A meta-study analysing the discourses of discourse analysis in health professions education

INTRODUCTION

Discourse analysis has been used as an approach to conducting research in health professions education (HPE) for many years. However, because there is no one 'right' interpretation of or approach to it, quite what discourse analysis is, how it could or should be used, and how it can be appraised are unclear. This ambiguity risks undermining the trustworthiness and coherence of the methodology and any findings it produces.

METHOD

A meta-study review was conducted to explore the current state of discourse analysis in HPE, to guide researchers engaging using the methodology and to improving methodological, analytical and reporting rigour. Structured searches were conducted, returns were filtered for inclusion and 124 articles critically analysed.

RESULTS

Of 124 included articles, 64 were from medical education, 51 from nursing and 9 were mutli-disciplinary or from other HPE disciplines. Of 119 articles reporting some sort of data, 50 used documents/written text as the sole data source, while 27 were solely based on interview data. Foucault was the most commonly cited theorist (n = 47), particularly in medical education articles. The quality of articles varied: many did not provide a clear articulation what was meant by discourse, definitions and methodological choices were often misaligned, there was a lack of detail regarding data collection and analysis, and positionality statements and critiques were often underdeveloped or absent.

DISCUSSION

Seeking to address these many lacunae, the authors present a framework to facilitate rigorous discourse analysis research and transparent, complete and accurate reporting of the same, to help readers assess the trustworthiness of the findings from discourse analysis in HPE. Scholars are encouraged to reflect more deeply on the applications and practices of discourse analysis, with the ultimate aim of ensuring more breadth and depth when using discourse analysis for understanding and constructing meaning in our field.

Patient recall of intensive care delirium: A qualitative investigation

BACKGROUND

Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering. The aim of our study was to investigate the subjective patient experience of delirium, delirium-related distress, and delirium management in ICU.

METHODS

Our study had a qualitative multicenter design applying individual interviews and thematic analysis. Participants were critically ill adult patients that were determined delirium positive according to validated delirium screening tools during ICU admission. The interviews were conducted after ICU discharge when patients were delirium-free as assessed by the "Rapid clinical test for delirium" (4AT) and able to participate in an interview.

RESULTS

We interviewed 30 patients choosing the main themes deductively: Delirium experience; Delirium related distress; and Delirium management. Despite variations in recollection detail, ICU survivors consistently reported delirium-related distress during and after their ICU stay, manifesting as temporal confusion, misinterpretations, and a sense of distrust towards ICU staff. Delusions were characterized by a blend of factual and fictional elements. Impaired short-term memory hindered communication and intensified feelings of isolation, neglect, and loss of control.

CONCLUSION

The ICU survivors in our study recalled delirium as an unpleasant and frightening experience, often leading to delirium-related distress during and after their ICU stay, indicating the necessity for enhanced assessment and treatment.

Coping with emotional dysregulation among young adults with ADHD: A mixed-method study of self-awareness and strategies in daily life

BACKGROUND

Emotional dysregulation (ED) impacts functional outcomes among individuals with attention-deficit hyperactivity disorder (ADHD). Self-awareness and strategies may enhance coping with ED yet are rarely studied in ADHD.

OBJECTIVES

To explore ED-related self-awareness and strategies in daily life of adults with ADHD, and to examine the interrelations between them and their association with symptoms.

METHODS

Sixty young adults with ADHD participated in a mixed-method study. At baseline, self-awareness and strategies were assessed using the Self-Regulation Skills Interview (SRSI); ADHD symptoms were self-rated using the ASRS symptom checklist. Then, symptoms were rated over 5-days using ecological momentary assessment (EMA).

RESULTS

Significant challenges in self-awareness and strategies were demonstrated quantitatively and qualitatively. Awareness of ED was associated with variability of ADHD symptoms on EMA yet not with symptom severity. Qualitative content analysis revealed a range of self-awareness levels, which were related to noticing ED-related cues and understanding contextual factors predictive of ED. Self-awareness and strategies were significantly associated. Strategies varied regarding effort, individual preference and temporality.

CONCLUSIONS

Variability of ADHD symptoms was negatively associated with self-awareness of ED. Strategy selection in daily-life among adults with ADHD may be affected by self-awareness and by a possible trade-off between short-term effort and long-term effectiveness.

Developing a haemodialysis acuity tool (the HAT study): A qualitative study

BACKGROUND

Haemodialysis units are now managing an increasing number of patients with varying needs and levels of acuity. To maintain safety, haemodialysis patients must be placed in the most appropriate dialysis unit that has the required human and physical resources to care for them. The first step towards achieving these goals is to develop a tool specific to haemodialysis units to effectively measure patient acuity.

OBJECTIVE

To develop a haemodialysis acuity tool, utilising a focus group approach, in assessing patient's suitability for a specific dialysis location thus ensuring patient safety.

DESIGN

This is a cross-sectional qualitative study via a focus group approach.

PARTICIPANTS

Participants were nurse unit managers and team leaders of a District Renal Service.

APPROACH

Participants were interviewed to explore their views on the elements and measures identified in the research aims. Themes for interviews were informed by current literature on acuity tools for haemodialysis patients' admission to the dialysis units. Interviews were recorded and transcribed verbatim and progressively analysed using a thematic analysis approach.

RESULTS

Ten nurse unit managers/team leaders (100%) were interviewed and thematic analysis of the transcripts was conducted utilising the deductive approach. Five themes were identified which will form the main categories in the development of the tool, namely: Age/frailty; co-morbidity; physical; dialysis; and psychosocial.

CONCLUSION

This study is instrumental in the development of the haemodialysis acuity tool which can be used in allocating dialysis location specific to patient's needs and available resources. The tool can also be used in analysing patient care processes and resource requirements based on the patients' and unit's profile.

Mixed methods assessment of the influence of demographics on medical advice of ChatGPT

OBJECTIVES

To evaluate demographic biases in diagnostic accuracy and health advice between generative artificial intelligence (AI) (ChatGPT GPT-4) and traditional symptom checkers like WebMD.

MATERIALS AND METHODS

Combination symptom and demographic vignettes were developed for 27 most common symptom complaints. Standardized prompts, written from a patient perspective, with varying demographic permutations of age, sex, and race/ethnicity were entered into ChatGPT (GPT-4) between July and August 2023. In total, 3 runs of 540 ChatGPT prompts were compared to the corresponding WebMD Symptom Checker output using a mixed-methods approach. In addition to diagnostic correctness, the associated text generated by ChatGPT was analyzed for readability (using Flesch-Kincaid Grade Level) and qualitative aspects like disclaimers and demographic tailoring.

RESULTS

ChatGPT matched WebMD in 91% of diagnoses, with a 24% top diagnosis match rate. Diagnostic accuracy was not significantly different across demographic groups, including age, race/ethnicity, and sex. ChatGPT's urgent care recommendations and demographic tailoring were presented significantly more to 75-year-olds versus 25-year-olds (P < .01) but were not statistically different among race/ethnicity and sex groups. The GPT text was suitable for college students, with no significant demographic variability.

DISCUSSION

The use of non-health-tailored generative AI, like ChatGPT, for simple symptom-checking functions provides comparable diagnostic accuracy to commercially available symptom checkers and does not demonstrate significant demographic bias in this setting. The text accompanying differential diagnoses, however, suggests demographic tailoring that could potentially introduce bias.

