Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research

Applying the photovoice method with adolescents in mining areas in rural Mozambique: critical reflections and lessons learned

There is a recognised need for innovative methods to elicit the perspective of adolescents on public health issues, particularly when addressing sensitive topics such as the impact of mining projects on their health. Participatory approaches such as "photovoice" allow for deep engagement of vulnerable and marginalised populations, including adolescents. However, few existing studies have used the photovoice method to reflect on issues related to the environment and its impact on public health. To date, no studies have been found that have used photovoice to gain insight into adolescents' perspectives in mining areas. In this paper, we discuss the application of the photovoice method to understand adolescents' perceptions about the impact of mining on their health and well-being in rural areas in Mozambique. The study was conducted in northern and central Mozambique. Photovoice was successfully integrated into eight focus group discussions with adolescent girls and boys aged 15 to 17 years. Several lessons for guiding future research were learned. First, it provided an understanding of the perceived impacts of mining on their health and well-being. Second, photovoice promoted active engagement and interest in the study by the adolescents. Finally, compared to its ability to capture perceptions of physical and environmental aspects affecting adolescents' well-being, the method was less straightforward in revealing their concerns regarding social, relational and community aspects that are less tangible. Programs can make use of photovoice to address health issues without setting adolescents' views and priorities aside, allowing them to influence health decisions on issues that are meaningful to them. Future studies should explore strategies to minimise the role of the power dynamics that affect the engagement and contribution of adolescents in advocating for necessary and meaningful changes. Additionally, it is important to investigate how health programs and policies can help to reduce the impact of existing inequalities.

Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia

BACKGROUND

Postpartum depression (PPD) affects approximately 17% of the women worldwide with nearly half of all cases going undetected. More research on maternal mental health, particularly among healthcare professionals and pregnant mothers, could help identify PPD risks and reduce its prevalence.

OBJECTIVE

Given that awareness of PPD is a crucial preventive factor, we studied PPD awareness among midwives and pregnant women in Arkhangelsk, Arctic Russia.

METHODS

A qualitative study was conducted using in-depth semi-structured interviews. Midwives and pregnant women were recruited from the women's clinic of the Arkhangelsk municipal polyclinic. Seven midwives and 12 pregnant mothers were interviewed.

RESULTS

Midwives described limited time for psychological counselling of pregnant women; they reported that their primary focus was on the physiological well-being of women. Pregnant women have expressed a desire for their families to share responsibilities. The participants considered PPD as a mix of psychological and physiological symptoms, and they also highlighted a discrepancy between the expectations of pregnant women and the reality of motherhood. The present study underscored the limited understanding of PPD identification.

CONCLUSIONS

The findings suggest that there is a need for increased awareness among midwives and pregnant women regarding PPD. Prevention programs targeting PPD with a specific emphasis on enhancing maternal mental health knowledge are warranted.

Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol

BACKGROUND

Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved.

OBJECTIVES

The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach.

METHOD

The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions.

RESULTS

It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems.

CONCLUSION

This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.

Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions

OBJECTIVES

Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany.

METHODS

Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020.

RESULTS

Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation.

CONCLUSIONS

Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients.

PRACTICE IMPLICATIONS

Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.

Impact of the COVID-19 Pandemic on the State Enteric Disease Public Health Workforce in the Western United States, March-April 2022

OBJECTIVE

To assess the impact of the COVID-19 pandemic on the state-level enteric disease workforce and routine enteric disease surveillance and outbreak investigation activities in the western United States.

DESIGN AND SETTING

Key informant interviews conducted using bidirectional video from March to April 2022.

PARTICIPANTS

Enteric disease epidemiologists at state public health agencies in the western states served by the Colorado and Washington Integrated Food Safety Centers of Excellence.

MAIN OUTCOMES

Key themes were identified using grounded theory.

RESULTS

Nine themes were identified including excessive workload, shifts in local and state responsibilities, challenges with retention and hiring, importance of student teams, laboratory supplies shortages, changes to case and outbreak investigation priorities, transitioning back to enterics, adoption of new methods and technology, and current and future needs.

CONCLUSIONS

The COVID-19 pandemic response had a substantial impact on state-level enteric disease activities in western states, with many staff members diverted from routine responsibilities and a de-prioritization of enteric disease work. There is a need for sustainable solutions to address staffing shortages, prioritize employee mental health, and effectively manage routine workloads when responding to emergencies.

Patients', physiotherapists' and other stakeholders' experiences and perceptions about supported home physiotherapy for people with musculoskeletal conditions: a qualitative study

OBJECTIVES

Exercise, support and advice are the key treatment strategies of musculoskeletal problems. The aims of this study were to determine patients', physiotherapists', and other stakeholders' perspectives about supported home physiotherapy for the management of musculoskeletal problems and to identify the barriers and facilitators to rolling out this model of physiotherapy service delivery.

