS In 2022-23, the authors conducted an explanatory, sequential, mixed methods study using a constructivist paradigm to analyze the experiences of trainee advocates. They used descriptive statistics to analyze quantitative data collected through surveys. Participant interviews then yielded qualitative data that they examined using team-based deductive and inductive thematic analysis. The authors applied Kern's six-step approach to curriculum development as a framework for analyzing and reporting results. RESULTS A total of 24 participants completed the surveys, of whom 12 volunteered to be interviewed. Most survey participants were medical students who reported successful advocacy efforts despite administrative challenges. Several themes were identified that mapped to Steps 2, 4, and 5 of the Kern framework: "Utilizing Trainee Feedback" related to Needs Assessment of Targeted Learners (Kern Step 2); "Inclusion" related to Educational Strategies (Kern Step 4); and "Obstacles", "Catalysts", and "Sustainability" related to Curriculum Implementation (Kern Step 5). CONCLUSIONS Trainee advocates are influencing the development and implementation of medical education related to the care of people with intellectual and/or developmental disabilities. Their successes are influenced by engaged mentors, patient partners, and receptive institutions and their experiences provide a novel insight into the process of trainee-driven curriculum advocacy.
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Affiliation(s)
- Lauren Clarke
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | | | - Binisha Patel
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Samantha Steeman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Gabrielle Segal
- University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, USA
| | | | - Michael A Gisondi
- Department of Emergency Medicine and Principal, The Precision Education and Assessment Research Lab, Stanford University School of Medicine, Stanford, CA, USA
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191
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Lewis H, Taubert M, Nelson A. Virtual consultations: the experience of oncology and palliative care healthcare professionals. BMC Palliat Care 2024; 23:114. [PMID: 38698367 PMCID: PMC11064317 DOI: 10.1186/s12904-024-01400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES To maintain continuity of care during the Covid-19 pandemic, virtual consultations (VC) became the mainstay of patient-healthcare practitioner interactions. The aim of this study was to explore the views of oncology and palliative care healthcare professionals (HCPs) regarding the medium of VC. METHOD A cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. This was undertaken in accordance with relevant guidelines and regulations. RESULTS 87 surveys were completed. Three master themes were identified. Personal, professional, and familial factors including patient age, illness and VC skillset all influenced practitioner's experience of VC. Relationships and connection were highlighted by survey respondents as important influences, with a perception that VC could reduce usual relationships with patients, compared to previous face-to-face consults. There was a perceived loss in these domains with VC. Sharing bad news and having challenging conversations was seen as particularly difficult via VC. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Within the domain of logistical and practical implications reduced travel and increased accessibility were seen as a significant benefit of VC. The inability to examine patients and concerns regarding missing clinical signs was emphasised as a significant worry, alongside the challenges faced with occasionally failing technology. CONCLUSION VC were felt to have a role for those patients who are already known to professionals, where there was an established relationship. VC for difficult discussions and for unstable patients were felt to be inadequate. Triaging patient suitability prior to offering VC, with emphasis on the importance of patient choice, was seen as a priority in this new era of VC.
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Affiliation(s)
- Heledd Lewis
- Velindre University NHS Trust, Cardiff, CF14 2TL, UK.