CONCLUSION

These results highlight the need for continued rigorous evaluation of AI-driven medical platforms, focusing on demographic biases to ensure equitable care.

Tensions in caring for chronic patients' medication adherence: A qualitative study in Cyprus

Medication adherence (MA) to recommended treatment is a multi-faceted problem and an ongoing challenge for healthcare providers (HCPs) to monitor. This qualitative study with 10 HCPs in Cyprus aims to explore HCPs' perceptions and strategies used on addressing medication non-adherence (MNA) in patients with chronic conditions. Two main themes emerged from the analysis reflecting the ways that HCPs described their reactions to MNA of their patients: (1) "Relying on information provision to improve MA" and (2) "Trying to understand patients' perspective." HCPs reported empathizing with patients and engaging in discussions to understand patients' perspective and reasons for MNA, so as to explore alternative solutions. Simultaneously, some HCPs reflected that the techniques used to improve MA are solely centered around information on medication and side-effects. HCPs experienced an internal conflict between providing patient-centered care versus using directive approaches to improve MA. Findings suggest how HCPs could thoroughly address patients' individual barriers.

Exploring adolescent-adult connections, coping, and safety among minoritized youth in neighborhoods impacted by community violence

Dyadic interviews were conducted with 32 youth ages 13-21 and their self-identified key adult supports to illuminate how adult supports help protect youth in communities impacted by high levels of violence. Interview transcripts were analyzed using thematic content analysis. Youth described choosing social interactions carefully, avoiding high-violence areas, and keeping busy with activities. Many youths discussed the necessity of minimizing contact with peers to avoid violence, resulting in isolation from friends and increased engagement with family at home. Adult supports reflected upon an intergenerational transfer of violence avoidance, safety planning, and coping strategies through sharing their own lived experiences. Dyads highlighted the need for intergenerational programming to address social isolation and build supportive social networks.

The Effects of Safe Zone Badges in Physicians' Online Biographies: Evidence from an Experimental Study

Earning digital badges to showcase a person's expertise or knowledge are becoming increasingly popular. A healthcare provider's displaying of a Safe Zone badge within their online profile may offer prospective patients a cue as to the kind of care they might receive if they selected that particular provider. Prior research indicates LGBTQ+ individuals are looking for these types of cues within providers' biographies to make their selections. A between subjects, 2 (Safe Zone badge present/absent) x 2 (male/female doctor) online experiment was conducted (n = 658). Results revealed a main effect for the presence of the Safe Zone badge. Participants had greater anticipated satisfaction, liking, were more likely to view the provider as approachable, and were more willing to schedule an appointment with the provider displaying a Safe Zone badge.

Bridging the evidence-to-practice gap: exploring dental professionals' perspectives on managing oral health during pregnancy in Tasmania, Australia

BACKGROUND

Poor oral health is associated with adverse health, social and economic consequences for pregnant women. While dental professionals promote good oral health within the dental practice context, more broadly, women in the antenatal period face poor oral health outcomes. Therefore, this study explored dental professionals' perceptions of their role in managing the oral health of pregnant women and identified the barriers and facilitators to improving maternal oral health.

METHODS

This study employed a descriptive qualitative method utilizing semi-structured interviews. Convenience and snowball sampling were used to recruit 13 dental professionals from Tasmania, Australia, comprising dentists (n = 10), oral health therapists (n = 2) and dental therapist (n = 1). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.

RESULTS

Three major themes were constructed from the interviews: (1) dental professionals' oral health care of women during pregnancy; (2) perceived challenges to maternal oral health; and (3) proposed strategies to improve maternal oral health.

CONCLUSIONS

Findings suggest dental professionals' competence in maternal oral health, but that several barriers, such as dental care access and maternal factors, hinder oral health outcomes. To address these barriers, oral health policies that support interprofessional collaboration, professional training and evaluation of existing community oral health programmes are needed. © 2024 Australian Dental Association.

Application of immersive virtual reality mirror therapy for upper limb rehabilitation after stroke: a scoping review

Mirror therapy is a commonly used rehabilitation intervention in post stroke upper limb rehabilitation. Despite many potential technological developments, mirror therapy is routinely delivered through the use of a static mirror or mirror box. This review aims to synthesise evidence on the application of immersive virtual reality mirror therapy (IVRMT) in poststroke upper limb rehabilitation. A scoping review was performed on relevant English studies published between 2013 to 2023. Literature search was undertaken on APA PsycInfo, CINAHL, Cochrane Library, MEDLINE, PubMed and Web of Science between August 5 and 17, 2023. Additional studies were included from Google Scholar and reference lists of identified articles. A total of 224 records were identified, of which 8 full-text articles were selected for review. All included studies were published between 2019 and 2023, and from high- and upper-middle-income nations. All the studies were experimental (n = 8). The total sample size in the studies was 259, most of whom were stroke patients with upper limb weakness (n = 184). This review identified three major themes and two sub-themes based on the contents of the studies conducted on the application of IVRMT: IVRMT's technical application, feasibility and impact on clinical outcomes (motor recovery and adverse events). IVRMT was concluded to be a safe and feasible approach to post-stroke upper limb rehabilitation, offering enhanced engagement and motor recovery. However, more methodologically robust studies should be conducted to advance this area of practice, and to include a uniform IVRMT intervention protocol, dose, and use of outcome measure.

Multidisciplinary First-Line Healthcare Leaders' Roles and Experiences During the COVID-19 Pandemic in Ontario Canada

BACKGROUND

Throughout the COVID-19 pandemic, first-line healthcare leaders across the healthcare system played crucial roles leading, motivating, and supporting staff.

PURPOSE

This study aims to describe multidisciplinary first-line healthcare leaders' experiences during the COVID-19 pandemic in Ontario, Canada using transformational and crisis leadership theory.

METHODS

A descriptive two-phase (quantitative & qualitative) design was conducted in the spring of 2021. Phase 1 employed an online survey sent via email to first-line leaders from various sectors who were members of healthcare professional associations in Ontario. Participants included nurse managers, professional practice leaders (e.g., occupational and physiotherapists), advanced practice nurses, and clinical educators. In Phase 2, a subset (n  =  19) of the Phase 1 participants were interviewed to gain a deeper understanding of these leaders' experiences including role impact and support available. Semistructured individual interviews were conducted and recorded via Zoom©. Inductive and deductive analysis approaches identified key themes. This paper reports the qualitative findings from Phase 2.

RESULTS

Leaders' behaviors were representative of the key dimensions of transformational and complexity leadership theories. Recommendations for leading during a crisis included: engaging in self-care activities to manage the personal impact of the crisis; teamwork and collaborative leadership; and support from fellow first-line leaders and senior leaders. Findings can inform healthcare leadership education programs designed to manage future crises for both academic and practice settings.

CONCLUSION

Descriptions of first-line healthcare leaders' roles and experiences during multiple waves of the COVID-19 pandemic validated their important contributions within various health sectors.

Exploring potential drivers of patient engagement with their health data through digital platforms: A scoping review

BACKGROUND

Patient engagement when providing patient access to health data results from an interaction between the available tools and individual capabilities. The recent digital advancements of the healthcare field have altered the manifestation and importance of patient engagement. However, a comprehensive assessment of what factors contribute to patient engagement remain absent. In this review article, we synthesised the most frequently discussed factors that can foster patient engagement with their health data.