METHODS

This study was conducted as part of a process evaluation run alongside a large trial designed to determine whether supported home physiotherapy is as good or better than a course of in-person physiotherapy. Forty interviews were conducted with 20 trial participants, 15 physiotherapists, and 5 other stakeholders. The interviews were semi-structured and based on interview guides. Each interview was transcribed and a three-tiered coding tree was developed.

RESULTS

Six key themes were identified. Supported home physiotherapy (i) is convenient for some patients, (ii) does not always align with patients' and therapists' expectations about treatment (iii) is suitable for some but not all, (iv) can reduce personal connection and accountability, (v) has implications for physiotherapists' workloads, and (vi) has barriers and facilitators to future implementation.

CONCLUSIONS

Findings suggest that patients are far more accepting of supported home physiotherapy than physiotherapists assume. This model of service delivery could be rolled out to improve access to physiotherapy and to provide a convenient and effective way of delivering physiotherapy to some patients with musculoskeletal conditions if our trial results indicate that supported home physiotherapy is as good or better than in-person physiotherapy.

CLINICAL TRIAL REGISTRY NUMBER

ACTRN12619000065190 CONTRIBUTIONS OF THIS PAPER.

An insight into clinicians' practices in breaking bad news of oral cancer diagnosis

Communication is an integral component of effective healthcare delivery to patients, and this includes breaking bad news (BBN). However, clinicians in dentistry are rarely exposed to diseases that can negatively and seriously affect an individual's view of their future and pose a mortality risk, except for oral cancer. The aim of this study was to assess clinician practices in BBN of oral cancer diagnosis in Malaysia. An exploratory sequential mixed-methods study design was used. A qualitative study was conducted among 12 clinicians to gather relevant information regarding their practices in BBN of oral cancer diagnosis using a descriptive-interpretive approach. The themes that emerged were preparation for BBN, BBN setting, communication, emotional aspects, and summarizing the session. These themes were used to develop a questionnaire with 34 items. In the quantitative study, this questionnaire was sent to 87 clinicians who had experienced BBN of oral cancer diagnosis in the past 5 years; the response rate was 100%. An arbitrary cut-off score between the third and fourth quartiles was set to distinguish 'good' and 'poor' practice in BBN among the clinicians. The data analysis was performed using IBM SPSS Statistics version 23.0. Overall, at least two-thirds of the clinicians had good practices in BBN of oral cancer diagnosis. The clinicians' designation (oral and maxillofacial surgery consultant/specialist vs dental officer) and BBN experiences were factors associated with their practices in BBN of oral cancer diagnosis.

Impact of disability-based discrimination in healthcare on parents of children with medical complexity

AIM

To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC).

METHOD

In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC.

RESULTS

Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination.

INTERPRETATION

The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.

Preliminary feasibility study of a cognitive stimulation therapy programme for older adults with an intellectual disability

BACKGROUND

Despite the increased risk for people with an intellectual disability developing dementia, post-diagnostic psychosocial supports such as cognitive stimulation therapy (CST) are not routinely offered and there is limited research examining this intervention with people with intellectual disabilities. The aim of this study was to explore the feasibility of CST for older adults with intellectual disability to support active ageing.

METHODS

Five client participants attended a 14-session CST group and four staff attended a focus group. Reflexive thematic analysis was used to investigate the client and staff narratives.

RESULTS

Three key themes were generated: (1) Brain Health, (2) Connecting with others, and (3) Barriers and Enablers.

CONCLUSION

Findings indicated the suitability of CST as a way of supporting active ageing for older adults with intellectual disability. This study adds to the growing knowledge about service provision for older adults and their changing needs as they age and identifies clinical implications such as staff training to support intervention adherence.

Patient Experiences of Specialty Palliative Care in the Perioperative Period for Cancer Surgery

CONTEXT

Though patients undergoing treatment for upper gastrointestinal (GI) cancers frequently experience a range of sequelae and disease recurrence, patients often do not receive specialty palliative care soon after diagnosis and it is unknown in what ways they may benefit.

OBJECTIVES

To understand patient experiences of specialty palliative care in the perioperative period for patients seeking curative intent upper GI oncologic surgery.

METHODS

As part of a randomized controlled trial, we conducted in-depth interviews between November 2019 and July 2021 with 23 patients in the intervention arm who were undergoing curative intent treatment for upper GI cancers and who were also followed by the specialty palliative care team.