| | - Mark Taubert
- Velindre University NHS Trust, Cardiff, CF14 2TL, UK
| | - Annmarie Nelson
- School of Medicine, Marie Curie Palliative Care Research Centre, Cardiff, UK
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192
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Colton ZA, Liles SM, Griffith MM, Stanek CJ, Walden J, King A, Barnard-Kirk T, Creary S, Nahata L. Using the consolidated framework for implementation research to identify challenges and opportunities for implementing a reproductive health education program into sickle cell disease care. J Pediatr Psychol 2024:jsae031. [PMID: 38699955 DOI: 10.1093/jpepsy/jsae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND As survival rates for individuals with sickle cell disease (SCD) increase, calls have been made to improve their reproductive healthcare and outcomes. The research team created a web-based program entitled Fertility edUcaTion to Understand ReproductivE health in Sickle cell disease (FUTURES). The study aim was to use the Consolidated Framework for Implementation Research (CFIR) during pre-implementation to identify challenges and opportunities from the individual to systems level of implementation to ultimately optimize the integration of FUTURES into clinical practice. METHODS Semi-structured interviews were conducted with clinicians, research team members, and adolescent and young adult (AYA) males with SCD and their caregivers who participated in pilot testing. Interviews (N = 31) were coded inductively and then mapped onto CFIR domains (i.e., outer setting, inner setting, characteristics of individuals, and intervention characteristics). RESULTS Research team interviews indicated the lack of universal guidelines for reproductive care in this population and gaps in reproductive health knowledge as key reasons for developing FUTURES, also highlighting the importance of collaboration with community members during development. Clinicians reported intraorganizational communication as essential to implementing FUTURES and discussed challenges in addressing reproductive health due to competing priorities. Clinicians, AYAs, and caregivers reported positive views of FUTURES regarding length, engagement, accessibility, and content. Suggestions for the best setting and timing for implementation varied. CONCLUSIONS Using CFIR during the pre-implementation phase highlighted challenges and opportunities regarding integrating this program into SCD care. These findings will inform adaptation and further testing of FUTURES to ensure effective implementation of this novel education program.
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Affiliation(s)
- Zachary A Colton
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Sophia M Liles
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Megan M Griffith
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Charis J Stanek
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Joseph Walden
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Allison King
- Department of Pediatrics, Washington University in St Louis, St Louis, MO, United States
| | - Toyetta Barnard-Kirk
- Department of Social Work at Nationwide Children's Hospital, Columbus, OH, United States
| | - Susan Creary
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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Singh N, Giannitrapani KF, Gamboa RC, O’Hanlon CE, Fereydooni S, Holdsworth LM, Lindvall C, Walling AM, Lorenz KA. What Patients Facing Cancer and Caregivers Want From Communication in Times of Crisis: A Qualitative Study in the Early Months of the COVID-19 Pandemic. Am J Hosp Palliat Care 2024; 41:558-567. [PMID: 37390466 PMCID: PMC10315453 DOI: 10.1177/10499091231187351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis. METHODS We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code "Communication," which appeared 71 times, and identified 5 themes. RESULTS Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time. CONCLUSION Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises.
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Affiliation(s)
- Nainwant Singh
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Karleen F. Giannitrapani
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Raziel C. Gamboa
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | | | | | | | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anne M. Walling
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Karl A. Lorenz
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
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194
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Kinney AR, Brenner LA, Nance M, Mignogna J, Cobb AD, Forster JE, Ulmer CS, Nakase-Richardson R, Bahraini NH. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med 2024; 20:801-812. [PMID: 38189353 PMCID: PMC11063707 DOI: 10.5664/jcsm.10994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. METHODS Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. RESULTS Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. CONCLUSIONS Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. CITATION Kinney AR, Brenner LA, Nance M, et al. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.
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Affiliation(s)
- Adam R. Kinney
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Lisa A. Brenner
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Aurora, Colorado
| | - Morgan Nance
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Joseph Mignogna
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Audrey D. Cobb
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Jeri E. Forster
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Christi S. Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Risa Nakase-Richardson
- Research Service, James A. Haley Veterans Hospital, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida, Tampa, Florida
| | - Nazanin H. Bahraini
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation and Psychiatry, Aurora, Colorado
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D'Arcy E, Burnett T, Capstick E, Elder C, Slee O, Girdler S, Scott M, Milbourn B. The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children. J Autism Dev Disord 2024; 54:1857-1869. [PMID: 36757543 PMCID: PMC9909132 DOI: 10.1007/s10803-023-05910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Caregivers of children with neurodiverse needs are known to experience challenges and hardship due to the increased needs of the child and the lack of support available. This study aimed to explore the support needs and well-being of caregivers of children with neurodiverse needs in Australia. Sixty-six caregivers participated in an online survey asking questions about support needs. The results highlighted five main themes that caregivers commonly experienced including: barriers to community engagement, impact on close relationships, negative impact on mental health and identity, financial hardship, and identified support needs. Findings identified multiple unmet needs existing amongst caregivers and further emphasises the importance of addressing these needs to improve the quality of life of caregivers of children with neurodiverse needs.