METHODS

A scoping review was conducted in MEDLINE, Embase, and Google Scholar. Relevant data were synthesized within 7 layers using a thematic analysis: (1) social and demographic factors, (2) patient ability factors, (3) patient motivation factors, (4) factors related to healthcare professionals' attitudes and skills, (5) health system factors, (6) technological factors, and (7) policy factors.

RESULTS

We identified 5801 academic and 200 Gy literature records, and included 292 (4.83%) in this review. Overall, 44 factors that can affect patient engagement with their health data were extracted. We extracted 6 social and demographic factors, 6 patient ability factors, 12 patient motivation factors, 7 factors related to healthcare professionals' attitudes and skills, 4 health system factors, 6 technological factors, and 3 policy factors.

CONCLUSIONS

Improving patient engagement with their health data enables the development of patient-centered healthcare, though it can also exacerbate existing inequities. While expanding patient access to health data is an important step towards fostering shared decision-making in healthcare and subsequently empowering patients, it is important to ensure that these developments reach all sectors of the community.

Recognizing and coping with suicidal thoughts: A mixed-methods investigation of digital safety plan content

OBJECTIVES

Suicide safety plans are a personalized means of documenting how a person at risk of suicide recognizes and intends to cope with emerging suicidal thoughts. This study aimed to understand how users of digital suicide safety plans describe their warning signs, methods of coping and any relationships between these that may emerge.

METHODS

A sample comprising 150 users of the Australian suicide safety planning smartphone app Beyond Now consented to share the content of their safety plans. Reflexive thematic analysis was used to identify themes in overall plan content. Most participants identified as women (61%), had a history of at least one suicide attempt (61%) and completed their plans by themselves (84%).

RESULTS

Three major themes emerged: (1) interpersonal challenges and complexity; (2) matching coping strategies to warning signs; and (3) helpful and harmful digital technology use. Most plans appeared to demonstrate high self-awareness of warning signs and available supports.

CONCLUSIONS

Safety plan content provides a window into the thought process underlying the recognition of suicidal thoughts and the attempts to manage them. An opportunity exists for practitioners and support persons to use this content when collaboratively supporting a safety plan user to improve their coping strategies and support networks.

Implementation lead nurses to lead EBP quality improvement project using the PEACE framework

Implementing evidence-based practice (EBP) in clinical practice is an ongoing challenge for nurses. EQUIP-Evidence-based QUality Improvement Project- is a multiphase project aimed at equipping nurses with the essential skills to implement EBP and advanced nursing practice. EQUIP embraces the assumption that implementation science models and partnership models can facilitate the implementation process of EBP, leading to successful and sustainable change. The current study is one of the EQUIP feasibility investigations in which the perspective of 12 implementation lead nurses (IL nurses) who attended a 1-day PEACE-based workshop was explored. Thematic analysis identified 2 overarching themes, 6 themes, and 18 subthemes. The first overarching theme showed that the PEACE-based workshop has successfully achieved its intended training implications, and the second overarching theme gave insight into factors that may influence the role of IL nurses. IL nurses reported general satisfaction and willingness to use the PEACE model at work; however, some IL nurses found Step 3 difficult to apply. The study's findings provide evidence of the perceived usefulness of adopting the PEACE model as an augmented approach in the EQUIP and the interest and enthusiasm of IL nurses in receiving more training on the implementation process of EBP.

Sexual health and fertility in Duchenne muscular dystrophy-An exploratory study

INTRODUCTION/AIMS

Recent clinical guidelines recommend that adolescents with Duchenne muscular dystrophy (DMD) who are on daily glucocorticoid treatment should be offered pubertal induction in order to ensure adult levels of sex hormones as they reach adulthood. However, it remains unclear how gonadal status, including androgen concentrations, impacts physical function and future fertility. The aim of this study was to give a voice to adults with DMD, exploring their perspectives around sexual health, hormone treatment, and fertility.

METHODS

Qualitative data was collected from six adults with DMD through two online focus groups. Participants were recruited through Pathfinders Neuromuscular Alliance and Duchenne UK and invited to take part if they had DMD and were 18 years of age or older. Conversations were transcribed verbatim and an interpretivist paradigm was used with thematic analysis.

RESULTS

The main themes identified were (1) the need for communication and information about sexual health, (2) dealing with the potential fear of rejection, (3) physical barriers to relationships including sex, (4) testosterone supplementation in DMD, and (5) parenthood and fertility.

DISCUSSION

We recommend that clinicians work with young people with DMD individually, to explore the benefits of testosterone treatment for them and their personal sexual health needs. If they are offered treatment, this should always be accompanied by the opportunity for psychological support. This work highlights the need for further research to establish the role of testosterone supplementation in adults with DMD and its effects on fertility and the value of specific emotional and practical support for sexual health.

Nephrology nurses' perspectives working with patients experiencing needle-related distress

BACKGROUND

A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients.

OBJECTIVES

To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress.

DESIGN

A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied.

PARTICIPANTS

Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service.

RESULTS

Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies.

CONCLUSION

This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.

'If I don't take care of me, then I can't be there for others:' a qualitative study of caregiving relationships among older women living with HIV

OBJECTIVE

The population of women ages 50 years and older living with HIV is increasing. Yet, little is known about the care networks that older women living with HIV (OWLH) use to manage their health. The goal of this study was to explore the caregiving and care receiving relationships among OWLH and how these relationships impact HIV management.

METHODS

OWLH aged 50 years and older were recruited from clinics and community-based organizations across the U.S. We conducted semi-structured, in-depth phone interviews and performed content and thematic analysis on transcripts.

RESULTS

Participants (N = 23) were on average 60 years old and had been living with HIV for an average of 23.7 years. Participants 1) relied on diverse care networks; 2) were caregivers for grandchildren and parents; 3) had pride and joy in being caregivers; and 4) were highly proactive in their own HIV management. Care networks promoted self-love and acceptance. However, concerns about aging with HIV were still highly prevalent.

CONCLUSION

Being a caregiver and care recipient are sources of meaning and strength to help OWLH manage HIV. Public health programs should consider engaging both OWLH and their care networks in healthcare discussions and educational efforts.

Intimate partner violence survivors' reported experiences of discrimination in mental health treatment settings

Research indicates that survivors of intimate partner violence (IPV) face substantial stigma and discrimination, with varying impacts based on demographic factors such as race and income. This study explored perceived discrimination among 88 IPV survivors across different racial backgrounds and income levels in mental health settings. Participants completed a mixed-method electronic survey assessing discrimination experiences related to survivor status, income, and race within mental health treatment. Results revealed high levels of perceived discrimination based on survivor status among both racially minoritized and majoritized survivors. However, racially minoritized survivors reported greater racial discrimination and associated stress within mental healthcare settings. Regardless of income level, all survivors reported significant discrimination experiences. Qualitative analysis highlighted factors perceived as helpful or unhelpful within mental health settings. This study underscores the need for further research on socioeconomic influences on stigma experiences among IPV survivors and suggests implications for provider training to better support survivors, especially those from diverse racial backgrounds.