RESULTS

We found five themes that characterized patient experiences and perceptions of specialty palliative care. Patients typically had limited prior awareness of palliative care (theme 1), but during the study, came to understand it as a "talking" intervention (theme 2). Patients whose concerns aligned with palliative care described it as being impactful on their care (theme 3). However, most patients expressed a focus on cure from their cancer and less perceived relevance for integration of palliative care (theme 4). Integrating specialist palliative care practitioners with surgical teams made it difficult for some patients to identify how palliative care practitioners differed from other members of their care team (theme 5).

CONCLUSION

While receipt of specialty palliative care in the perioperative period was generally perceived positively and patients appreciated palliative care visits, they did not describe many needs typically met by palliative care practitioners.

TRIAL REGISTRATION

clinicaltrials.gov registration: NCT03611309.

A Core Outcome Set for Research Evaluating Interventions to Enable Communication in Patients With an Artificial Airway: An International Delphi Consensus Study (Comm-COS)

OBJECTIVES

Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population.

DESIGN

1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages.

SETTING

Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting.

SUBJECTS

Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention.

CONCLUSIONS

This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity.

Barriers and facilitators for implementation of OptiBreech collaborative care: A qualitative study as part of an implementation process evaluation

PROBLEM

Lack of opportunity for breech training and clinical experience reduced professional confidence and expertise in supporting vaginal breech birth.

BACKGROUND

OptiBreech collaborative care is a care pathway for breech presentation at term that aims to enable improve safety through person-centred care and improved training opportunities for maternity professionals, within dedicated clinics and intrapartum support. In feasibility work, barriers and facilitators to team implementation were observed by team members.

AIM

This study sought to describe factors affecting optimal future implementation and safety of OptiBreech care.

METHODS

Semi-structured interviews were conducted with staff members at 13 OptiBreech trial sites (17 midwives and 4 obstetricians, n=21), via video conferencing software. The Theoretical Domains Framework (TDF) was used to identify factors impacting team implementation. Themes identified in the TDF were refined in reflexive discussion and grouped into key facilitators, key barriers, and dynamic factors (which span both barriers and facilitators). The interviews were then coded, analysed, and interpreted according to the refined framework.

FINDINGS

The key facilitators were broadly categorised within skill development, beliefs about capabilities, and social support from the wider multidisciplinary team. Key barrier categories were resources, social obstacles, and fears about consequences. Dynamic factor categories were individual responsibility, training, and attending births.

CONCLUSION

While some factors affecting implementation were specific to the individuals and cultures of certain Trusts, recommendations emerged from analysis that are more widely applicable across multiple settings. These should be considered going forward for future service implementation, and in the next stage of OptiBreech clinical trials.

A novel framework for Indigenous eye health care in New Zealand: Ngā Mata o te Ariki

CLINICAL RELEVANCE

Development of an Indigenous eye health framework could offer the opportunity for eye health professionals to enhance engagement with Indigenous populations.

BACKGROUND

Indigenous populations globally experience disproportionately poorer eye health outcomes than non-Indigenous peoples. Incorporating Māori perspectives of eye care and pre-existing Indigenous models of health offers potential to enhance Māori experience and engagement with eye health services. This study seeks to develop and refine a practical framework for eye health care that incorporates nine established Indigenous health principles.

METHODS

Qualitative methodology, guided by Indigenous Māori research principles, was used to evaluate interviews with five leading senior Māori academics surrounding the ongoing development and refinement of a Kaupapa Māori (Māori worldview centric) framework for eye care in Aotearoa New Zealand, created following Māori health consumer consultation. Interviews were semi-structured and analysed using reflexive thematic analysis.

RESULTS

Seven key themes arose in relation to the development of a Kaupapa Māori framework for eye care in Aotearoa New Zealand: 1) vision is critical to Māori well-being, 2) cultural safety is important, 3) Māori health beliefs must be upheld, 4) achieving pae ora (healthy futures) is important, 5) key concepts and focus of the framework must be clear, 6) pūrākau (traditional Indigenous stories) are valuable resources in developing health frameworks and 7) embedding Matariki (fundamental Māori) principles is valuable.

CONCLUSIONS

Using Kaupapa Māori principles allowed development and refinement of a framework that encourages clinicians to consider Indigenous health principles when engaging with Māori patients who seek eye care. Application of this framework may contribute to enhancing cultural safety and responsiveness of eye care for Māori.

Development and content validation of a questionnaire identifying patients' functional priorities and abilities after hip or knee arthroplasty

PURPOSE

To develop a self-report questionnaire evaluating functional priorities after hip or knee arthroplasty and evaluate patients' understanding of its items and conceptual relevance.

METHODS

A self-report questionnaire was first developed based on the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA). In the second stage, two research physiotherapists thoroughly reviewed and refined the questionnaire, and another physiotherapist conducted cognitive think-aloud interviews with 18 patients to assess the face and content validity of the questionnaire.