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Affiliation(s)
- Emily D'Arcy
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Tayah Burnett
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Emily Capstick
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Catherine Elder
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Olivia Slee
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Sonya Girdler
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Melissa Scott
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Ben Milbourn
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia.
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196
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Gómez-Ibáñez R, Leyva-Moral JM, Cruzado-Reyes A, Platero LR, Granel N, Watson CE. Describing Non-Binary People's Encounters with the Healthcare System: A Qualitative Study in Catalonia (Spain). ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1957-1967. [PMID: 38565788 PMCID: PMC11106161 DOI: 10.1007/s10508-024-02849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1-This is me composed of the categories, "My Name and My Pronouns" and "One's Chosen Gender," and Theme 2-I do not exist for the health system consisting of "Uneducated Health System in Sexual Health" and "Feeling Like an Outsider for Being Non-Binary." Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.
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Affiliation(s)
- Rebeca Gómez-Ibáñez
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Juan M Leyva-Moral
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain.
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain.
| | | | - Lucas R Platero
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Nina Granel
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carolina E Watson
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
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197
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Şahan AG, Kilavuz A. Older Adults' Metaphorical Perceptions of Aging in Turkey. J Gerontol Nurs 2024; 50:27-34. [PMID: 38691114 DOI: 10.3928/00989134-20240416-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE To determine older adults' metaphorical perceptions of the concept of aging. METHOD Participants in this qualitative study comprised 57 older adults as determined using convenience and criterion sampling methods. Data were obtained using a personal data form and the metaphor form and analyzed with descriptive and content analysis techniques. RESULTS Fifty-seven metaphors were identified within three themes: 24 within Mental Aspect, 18 within Physical Aspect, and 15 within Psychosocial Aspect. CONCLUSION The fact that most metaphors appeared within the Mental Aspect theme was interpreted as an indication that participants felt the effects of aging more in the mental dimension. Results of the research show that aging is perceived as experience and accumulation mentally, as inadequacy physically, and as the end or loneliness psychosocially. [Journal of Gerontological Nursing, 50(5), 27-34.].
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198
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Tripathi T, Watson J, Skrzypek H, Stump H, Lewis S, Hui L. "The anxiety coming up to every scan-It destroyed me": A qualitative study of the lived experience of cytomegalovirus infection during pregnancy. Prenat Diagn 2024; 44:623-634. [PMID: 38578535 DOI: 10.1002/pd.6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Emerging evidence supporting the use of valaciclovir to reduce fetal infection after maternal primary cytomegalovirus (CMV) infection has stimulated interest in routine CMV serological screening in pregnancy. It is important to understand the healthcare consumer perspective of a CMV infection during pregnancy to minimize unintended harms of screening. METHODS We conducted a qualitative study using semi-structured interviews with Australian women who had a lived experience of CMV infection following serological testing during pregnancy. Participants were recruited via social media and healthcare consumer networks, and purposively selected to capture a range of perinatal outcomes. Interview transcripts were analyzed using inductive content analysis. RESULTS Twelve participants were interviewed: 6 had a live birth, 4 had terminations of pregnancy, 1 had a neonatal death and 1 was pregnant at the time of interview. Four major categories emerged from the analysis. Women reported a lack of CMV awareness among themselves, their social networks, and among their health care providers. The participants described their experience as "hard" and "stressful". Uncertainty and variability characterized their clinical decision-making process. The pregnancy and postpartum periods were marked by ongoing anxiety about the long-term impacts of CMV. Women supported screening for CMV, decision making and reproductive choice, but acknowledged that routine testing may not be desired by everyone and may increase stress and terminations of pregnancy. Important coping strategies included obtaining support from partners, family, and other families with lived experience of CMV, as well as having access to knowledgeable and sensitive healthcare professionals. CONCLUSION Serological diagnosis of maternal CMV infection during pregnancy can have severe and prolonged psychological impacts on parents, regardless of the pregnancy outcome. Improving healthcare professionals' knowledge and public awareness are essential before widespread serological screening can be responsibly introduced. Healthcare administrators that are considering implementing a prenatal screening program for secondary prevention of fetal CMV infection should pay attention to consumer perspectives to minimize unintended harms to women and their families.