Nurse managers' perceptions of the prospective acceptability of an implementation leadership training programme: A qualitative descriptive study

AIM

To explore the prospective acceptability of an implementation leadership training programme prototype for nurse managers in China to implement evidence-based practices, from the perspectives of potential programme participants and deliverers.

DESIGN

A qualitative descriptive study was conducted in Spring 2022 at three tertiary hospitals in Hunan, China.

METHODS

We conducted individual semi-structured interviews with unit-level nurse managers (n = 14), including 12 potential participants, and two potential deliverers that have been involved in developing the programme prototype. Interview questions and thematic analysis were guided by the Theoretical Framework of Acceptability.

RESULTS

After reviewing the programme content, potential participants and deliverers reported that unit nurse managers would benefit from engaging in the programme, acknowledging that the programme fit with professional nursing values for implementing research evidence. They expressed positive views about being involved in producing academic papers through the training process, and interactive multi-modal training activities such as group work, experience-sharing and coaching. Seven participants were not very confident about being fully engaged in the training, as they could not navigate the English research literature. Both participants and deliverers highlighted factors that would influence their participation, including time constraints, the impact of the COVID-19 pandemic, and support from senior organizational leadership.

CONCLUSIONS

The training programme prototype was perceived to be useful and acceptable. The multimodal training activities were considered a strength and managers expressed an interest in writing academic papers about their implementation processes. Support from senior hospital leaders and programme deliverers was identified as critical to the training programme's success.

IMPACT

The study helps understand nurse managers' perceptions and concerns of participating in an implementation leadership training programme and could inform the development and refinement of similar programmes in various nursing contexts globally.

Eating on the move: experiences of food insecurity and hunger during overland transit through Mexico

Objective

To explore migrants' experiences of food insecurity during their overland transit through Mexico, using qualitative methods.

Methods

We conducted a qualitative study (May - July 2016) of 26 Central American migrants in a migrant shelter in San Luis Potosí, México. The semi structured interview explored four domains of food insecurity: 1) availability; 2) accessibility; 3) utilization (eating practices and consumption; and 4) stability (experiencing hunger).

Results

Participants shared common food choices and reasons for selecting these foods. These included properties such as ease of transportability, storage (e.g., packaging) and preparation needed prior to intake (e.g., whether cooking was required). Shelters provided access to humanitarian assistance including food. The informants also experienced hunger and multiple challenges impeding their physical access to food. These were further aggravated by the disadvantaged socioeconomic conditions of areas through which they transited.

Conclusion

Migrants transiting overland through Mexico experienced challenges that limit availability, access, consumption, and stability of food, showcasing the critical nature of providing food security to ensure their human rights.

A mixed-methods stress audit with midwives in the United Kingdom

PROBLEM

UK midwives report high work-related stress, which can negatively impact their health and wellbeing, with many considering leaving the profession.

BACKGROUND

An occupational stress audit guides the implementation of stress management intervention, by identifying which stressors have the most negative impact and why, and highlighting "at risk" groups.

AIM

To conduct a concurrent mixed-methods stress audit with UK midwives in an NHS Trust.

METHODS

Seventy-one midwives (Mage= 39 years, SD = 11) completed a survey assessing stressors (e.g., relationships), stress appraisals (i.e., challenge vs. threat), coping strategies (e.g., avoidance-focused), and outcomes (i.e., mental health, performance, and intention to leave). Ten midwives (Mage = 42 years, SD = 10) participated in semi-structured interviews.

FINDINGS

Quantitative data revealed that more work-related demands, poorer peer support and relationships, and threat appraisals predicted worse mental health. Moreover, less control and more work-related demands predicted poorer performance, while less control, poorer manager support, more change-related demands, and threat appraisals predicted greater intention to leave. Qualitative data generated three themes: organisational pressures exacerbated by unexpected changes; individualised responses but largely debilitative emotions; and personal coping and power of social support.

DISCUSSION AND CONCLUSION

This study offered a comprehensive and novel insight into the stress experiences of UK midwives, highlighting targets for future stress management interventions, including key stressors (e.g., manager support), underlying mechanisms (e.g., stress appraisals), and "at-risk" groups (e.g., night shift workers). Practical recommendations are provided for stakeholders operating at multiple levels (e.g., midwife, trust, policy) to better support midwives with work-related stress.

The role of spirituality and identity formation in personal recovery from traumatic brain injury: A qualitative analysis through the personal experiences of survivors

Traumatic brain injury (TBI) is a type of acquired brain injury (ABI) that happens when a sudden, external, physical assault damages the brain. TBI can cause long-term cognitive impairments and other lifestyle changes that may affect psychological wellbeing. Among the psychological challenges people recovering from TBI often face is the subjective loss of their pre-injury identity. Quantitative and qualitative research suggests that spirituality can play a positive role in recovery from TBI, increasing the quality of life and overall mental health. However, thus far, the research into this topic has not directly addressed the relationship between identity and spirituality after TBI. The present study sought to do this by thematically analyzing 22 public podcasts featuring interviews of people recovering from TBI telling their stories. The authors review the spiritual themes discussed in the podcasts and then propose a hypothesis about how, through a sense of connection to something self-transcendent, spirituality may enable people to test new meanings and identities, relatively free from the consequences of discrepancy in meaning and identity after TBI.

Long-term work disability: loss of rights, survival and tangency of primary health care

This article aims to explore the experience of long-term work disability (LWD) of users-workers in primary health care (PHC), understanding the therapeutic itineraries and the search for social protection, the elements that contribute to the incapacitation process and the strategies constructed for living with this condition. LWD is a multidimensional phenomenon, with a negative impact on the lives of workers, families and society. PHC has an important role in caring for people on leave from work. This is a qualitative, descriptive-exploratory study of the daily lives of people in situations of LWD. The comprehensive perspective guides the analysis of data co-produced in interviews and field observation. Cross-cutting themes such as social lack of protection, lack of communication and co-operation between key actors that enhance or mitigate LWD were recognised. The social support network proved to be important to access health care and to avoid social decadence. The Family Health Strategy, with technical support in Occupational Health, emerges with potential in the production of care for worker-users, although the fragility of maintaining long-term care.

'Do I cry or just carry on?' A story completion study of healthcare professionals' anticipated responses to experiencing chest pain

Healthcare professionals may experience barriers to seeking healthcare that differ from the general population. We explored healthcare professionals' anticipated responses to experiencing chest pain following a period of stress using qualitative story completion method with healthcare professionals (n = 44). Data were analysed using reflexive thematic analysis, which identified three themes: '"Do I cry or just carry on?": A Culture of Suffering in Silence' identified worries that expressing health concerns would be perceived as weakness, with potential impact on career opportunities. Participants also described self-diagnosis and self-medication rather than help-seeking. '"Me? Have a panic attack?": Psychosomatic Shame' suggested mental health issues may be ignored due to stigma. '"We definitely don't take care of ourselves": Prioritising Pressures of Multiple Responsibilities over Self-care' identified real or perceived pressures to de-prioritise their health. Future research should explore the design of confidential, time efficient support for healthcare professionals that tackle cultural norms and barriers to self-care.