RESULTS

All categories and corresponding activities of ICF core set for OA were used to develop the questionnaire. Several questionnaire issues were identified and addressed. Most challenges were related to comprehension, followed by item ordering and visual elements. Patients identified ambiguous wording which we subsequently simplified. Ten activities of the core set were excluded due to lack of face validity, two activities were added, and four activities were modified.

CONCLUSION

The findings suggest that the ICF core set for OA needs to be adjusted for patients undergoing hip or knee arthroplasty and highlight the feasibility of applying a modified core set to assess functional priorities after hip or knee arthroplasty.

A qualitative exploration and a Fuzzy Delphi validation of high-risk scaffolding tasks and fatigue-related safety behavioural deviation among scaffolders

Background

Most construction mishaps were caused by scaffolding incidents despite implementing various safety measures, and the association with human factors like fatigue has been widely reported. This study aims to identify all high-risk task sequences involved during the erection of the most commonly used scaffold; the deviation from the standard protocol led to a substandard fatigue state, followed by content validation using the Fuzzy Delphi Method.

Methods

Qualitative exploration was conducted via focal group discussions (FGDs) involving 30 certified experts. The findings generated from FGDs were further validated by utilising the Fuzzy Delphi Method (FDM) by consulting 19 experts with extensive practical experience and leadership roles in scaffolding safety.

Results

The FGDs identified a total of 7 constructs and 50 items for task sequences involved in the tubular scaffold erection, namely construct Instruction (3 items), Preparation (3 items), Foundation (10 items), First Lift (8 items), Working Platform (7 items), Guardrails (5 items) and Second Lift (14 items). In the FDM validation process, the experts' consensus for each construct was fulfilled with a threshold value (d) ≤ 0.2; thus, all constructs were accepted. Experts' consensus for all items achieved an expert agreement of 75 % and above. Items ranking was conducted using average fuzzy numbers. The highest average fuzzy number documented was 0.8, while the lowest was 0.588. None of the items with the lowest ranking was discarded as all items perfectly fulfilled the second prerequisite and obtained excellent experts' agreement.

Conclusions

The tool generated will help guide the development of a protocol for scaffolding safety management.

Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study

BACKGROUND

Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs.

AIM

This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference.

METHODS

The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions.

RESULTS

The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation.

CONCLUSION

Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.

Slipping Through the Cracks: Clinicians' Perspectives on the Gaps in New York City's Public Mental Health System

Most people who seek mental health treatment cannot access it. Certain groups (e.g., Medicaid enrollees and the uninsured) face particularly severe treatment access barriers along the care continuum. We interviewed 31 clinicians across two studies about their perspectives working in New York City's public mental health system. Because every clinician across both studies reported gaps in the system, we deployed an emergent, "serendipitous finding" approach and qualitatively analyzed the interviews together. Clinicians described three public mental health system gaps. First, many treatment-seekers must wait long periods of time to receive care and some never receive it at all. Second, patients with more serious challenges cannot access longer-term, higher-intensity, or specialized treatment. Third, some patients receiving high-intensity services may benefit from lower-intensity mental health support that is better integrated with medical and social service support. Coordinated and sustained financial investments at every step of the mental healthcare continuum are needed.

Building a performance measurement framework for telephone triage services in Finland: a consensus-making study based on nominal group technique

BACKGROUND

There has been a significant expansion in the measurement of healthcare system performance. However, there is a lack of a comprehensive performance measurement framework to assess the effects of telephone triage services on the urgent care system. The aim of our Delphi study was to construct and validate a performance measurement framework designed explicitly for telephone triage services.

METHODS

This study was conducted in Finland with a group of eight experienced senior physicians from the country's 20 largest joint emergency departments, serving over 90% of the population for urgent care. The Nominal Group Technique (NGT) was utilised to achieve consensus on measuring telephone triage performance. Initially, performance indicators (PIs) were identified through Delphi method rounds from December 10th to December 27th, 2021, with eight experts participating, and from December 29th, 2021, to January 23rd, 2022, where five of these experts responded. NGT further deepened these themes and perspectives, aiding in the development of a comprehensive performance measurement framework. The final framework validation began with an initial round from February 13th to March 3rd, 2022, receiving five responses. Due to the limited number of responses, an additional validation round was conducted from October 29th to November 7th, 2023, resulting in two more responses, increasing the total number of respondents in the validation phase to seven.

RESULTS

The study identified a strong desire among professionals to implement a uniform framework for measuring telephone triage performance. The finalised framework evaluates telephone triage across five dimensions: service accessibility, patient experience, quality and safety, process outcome, and cost per case. Eight specific PIs were established, including call response metrics, service utility, follow-up care type and distribution, ICPC-2 classified encounter reasons, patient compliance with follow-up care, medical history review during assessment, and service cost per call.