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Affiliation(s)
- Tanya Tripathi
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jotara Watson
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hannah Skrzypek
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hanako Stump
- CMV Australia, Sydney, New South Wales, Australia
| | - Sharon Lewis
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Lisa Hui
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Northern Hospital, Northern Health, Epping, Victoria, Australia
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199
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Ward CE, Singletary J, Zaslavsky J, Boogaard C, Campanella V, Simpson JN. Pediatric Primary Care Provider Perspectives on Including Children in Alternative Emergency Medical Services Disposition Programs. J Pediatr Health Care 2024; 38:392-400. [PMID: 37897453 DOI: 10.1016/j.pedhc.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/05/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Many emergency medical services (EMS) agencies have implemented alternative disposition programs for low-acuity complaints, including transportation to clinics. Our objectives were to describe pediatric primary care providers' views on alternative EMS disposition programs. METHOD We conducted virtual focus groups with pediatric primary care providers. A hybrid inductive and deductive analytical strategy was used. Codes were grouped into themes by consensus. RESULTS Participants identified the benefits of alternative dispositions, including continuity of care, higher quality care, and freeing up emergency resources. Participants' concerns included undertriage, difficulty managing patients not previously known to a clinic, and inequitable implementation. Commonly identified logistical barriers included inadequate equipment, scheduling capacity, and coordinating triage. DISCUSSION Participants agreed there could be significant benefits from including clinics in EMS disposition programs. Participants identified several logistical constraints and raised concerns about patient safety and equitable implementation. These perspectives should be considered when designing pediatric alternative EMS disposition programs.
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200
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Koch GGV, Engel-Hills P, Friedrich-Nel H. Individual patient radiation dose tracking: Perceptions of radiographers in South Africa. Radiography (Lond) 2024; 30:1014-1020. [PMID: 38704978 DOI: 10.1016/j.radi.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Medical imaging examinations that make use of ionising radiation provide valuable information towards patient management. Literature suggests that there is a significant rise in the number of patient referrals for such examinations. The concept "individual patient radiation dose tracking" (IPRDT) is introduced to optimise radiation monitoring. Many countries across the globe explored and implemented methods to enhance and promote the justification and optimisation principles essential for patient radiation safety. In South Africa (SA), however, attention to IPRDT is limited. METHODS A qualitative research design was employed. Radiographers in the Western Cape Province of SA were purposefully sampled for participation in one-on-one, semi-structured interviews. Thematic analysis was applied to the transcribed interview data. RESULTS This paper presents a theme developed from the radiographer cohort of ten (10) participants. The theme: the need for creating awareness and implementing legislative support structures, was developed from the data, with the following supporting subthemes: 1) stakeholder awareness and 'buy-in' 2) continuous professional development and 3) mandated practice. CONCLUSION This study provides findings that are of value for patient radiation safety in SA by giving a voice to local stakeholders. Other countries that are conducting similar research investigations toward the integration of an IPRDT model, method, or framework, may also benefit from these findings. IMPLICATIONS FOR PRACTICE The effective integration of IPRDT into the clinical environment requires unison amongst the relevant stakeholders and clarity on the various professionals' roles and responsibilities. The findings of this study furthermore suggest the involvement of regulatory organisations for the provision of a mandated form of practice at national and international levels.
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Affiliation(s)
- G G V Koch
- Cape Peninsula University of Technology, Faculty of Health and Wellness Sciences, Department of Medical Imaging and Therapeutic Sciences, South Africa.
| | - P Engel-Hills
- Cape Peninsula University of Technology, Faculty of Health and Wellness Sciences, Department of Medical Imaging and Therapeutic Sciences, South Africa
| | - H Friedrich-Nel
- Central University of Technology, Free State, Faculty of Health and Environmental Sciences, Department of Clinical Sciences, South Africa
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