Complicating critical discussions in gender sexuality alliances: Youth desire for intersectional conversations and the experience of fragmentation

Gender sexuality alliances (GSAs) represent consciousness-raisings that hold potential for critical consciousness development in youth. In this study, we focus on critical reflection-the understanding that oppression is structured and maintained by human action. We engage intersectionality as our analytical framework and analyze both student interview data (n = 38) and advisor closed-ended and open-ended survey data (n = 58) to examine: (1) the nature/content of critically reflective discussions in GSAs and (2) how advisors support critically reflective discussions in GSAs and their role in these discussions. Our findings suggest that (1) conversations centering race and its intersections with other socio-structural axes occur, albeit infrequently; (2) youth recognize and understand the concept of intersectionality in nuanced ways, desire to have critical intersectional conversations, and experience fragmentation from conversations around race, sexuality, and gender if they are situated at privileged locations on those axes; and (3) students want advisors to engage in critically reflective discussions in GSAs. The findings suggest that interventions and programming are needed that could cultivate advisors' and youth leaders' skills in facilitating intersectional dialogues for critical reflection among members.

The Influence of Culture on the Cause, Diagnosis and Treatment of Serious Mental Illness (Ufufunyana): Perspectives of Traditional Health Practitioners in the Harry Gwala District, KwaZulu-Natal

Cultural beliefs influence the perceived cause, methods of diagnosis and treatment of mental illnesses. A qualitative study was conducted among traditional health practitioners (THPs) in the Harry Gwala District Municipality to further explore this influence. Purposive sampling assisted in the recruitment of 31 participants (9 males and 22 females). The four key themes this study investigated in relation to mental illness included its causes, methods of diagnosis, common symptoms observed and treatment approaches used by THPs, and the system of patient management. Culturally, mental illness was reported to be caused by witchcraft and an ancestral calling in this study. Mental illness was predominantly diagnosed by spiritual intervention which included divination through consultation with the ancestors, familial background, burning of incense which can also be part of communicating with the ancestors and through examining the patient. The common symptoms included aggression, hallucination and unresponsiveness. Prevalent modes of treatment included the use of a medicinal concoction and performing cultural rituals where ancestors and other spirits were assumed influential. The duration of the treatment process was dependent on guidance from the ancestors. Most causal aspects of mental illness from diagnosis to treatment seemed to be influenced by cultural beliefs and ancestors.

The Meaning of Physical Education Practice in Students with Attention-Deficit Hyperactivity Disorder (ADHD)

Purpose: This study seeks to describe the perspective of students with attention-deficit hyperactivity disorder (ADHD) and physical education (PE) teachers concerning physical activity practice in high school. Methods: A qualitative descriptive study based on an interpretative framework was conducted with secondary school students with ADHD, and their teachers of physical education. In-depth interviews and researchers' field notes were used to collect the data. Purposive sampling and inductive thematic analysis were applied. Results: Results show that ADHD is not experienced as limiting the practice of PA and PE by students, except in motor activities that require concentration such as tactical games. On the contrary, PA and PE helps them feel better. Teachers have not had to make extensive methodological modifications in their teaching styles with students with ADHD in relation to other situations or incidents. Conclusions: Students with ADHD do not seem to show significant difficulties in PE lessons or in the practice of extracurricular PA. PE teachers do not need to make significant adaptations with these students.

Children's descriptions of their involvement within everyday food practices

BACKGROUND

The way in which children interact with food has a profound impact on their health and wellbeing. However, most research, strategy and policy where food is the focus are derived from adult perspectives. There is limited understanding of children's perspectives of the nature of their everyday food practices, and their level of involvement and influence. This work garnered children's (8-12 years old) descriptions of, and involvement in, their everyday food practices.

METHODS

Forty-two children from 28 families from across Brisbane (Australia) participated in qualitative creative draw-and-tell interviews and 20 of these children (from 15 families) also completed Photovoice data collection. Data were abductively analysed through a social practice theory lens.

RESULTS

Children reported engaging in food planning, acquisition, preparation, consumption and tidy-up practices, to varying degrees of 'less involved', 'in partnership with adults or other children' or 'independently'. This was influenced largely by the willingness of adults to relinquish control and children's desire to participate, as well as other contextual factors. Children were more independent in consumption practices, as well as packing lunchboxes and preparing food spaces (as preparation practices). Partnerships were established more so within food acquisition and preparation practices, with less involvement described within planning and tidy-up practices.

CONCLUSIONS

The findings add new knowledge and depth and breadth to that already obtained from parents, teachers and adult researchers, highlighting the importance of privileging children's voices when investigating their food experiences. This work may be used to guide adults to invite and support children to be involved in food practices that they report being less involved in, as well as inform how best to work with and include children in future research and food and nutrition strategies and policies.

The meaning of adulthood for emerging adults with Down syndrome: Parent perspectives on relevant skills

BACKGROUND

Parents' conceptualizations of adulthood for their emerging adults with Down syndrome have the potential to impact the transition planning process as families prepare for life after graduation.

AIMS

This study aimed to explore parent perceptions of the meaning of adulthood for their emerging adults with Down syndrome.

METHODS

In this qualitative study, we interviewed 11 parents of emerging adults with Down syndrome using phenomenological methodology and analysed these data using thematic analysis.

RESULTS

Three topics emerged: (1) Parents' constructions of the meaning of adulthood; (2) Parents' perceptions about the transition to adulthood; and (3) Parents' perceptions of current adult life skills. Ten themes arose out of these topics.

CONCLUSIONS

Parents expressed ambivalence about the meaning of adulthood for their emerging adults with Down syndrome, sharing that in some ways they were adults and in others they were not. The meaning of adulthood was closely tied to obtained skills, particularly those related to personal safety.

Risk Controls Identified in Action Plans Following Serious Incident Investigations in Secondary Care: A Qualitative Study

OBJECTIVES

The impact of incident investigations in improving patient safety may be linked to the quality of risk controls recommended in investigation reports. We aimed to identify the range and apparent strength of risk controls generated from investigations into serious incidents, map them against contributory factors identified in investigation reports, and characterize the nature of the risk controls proposed.

METHODS

We undertook a content analysis of 126 action plans of serious incident investigation reports from a multisite and multispeciality UK hospital over a 3-year period to identify the risk controls proposed. We coded each risk control against the contributory factor it aimed to address. Using a hierarchy of risk controls model, we assessed the strength of proposed risk controls. We used thematic analysis to characterize the nature of proposed risk controls.

RESULTS

A substantial proportion (15%) of factors identified in investigation reports as contributing to serious incidents were not addressed by identifiable risk controls. Of the 822 proposed risk controls in action plans, most (74%) were assessed as weak, typically focusing on individualized interventions-even when the problems were organizational or systemic in character. The following 6 broad approaches to risk controls could be identified: improving individual or team performance; defining, standardizing, or reinforcing expected practice; improving the working environment; improving communication; process improvements; and disciplinary actions.

CONCLUSIONS

The identified shortfalls in the quality of risk controls following serious incident investigations-including a 15% mismatch between contributory factors and aligned risk controls and 74% of proposed risk controls centering on weaker interventions-represent significant gaps in translating incident investigations into meaningful systemic improvements. Advancing the quality of risk controls after serious incident investigations will require involvement of human factors specialists in their design, a theory-of-change approach, evaluation, and curation and sharing of learning, all supported by a common framework.