CONCLUSIONS

This study validated a performance measurement framework for telephone triage services, utilising existing literature and the NGT method. The framework includes five key dimensions: patient experience, quality and safety, outcome of the telephone triage process, cost per case, and eight PIs. It offers a structured and comprehensive approach to measuring the overall performance of telephone triage services, enhancing our ability to evaluate these services effectively.

'Not taking medications and taking medication, it was the same thing:' perspectives of antiretroviral therapy among people hospitalised with advanced HIV disease

BACKGROUND

Despite HIV's evolution to a chronic disease, the burden of advanced HIV disease (AHD, defined as a CD4 count of < 200 cells/uL or WHO clinical Stage 3 or 4 disease), remains high among People Living with HIV (PLHIV) who have previously been prescribed antiretroviral therapy (ART). As little is known about the experiences of patients hospitalised with AHD, this study sought to discern social forces driving hospitalisation with AHD. Understanding such forces could inform strategies to reduce HIV-related morbidity and mortality.

METHODS

We conducted a qualitative study with patients hospitalised with AHD who had a history of poor adherence. Semi-structured interviews were conducted between October 1 and November 30, 2023. The Patient Health Engagement and socio-ecological theoretical models were used to guide a thematic analysis of interview transcripts.

RESULTS

Twenty individuals participated in the research. Most reported repeated periods of disengagement with HIV services. The major themes identified as driving disengagement included: 1) feeling physically well; 2) life circumstances and relationships; and 3) health system factors, such as clinic staff attitudes and a perceived lack of flexible care. Re-engagement with care was often driven by new physical symptoms but was mediated through life circumstances/relationships and aspects of the health care system.

CONCLUSIONS

Current practices fail to address the challenges to lifelong engagement in HIV care. A bold strategy for holistic care which involves people living with advanced HIV as active members of the health care team (i.e. 'PLHIV as Partners'), could contribute to ensuring health care services are compatible with their lives, reducing periods of disengagement from care.

Detection and management of localized prostate cancer in Nigeria: barriers and facilitators according to patients, caregivers and healthcare providers

BACKGROUND

Prostate cancer mortality rates are high in Nigeria. While prostate cancer is highly curable with early detection and effective multidisciplinary management, the quality of care is suboptimal in this setting. Sustainable delivery of high-quality care for patients with localized prostate cancer is needed to save more lives. To inform future interventions to improve care, this study aimed to identify barriers and facilitators that influence prostate cancer detection and management in Nigeria.

METHODS

Six focus group discussions (FGDs), stratified by stakeholders were conducted with a purposive sample of prostate cancer patients (n = 19), caregivers (n = 15), and healthcare providers (n = 18), in two academic tertiary hospitals in northern and southern Nigeria. A discussion guide organized based on the socio-ecological model was used. FGDs were recorded, transcribed, and analysed using the framework technique.

RESULTS

Barriers and facilitators were identified at the individual, interpersonal, and organizational levels. Barriers to detection included limited knowledge and misperceptions among patients, caregivers, and community-based non-specialist healthcare providers, and limitations of centralized opportunistic screening; while facilitators included the potential for religious institutions to encourage positive health-seeking behaviour. Barriers to management included non-uniformity in clinical guideline usage, treatment abandonment amidst concerns about treatment and survival, absence of patient interaction platforms and follow-up support systems, difficulty in navigating service areas, low health insurance coverage and limited financial resource of patients. Facilitators of management included the availability of resource stratified guidelines for prostate cancer management and the availability of patient peers, caregivers, nurses, and medical social workers to provide correct medical information and support patient-centred services. Participants also provided suggestions that could help improve prostate cancer detection and management in Nigeria.

CONCLUSION

This study identified multiple determinants affecting the detection and management of localized prostate cancer. These findings will inform the refinement of implementation strategies to improve the quality of prostate cancer care in Nigeria.

Physician-Reported Facilitators and Barriers for Side Effect Management of Heart Failure Medications

BACKGROUND

Physician underprescribing and patient nonadherence are major barriers to the benefits of guideline-directed medical therapy. An important contributor to both underprescribing and patient nonadherence is concern about medication-related side effects. Yet, there are few to no data on approaches used by physicians to: (1) elicit medication-related side effects, (2) attribute these side effects to specific medications, and (3) take appropriate action.