Visual reconstructions of endometriosis pain: An interdisciplinary visual methodology for illness representation

OBJECTIVES

Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside of the womb, causing severe chronic pain. Research demonstrates the physical, emotional and quality of life impact on people with endometriosis, but pain is reportedly difficult to communicate, resulting in lengthier diagnosis. This work aimed to gain insight into the value of imagery production as a pain communication strategy through a novel synergy of psychological and linguistic/socio-semiotic approaches.

DESIGN

A qualitative, multimodal, participant-generated imagery study.

METHODS

Interpretative phenomenological analysis (IPA) and conceptual metaphor and metonymy analysis were utilized to examine visual representations of endometriosis pain. Data were collected in two focus groups with four and six women, respectively; all with a diagnosis of endometriosis, aged 25-40 years old (M = 34.5, SD = 4.2) and a mean diagnosis delay of 8.4 years (SD = 3.6).

RESULTS

The overarching theme across visual representations was 'Pain as Physical Violence' with 'colour as emotional representation', 'texture as sensory qualities' and 'materials as sensation' as sub-themes. These are realized through metaphorical and metonymical relations in both the visual representations as well as the accompanying linguistic representation of the process.

CONCLUSIONS

This study demonstrates the value of a creative mixed-methodologies approach to capture experiential aspects of pain and its impact that are not verbalized in linguistic accounts alone. This can facilitate a deeper understanding of one's pain, acting as a medium for therapeutic adjustment to occur, while facilitating effective and empathic patient-professional conversations surrounding pain.

"He Tells People That I Am Going to Kill My Children": Post-Separation Coercive Control in Men Who Perpetrate IPV

Relatively little research has examined men's use of coercive controlling tactics against female partners after separation. This mixed-methods secondary analysis of 346 Canadian women documented coercive controlling tactics used by their ex-partners (86.4% identified at least one). The composite abuse scale emotional abuse subscale and women being older were associated with men using coercive control tactics post-separation. A secondary qualitative analysis of in-depth interviews with a sub-sample of 34 women provided additional examples. Abusive partners used numerous strategies to coercively control their ex-partners by stalking/harassing them, using financial abuse and discrediting the women to various authorities. Considerations for future research are presented.

Using Open Educational Practices: Implications for Nursing Education

BACKGROUND

This paper reports on our use of open educational practices (OEPs) with online students in nursing.

PURPOSE

Our aim was to provide nurse educators with knowledge about (and examples of) OEPs they could use to enhance student learning and their career satisfaction.

METHOD

Using collaborative autoethnography, we probed our open teaching strategies. With Swanson's middle-range theory of caring as a theoretical framework and thematic analysis of our data set (which included literature annotations, dialogic conversation transcripts, individual reflections, and course evaluations), we uncovered 5 themes relevant to nursing education.

RESULTS

The themes are student achievement of affective domain learning outcomes, our values as a blueprint for action, alignment of our OEPs and relational pedagogy, mutuality of the experience, and the ongoing process of learning to be an open educational practitioner.

CONCLUSION

Using OEPs can help develop skilled and caring nurses.

Psychologists' experience of working with people who hear voices and their views on the idea of voice simulation training: A qualitative study

OBJECTIVES

Research indicates psychologists typically lack subjective understanding of voice hearing. Voice hearing simulation training has potential to improve understanding, empathy and confidence among clinicians, but psychologists have had limited input into its development. This study investigated psychologists' and a psychotherapist's clinical experience of working with people who hear voices and their views and recommendations for voice hearing simulation training.

DESIGN

This was a qualitative study.

METHODS

Clinical psychologists and one psychotherapist (N = 17) participated in semi-structured interviews. Thematic analysis was used to analyse transcribed data.

RESULTS

The Clinical Experience theme comprised of subthemes Barriers to engagement, Diversity of voice hearing experiences, Lack of subjective understanding, Curiosity about voice hearing, Empathy for voice hearers, Using personal experiences to relate to voices, Clinical experience increases knowledge, Importance of supervision and colleague's support, Benefits of experiential training, Limited training in non-psychosis settings and Clinical experience increases confidence. The Views on Voice Hearing Simulation Training theme comprised of subthemes Improves subjective understanding, Concern about distress, Discomfort as a strength of voice hearing simulations, Artificiality of simulation, Increases empathy and Over-estimation of understanding. The Recommendations theme comprised of subthemes Discuss artificiality, Co-production, Promote voice diversity, Support staff and Maximise inclusivity.

CONCLUSIONS

Findings indicate that clinical experience improves psychologists' confidence and knowledge, yet participants reported a lack of subjective understanding of voice hearing. Co-produced simulation training between individuals who hear voices and clinicians was anticipated to improve subjective understanding, empathy and therapeutic relationships, which could support a range of staff and improve quality of care delivered.

Digital Reconstruction: A Critical Examination of the History and Adaptation of Ku Klux Klan Websites

In response to the data revolution, academic research and media attention have increasingly focused on the technological adaptation and innovation displayed by the far right. The greatest attention is paid to social media and how groups and organizations are utilizing technological advancement and growth in virtual networks to increase recruitment and advance radicalization on a global scale. As with most social and political endeavors, certain technologies are in vogue and thus draw the attention of users and regulators and service providers. This creates a technological blind spot within which extremist groups frequently operate older and less well regarded technologies without the oversight that one might expect. This article examines the less well-studied traditional and official websites of the Ku Klux Klan, the most established and iconic of American far-right organizations. By incorporating non-participant observation of online spaces and thematic analysis, this research analyzes the evolution of 26 websites, from their emergence in the early 1990s to the present day. We examine the ways in which traditional printed communications and other ephemera have progressed with advances in technology, focusing on the following central elements of Klan political activism and community formation: Klan identity, organizational history, aims and objectives; technology and outreach, including online merchandise and event organization; and the constructions of whiteness and racism. The results add value and insight to comparable work by offering a unique historical insight into the ways in which the Klan have developed and made use of Web 1.0, Web 2.0, and Web3 technologies.

Females and Housing First: An analysis of 18-month outcomes in a randomized controlled trial

The main objective of this research was to qualitatively examine the impacts of Housing First (HF) specifically on those participants who identified themselves as female in response to question asking what their gender was. The data analyzed are from a larger, muti-site, randomized controlled trial. χ2 analysis was used to compare the life changes (coded as positive, neutral, or negative) experienced by 64 females (42 HF and 22 TAU). An in-depth qualitative analysis was conducted on 45 of these participants (23 HF and 22 TAU). Significantly more female HF participants reported making positive life changes from baseline to 18-month than those in TAU. Relative to females in TAU, female HF participants reported a number of specific positive changes, including enhanced safety, improved recovery in mental illness, greater reductions in drug use, and individual changes. The implications of findings for strengthening HF programs to meet the unique needs of female participants are discussed.

Research Ethics of Involving Adolescents in Health Research Studies: Perspectives From Australia

PURPOSE

Adolescent participation in health research studies is critical yet complex given the lack of clarity around issues such as consent. This study aimed to understand how those conducting research in Australia navigate research ethics in health research involving adolescents, through qualitative interviews.

METHODS

Purposive sampling was used to recruit 23 researchers involved in adolescent health research using semi-structured in-depth interviews. Interviews were conducted via Zoom and audio-recorded after obtaining informed consent. Thematic analysis was used to construct themes and data were organised using NVivo.

RESULTS

Two contrasting positions emerged from the data: (1) framing of adolescents as inherently vulnerable, their participation in research understood in terms of risk and protection and (2) adolescent engagement in research is understood in terms of empowerment, emphasising their capacity to make decisions about research participation. We traced these positions through three key themes, particularly in relation to the role of ethics committees: (1) competing positions as a result of inferior or superior knowledge about adolescent lives, (2) competing positions resulting in a risk averse or an empowerment approach, and (3) reflections on processes of obtaining consent which involves gatekeeping and tokenism.

DISCUSSION

Our study highlights the contentious topic of navigating ethics committee requirements for the needs of adolescents. Majority of participants felt the current research ethics establishment is not favourable for researchers or adolescents themselves. While it is imperative that perceptions of ethics committees also be studied in the future, our study provides preliminary understanding of how experiences and perceptions shape how researchers interact with the research ethics establishment.

University serial winning coaches' experiences with low performance and maladaptive team culture

We sought to explore the strategies and behaviours employed by University serial winning coaches during seasons of both low performance and a maladaptive team culture. We interviewed seven University team sport coaches and subsequently analyzed the data using a reflexive thematic analysis (RTA). Results indicated that our coaches generally felt unprepared for the unexpected and challenging season, leading to increased stress and decreased psychological well-being. Coaches experienced frustration, disappointment, and self-doubt, which was either exacerbated or mitigated by their access to social support. Despite the emotional turmoil coaches experienced, they were able to reflect on their actions and take away key lessons, helping them perform well in the future. Findings provide insight into how winning coaches manage and overcome inevitable adverse situations. Moreover, these results provide a deeper understanding of how these highly successful coaches navigate these key challenges that over time can inform policy and practice in coach development. These coaching strategies may help coaches of all levels overcome barriers to success and may be transferable to leaders of all levels across a range of disciplines outside of sport.

Recognition of nursing qualification and credentialing pathway of Filipino nurses in Finland: A qualitative study

AIM

To understand the experiences of Filipino internationally educated nurses (FIENs) on their recognition and credentialing pathway in the recruitment process in Finland.

BACKGROUND

The nursing shortage in Finland results in the recruitment of internationally educated nurses (IENs) such as those from the Philippines. In the context of migration, IENs experience a rigorous process to become qualified nurses in the destination country.

METHODS

A thematic analysis of the secondary data from qualitative interviews was conducted. Ten FIENs (n = 10) were recruited from university hospitals in Finland through purposeful and snowball sampling. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

Three main themes were identified. First, pre-migration victories and predicaments described the experiences of FIENs during the recruitment process and the pathway to acquiring a Registered Nurse qualification. Second, ambiguous integration implied integrating into the workplace while working on the top-up education programme as a prerequisite to nursing registration. Lastly, migration uncertainty discussed the interest among FIENs to continue practising as Registered Nurses (RNs) in Finland.

CONCLUSIONS

Pre-migration orientation and workplace integration experiences influenced FIENs' choice to practise as RNs in Finland. The licensure pathway for FIENs required collaboration from various stakeholders in Finnish society. It is recommended to structure the system for the recognition and qualification process of IENs by creating a national model in line with international standards and requirements in collaboration with higher education institutions.

IMPLICATION FOR NURSING POLICY

Recognition of previous education and clinical experience can facilitate the transition to becoming an RN for IENs, but the lack of a clear education model and recognition of foreign nursing qualifications leads to deskilling and hinders IENs from practising. Policies prioritising education and integration into the local healthcare system can facilitate the integration and professional growth of IENs, enabling them to contribute significantly to the healthcare system.

The experiences of ethical conflict among critical care professionals in China: A qualitative study

BACKGROUND

Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders.

AIM

This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China.

STUDY DESIGN

From December 2021 to February 2022, we performed semi-structured, face-to-face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data.

RESULTS

Five themes and 14 sub-themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth.

CONCLUSIONS

The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies.

RELEVANCE TO CLINICAL PRACTICE

The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice.

Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review

IMPORTANCE

 Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary.

OBJECTIVE

 To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy.

DATA SOURCES

 PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science.

STUDY SELECTION AND DATA COLLECTION

 We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis.

FINDINGS

 Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups).

CONCLUSIONS AND RELEVANCE

 We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.

Feasibility and acceptability of a theory-based online tool for reducing stress-induced eating

Stress-induced eating is associated with various health risks like obesity and cardiovascular disease, exacerbated by the overconsumption of unhealthy foods. This study sought to investigate replacement coping strategies for stress-induced eating that participants can seek to implement using behaviour change techniques like implementation intentions. The study adopted a feasibility and acceptability design, with 258 participants (88.37% female) aged 17-75 years old who self-reported stress-induced eating. Participants were asked to identify cues for their stress-induced eating and evaluate the acceptability of eight potential replacement coping strategies. After selecting their preferred strategy, participants formed implementation intentions, linking the strategy with their previously identified cues. There were six themes of cues for stress-induced eating as identified by participants, including a range of external and internal stressors. Themes regarding the acceptability of the replacement coping strategies were organised based on constructs from integrated social cognition theories. Participant responses reflected cognitive and affective attitudes, and control and normative beliefs behind engagement in coping behaviour; further, automatic and volitional processes were described by participants as playing a role in whether a coping strategy was deemed as useful. Plans formulated by participants commonly detailed specific situations and strategies to utilise, though few described start times or durations of their plan. Action planning was found to significantly increase following formation of implementation intentions, and participants' descriptions supported the feasibility and acceptability of utilising implementation intentions to adopt alternative coping strategies to stress-induced eating. Future research should conduct a randomised controlled trial to assess the efficacy of the implementation intentions intervention in promoting uptake of replacement coping strategies to reduce stress-induced eating.

Clinician perspectives on adolescent cannabis-related beliefs and behaviors following recreational cannabis legalization

BACKGROUND

As more states legalize cannabis, studies are needed to understand the potential impacts of recreational cannabis legalization (RCL) on adolescents from the perspective of clinicians who care for them.

METHODS

This qualitative study characterized clinician perspectives on whether cannabis legalization is associated with changes in adolescents' cannabis use beliefs, behaviors, and consequences. Semi-structured qualitative interviews were conducted with 32 clinicians in a large healthcare organization from 9/6/2022-12/21/2022. Video-recorded interviews were transcribed and analyzed using thematic analysis.

RESULTS

The 32 participants (56.3 % female, mean [SD] age, 45.9 [7.6] years; 65.3 % non-Hispanic White) were from Addiction Medicine (n = 13), Psychiatry/Mental Health (n = 7), Pediatrics (n = 5), and the Emergency Department (n = 7). Clinicians described post-RCL increases in adolescent cannabis use, use of non-combustible modes and high-potency products, and younger age of first use. Clinicians reported social, physical, and policy changes, including changes in social norms, appealing advertisements, marketing, and easier access. Many noted fewer perceived harms among adolescents and greater self-medication post-RCL. They described how RCL contributed to increased parental cannabis use and permissiveness around adolescent use. Finally, many described post-RCL increases in cannabis hyperemesis syndrome, and several noted increased cannabis-related psychosis and acute intoxication, and decreased court-mandated treatment.