METHODS AND RESULTS

The authors conducted semistructured interviews with physicians to identify facilitators and barriers to each critical step of heart failure medication management: elicitation of side effects, attribution of side effects to a medication, and action in response to attributed side effects. Interviews were transcribed and coded using directed content analysis. For elicitation of potential side effects, limited patient communication and family discordance in reporting were key barriers, whereas guiding questions, measurement, and open channels of communication were key facilitators. For attribution of side effects, confounding from other medications, limited time for clinical encounters, and nonspecific symptoms were key barriers, whereas time-limited medication discontinuation trials and medication rechallenges were key facilitators. For taking action, challenges with weighing risks and benefits and physician fear about causing harm or interfering with other clinicians were barriers, whereas patient-physician communication and the results of a medication discontinuation trials and medication rechallenge were facilitators.

CONCLUSIONS

This study generated key facilitators and barriers to 3 key aspects of heart failure medication management related to side effects that should drive future work to improve heart failure medication management.

Advancing minimally invasive hepato-pancreato-biliary surgery: barriers to adoption and equitable access

BACKGROUND

Despite a growing body of literature supporting the safety of robotic hepatopancreatobiliary (HPB) procedures, the adoption of minimally invasive techniques in HPB surgery has been slow compared to other specialties. We aimed to identify barriers to implementing robotic assisted surgery (RAS) in HPB and present a framework that highlights opportunities to improve adoption.

METHODS

A modified nominal group technique guided by a 13-question framework was utilized. The meeting session was guided by senior authors, and field notes were also collected. Results were reviewed and free text responses were analyzed for major themes. A follow-up priority setting survey was distributed to all participants based on meeting results.

RESULTS

Twenty three surgeons with varying robotic HPB experience from different practice settings participated in the discussion. The majority of surgeons identified operating room efficiency, having a dedicated operating room team, and the overall hospital culture and openness to innovation as important facilitators of implementing a RAS program. In contrast, cost, capacity building, disparities/risk of regionalization, lack of evidence, and time/effort were identified as the most significant barriers. When asked to prioritize the most important issues to be addressed, participants noted access and availability of the robot as the most important issue, followed by institutional support, cost, quality of supporting evidence, and need for robotic training.

CONCLUSIONS

This study reports surgeons' perceptions of major barriers to equitable access and increased implementation of robotic HPB surgery. To overcome such barriers, defining key resources, adopting innovative solutions, and developing better methods of collecting long term data should be the top priorities.

"Male athletes play well to feel good, and female athletes feel good to play well": Attitudes, beliefs, and practices pertaining to perceived sex-related differences in communication and interpersonal approach of strength and conditioning coaches in international women's rugby union

Effective communication and rapport building with athletes are key tenets of coaching. As the majority of empirical evidence to date has adopted an androcentric view of strength and conditioning, a potential knowledge gap exists regarding sex-related differences in physical preparation and coaching approaches. Therefore, this study explored the attitudes, beliefs and practices of strength and conditioning coaches (n = 8; M/F, 6/2) in elite level (international) women's rugby union using semi-structured interviews (mean ±standard deviation duration 59 ± 15 min). The interviews explored differences in coaching practices for elite female rugby players compared to males, with a specific focus on the interpersonal aspects of the athlete-coach relationship. Reflexive thematic analysis was used to generate a rich qualitative dataset. The analysis resulted in the identification of higher order themes: athlete engagement, and interpersonal approach. The coaches in this study consistently perceived important differences between male and female players in factors related to engagement and interpersonal approach. Coaches adopted differing coaching practices for male and female athletes. This study provides important contextual evidence for the understanding of differences in the interpersonal relationships of female rugby players compared to male athletes from the perspective of elite-level strength coaches.

Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial

OBJECTIVE

To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES).

DATA SOURCES AND STUDY SETTING

iHI-FIVES was delivered to caregivers at eight Veterans Affairs (VA) medical centers. Data sources were electronic health records, staff surveys, and interviews.

STUDY DESIGN

In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval start date for iHI-FIVES launch. Sites were then randomized 1:1 to either (i) CONNECT, a team collaboration training strategy plus Replicating Effective Programs (REP), brief technical support training for staff, or (ii) REP only (non-CONNECT arm). Implementation outcomes included reach (proportion of eligible caregivers enrolled) and fidelity (proportion of expected trainings delivered). Staff interviews and surveys assessed team function including communication, implementation experience, and their relation to CONNECT and iHI-FIVES implementation outcomes.

DATA COLLECTION/EXTRACTION METHODS

The sample for assessing implementation outcomes included 571 Veterans referred to VA home- and community-based services and their family caregivers eligible for iHI-FIVES. Prior to iHI-FIVES launch, staff completed 65 surveys and 62 interviews. After the start of iHI-FIVES, staff completed 52 surveys and 38 interviews. Mixed methods evaluated reach and fidelity by arm.