CONCLUSIONS

Clinicians from diverse specialties described post-RCL increases in adolescent cannabis use and cannabis-related consequences, alongside changes in social norms, access, marketing and advertisements, and decreased perceptions of harms. Findings can inform strategies to support adolescents in the context of increased cannabis availability and acceptability post-legalization and support the development of hypotheses for broader-scale quantitative work.

"I haven't got a clue what policies are in place for this!": physiotherapy students' preparedness to deal with self-harm

OBJECTIVES

The prevalence of self-harm and the potential link with suicidal ideation highlights the need to prepare future physiotherapists to deal with the potentially catastrophic outcomes to which a lack of understanding in this area can lead. The aim of this research was to investigate if final year physiotherapy students felt prepared to assess risk of suicide or self-harm following patient disclosure, or showing signs of intention to harm themselves.

DESIGN

An interpretive phenomenological methodology (IPA) was implemented to aid in the understanding and interpretation of participants' own experiences. In conjunction with the overarching design, semi-structured interviews, via two focus groups, were used to explore participants' views.

SETTING

Focus groups were conducted via an online platform.

PARTICIPANTS

Purposive sampling was employed as a sampling method to recruit final year physiotherapy students. The final sample consisted of ten participants.

RESULTS

Four main themes were identified: Experiences of disclosure; Encountering mental health; Lack of mental health education, and Lack of knowledge regarding policy and procedure.

CONCLUSIONS

The findings highlight a deficit with regards to the preparedness of final year students in dealing with disclosure to self-harm. A lack of both formal education regarding mental illness and of practice experience in the field of mental health contribute to this. Therefore, a more rigorous and directed approach to education regarding mental illness is essential. Furthermore, involvement in mental health practice placements would allow for a greater level of experiential learning and understanding of the issues faced by those living with mental illness.

CONTRIBUTION OF THE PAPER

Contribution to the evidence: Contribution to knowledge.

Postpartum care for parent-infant dyads: A community midwifery model

INTRODUCTION

Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies.

METHODS

We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis.

RESULTS

A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest.

CONCLUSION

The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.

Moments of change: Clients' immediate experiences when sharing emotions in psychotherapy

OBJECTIVE

In-session processing of emotions is important in facilitating psychotherapeutic change. This study explores how clients in active treatment experience inner changes when sharing emotions in psychotherapy sessions. The aim was to retrieve in-depth knowledge about clients' moment-by-moment experiences of change in a naturalistic psychotherapy context.

METHOD

Two psychotherapy sessions (session 3 or 4 and session 7 or 8) were videotaped and immediately followed by semi-structured interviews with clients (n = 11) in the format of Interpersonal Process Recall (IPR). Interviews were analysed using thematic analysis.

RESULTS

Four themes resulted from analysis: (1) reaching a new clarity about inner struggles; (2) a shift in how I approach and experience my feelings; (3) grieving losses and gaining a more positive understanding of myself; (4) feeling relief and liberation when allowing difficult emotions.

CONCLUSION

The resulting themes took into account the importance of the felt quality of change experiences within sessions, which appears to be important in making micro-processes of change salient. Across themes, we found accounts of shifts in awareness and self-compassion, which we discuss as micro-outcomes that clients can ideally be guided to dwell with.

Empathy in Nutrition and Dietetics: A Scoping Review

BACKGROUND

Empathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care.

OBJECTIVE

This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics.

METHODS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table.

RESULTS

Twenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies.

CONCLUSIONS

This review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.

Facilitators and Barriers in the Implementation and Adoption of Patient-Reported Outcomes Measurements in Daily Practice

OBJECTIVES

At the Erasmus Medical Center, patient-reported outcomes measures (PROMs) are implemented on a hospital-wide scale. However, less than half of the patients and healthcare professionals (HCPs) use these PROMs. Therefore, this study aimed to investigate facilitators and barriers for adoption of PROMs to develop guidance around implementation.

METHODS

A mixed-methods study with a combination of interviews and focus groups and questionnaires was conducted, involving patients, both PROM nonresponders and PROM responders, HCPs, and medicine students and nurse specialists in training (hereafter "students"). Interview transcripts were subjected to thematic content analysis. Subsequently, questionnaires were developed and presented to all stakeholders to validate the findings. Finally, identified themes and implementation recommendations were presented in a final questionnaire to the Value-Based Healthcare Erasmus Medical Center expert group to prioritize findings.

RESULTS

Interviews were conducted with 15 patients, 14 HCPs and 4 students, and 2 focus groups with 5 students. The questionnaire was completed by 370 of 999 responders (37.0%), 173 of 1395 nonresponders (12.5%), and 44 of 194 HCPs (22.7%), and 40 students were reached via an open link. The identified facilitators and barriers were grouped into 4 overarching themes: training on PROMs at different levels in the education of (future) HCPs, motivate and reduce the burden for the HCP, implement generic and disease-specific PROMs simultaneously, and motivate, activate, and reduce the patient burden.

CONCLUSIONS

Providing end users with digital tools, implementation support, and a clear hospital-wide vision is important, yet this does not guarantee successful adoption of PROMs. Successful adoption necessitates ongoing efforts to engage, motivate, and train end users.

A mixed-methods exploration of autonomy-supportive parenting, confidence, and natural mentoring relationships among Black adolescents

The current study examined whether autonomy-supportive parenting practices may be associated with Black adolescents' quantity of natural mentors (i.e., adults from youths' everyday lives who youth go to for support and guidance) via adolescents' confidence. This study employed survey data from 216 Black youth and qualitative interviews from a subsample of youth (n = 25), their primary caregivers (n = 25), and one nonparental adult relative with whom the youth reported feeling close (n = 25). Comparative analyses were then completed among a subset of 10 family triads corresponding to youth from the qualitative subsample who had the highest (n = 5) and the lowest (n = 5) scores on a survey measure of adolescents' confidence. Study findings suggest that Black adolescents' confidence may be an explanatory link in the association between autonomy-supportive parenting practices among primary caregivers and Black adolescents' quantity of natural mentoring relationships. Moreover, we found that a range of autonomy-supportive parenting practices may be associated with youth confidence, which may, in turn, inform how Black adolescents engage with adults in their social networks.

Evolving global responses to the pandemic: sustaining interprofessional education and collaborative practice

The COVID-19 pandemic created global disruption in health professions education and healthcare practice, necessitating an abrupt move to digital delivery. A longitudinal survey was conducted to track the evolution of global responses to the pandemic. During the initial stages, educational and health institutions were forced to adapt quickly without careful consideration of optimal pedagogy, practices, and effectiveness of implemented approaches. In this paper, we report the results of Phase 3 of the global survey that was distributed between November 2021 and February 2022 through InterprofessionalResearch.Global (IPR.Global). The Phase 3 qualitative survey received 27 responses, representing 25 institutions from 13 countries in 6 regions. Using inductive thematic analysis, the data analysis resulted in three emerging themes: Impact of the pandemic on the delivery of interprofessional education and collaborative practice (IPECP); Impact of the pandemic on the healthcare system (team, population/client health, clients); and Sustainability and innovation. This study highlights the evolving nature of health education and collaborative practices in response to the COVID-19 pandemic. IPECP educators need to be resilient and deal with the complexities of face-to-face and digital learning delivery. Preparing for emerging forms of teamwork is essential for new work contexts and optimal health services.