PRINCIPAL FINDINGS

Fidelity was high overall with 88% of expected iHI-FIVES trainings delivered, and higher among REP only (non-CONNECT) compared with CONNECT sites (95% vs. 80%). Reach was 18% (average proportion of reach across eight sites) and higher among non-CONNECT compared with CONNECT sites (22% vs. 14%). Qualitative interviews revealed strong leadership support at high-reach sites. CONNECT did not influence self-reported team function.

CONCLUSIONS

A team collaboration strategy (CONNECT), added to REP, required more resources to implement iHI-FIVES than REP only and did not substantially enhance reach or fidelity. Leadership support was a key condition of implementation success and may be an important factor for improving iHI-FIVES reach with national expansion.

A comprehensive perspective on local drivers in community-based health tourism industry development: a qualitative study of Mazandaran Province, Iran

BACKGROUND

Health tourism is an important component that may influence the direction of development in a region. Mazandarn, Iran, is recognized as a highly sustainable market in the region because of its abundant natural resources, temperate temperature, and strategic geographical location. Therefore, considering the importance of health tourism and its existing potential in Mazandaran, Iran, this study was conducted with the aim of exploring a comprehensive perspective on local drivers in community-based health tourism industry development and factors affecting the attraction of health tourism.

METHODS

We conducted this study in Mazandarn, Iran, using a qualitative approach. Participants included a sample of Iranian people, aged 34-54 years, with previous history of health tourism or expert in it. Participants were selected from three different categories of the community: academic professionals in health tourism, managers in health tourism, and health tourists. Data were obtained via semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was used to converge and compare themes through participant data. The interviews kept going until data saturation was achieved.

RESULTS

Based on our findings, we distilled local drivers in community-based health tourism industry development into five main categories and 30 subcategories: (Sharifabadi AM, Ardakani FA. A model for health tourism development using fuzzy TOPSIS and interpretive structural modeling in Yazd province. J Health Adm (JHA). 2014;17:55.) infrastructure and resources; (Hemmati F, Dabbaghi F, Mahmoudi G. Investigating the impact of Information Technology on the status of Health Tourism in Mashhad, Iran. Revista Publicando. 2018;5(15):54-65.) tourist attractions; (Sarabi Asiabar A, Rezapour A, Raei B, Tahernezhad A, Alipour V, Behzadifar M. Economic, Cultural, and Political Requirements for Medical Tourism Development in Iran: Insights from a Fuzzy Analytical Hierarchy Process Method. Med J Islamic Repub Iran. 2022;35:199.) socio-cultural contexts; (Mosadeghrad AM, Sadeghi M. Medical tourism: Reasons for choosing Iran. Payesh (Health Monitor). 2021;20(2):145-66.) economic-financial factors; and (Manna R, Cavallone M, Ciasullo MV, Palumbo R. Beyond the rhetoric of health tourism: shedding light on the reality of health tourism in Italy. Curr Issues Tourism. 2020;23(14):1805-19.) political-communicative factors. The findings of the study showed that, from the participants' point of view, although there are several strategies, such as the development of public service and tourism infrastructure, increasing tourist attractions, and formulating appropriate policies and procedures for the development of health tourism, they are also faced with many challenges, especially political, economic, and cultural challenges.

CONCLUSION

This study showed that improving infrastructure and resources, promoting tourist attractions, informing socio-cultural contexts, improving economic and financial capacity, and developing political and communicative contexts might increase the attraction of health tourists. The suggested components are not contextually driven, although empirical outcomes may differ based on the level of service offerings in health tourism locations.

How Mobile Health Can Change the Contexts of Living With HIV and Engaging With Treatment and Care in Iran: A Realist-Informed Qualitative Study

Mobile health (mHealth) interventions are increasingly used to address the challenges of living with HIV and engaging with antiretroviral therapy. A wealth of evidence supports the efficacy of mHealth in supporting living with HIV. Yet, there is a dearth of evidence on how mHealth improves outcomes, which features are effective, and why these work in a particular setting. This study uses stakeholder views, including patients, providers, peer supporters, counsellors, and program directors, to conceptualize how specific mHealth features could interact with contexts of living with HIV and mechanisms that shape engagement with treatment. The study is part of an ongoing research project on engagement with HIV care in Iran. We draw on the perspectives of recently diagnosed and more treatment-experienced patients and their providers, using purposive sampling, conducting 9 focus group discussions with a total of 66 participants, in addition to 17 interviews. Our findings suggest that mHealth designs that feature provider connection, proactive care, and privacy and personalization are expected to dilute the harsh contexts of living with HIV. We build on previously identified socioecological pathways that disrupt antiretroviral therapy in Iran and find that mHealth can enhance the relation between the health system and patients. Our findings suggest that personalized mHealth features and provisions can partially mitigate the compounded impacts of harsh socioecological pathways that impede treatment success in Iran. Our social constructivist study was augmented with realist-informed analysis and could have transferability to similar contexts that trigger similar mechanisms of treatment disruption.

Evaluating the impact of a ward environment with 20 single occupancy rooms and two four-bedded bays on patient and staff experiences and outcomes in an acute NHS Trust: a mixed-methods study protocol

INTRODUCTION

Traditionally, wards in acute care hospitals consist predominately of multioccupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the UK National Health Service (NHS) advocating for single-room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multioccupancy bays on patient care and organisational outcomes.

METHODS AND ANALYSES

This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP)-WP1 is a quantitative data extraction of routinely collected patient and staff data while WP2 is a mixed-methods process evaluation consisting of one-to-one, in-depth, semistructured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high-impact journals and presented at relevant conferences.

A randomized controlled trial of acupuncture and receptive music therapy for sleep disorders in the elderly-ELAMUS: study protocol

BACKGROUND

Globally, the demographic shift towards an aging population leads to significant challenges in healthcare systems, specifically due to an increasing incidence of multimorbidity resulting in polypharmacy among the elderly. Simultaneously, sleep disorders are a common complaint for elderly people. A treatment with pharmacological therapies often leads to side effects causing a high potential for dependency. Within this context, there is a high need to explore non-pharmacological therapeutic approaches. The purpose of this study is to evaluate the effectiveness of acupuncture and music therapy, both individually and combined as a multimodal therapy, in the treatment of sleep disorders in individuals aged 70 years and older.

METHODS

We conduct a confirmatory randomized controlled trial using a two-factorial study design. A total of n = 100 elderly people receive evidence-based standard care information for age-related sleep disorders. Beyond that, patients are randomly assigned into four groups of n = 25 each to receive acupuncture, receptive music therapy with a monochord, multimodal therapy with both acupuncture and music therapy, or no further therapy. The study's primary outcome measurement is the improvement in sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) (global score), at the end of intervention. Additionally, depression scores (Geriatric Depression Scale), health-related quality of life (Short-Form-Health Survey-12), neurovegetative activity measured via heart rate variability, and safety data are collected as secondary outcomes. Using a mixed-methods approach, a qualitative process evaluation will be conducted to complement the quantitative data.

DISCUSSION

The study is ongoing and the last patient in is expected to be enrolled in April 2024. The results can provide valuable insights into the effectiveness of non-pharmacological interventions for sleep disorders among the elderly, contributing to a more personalized and holistic approach in geriatric healthcare.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00031886).

Dental staff and patient attitudes about nicotine replacement therapy samples in dental care: A National Dental Practice-Based Research Network study

OBJECTIVES

Cigarette smoking negatively affects oral health. Nicotine replacement therapies (NRT; e.g. nicotine patch or lozenge) and brief interventions (e.g. Ask-Advise-Refer; AAR) can improve cessation outcomes but are underutilized. NRT sampling (NRTS) increases NRT utilization by providing patients with samples of NRT as part of routine healthcare. Ask-Advise-Refer is a brief intervention where practitioners: ask patients about tobacco use, advise those using tobacco to quit and refer to the state quit line. The objective of this qualitative study was to explore dental care practitioners' and patients' attitudes and experiences regarding tobacco cessation treatment and perceptions of two brief intervention models, assessed separately: NRTS and AAR.

METHODS

Twenty-four dental care practitioners and nine patients, recruited through the National Dental Practice-Based Research Network, participated in semi-structured telephone interviews. Interviews assessed experiences with tobacco use intervention and attitudes towards NRTS and AAR. Thematic analysis identified emergent themes related to feasibility and acceptability of NRTS and AAR.

RESULTS

Practitioners varied on how they address tobacco use, from systematically to idiosyncratically. Some practitioners recommend NRT; few had prescribed it. Practitioners had favourable attitudes towards AAR and NRTS, with most believing that both interventions would be acceptable and feasible to implement. Concerns regarding AAR were time and patient resistance to discussing tobacco use. Concerns regarding NRTS were patient resistance to using NRT, side effects or medication interactions, and capacity to provide follow-up. Patients reported that oral health practitioners generally ask about tobacco use but do not provide interventions. Patients were open to discussing their tobacco use with practitioners and had favourable attitudes about NRTS.

CONCLUSIONS

This formative work suggests that NRTS and AAR may be feasible to implement in dental care settings. Future studies are needed to assess the effectiveness and implementation potential of NRTS in dental care settings.

Listening to the Voices of Aboriginal and Torres Strait Islander Women in Regional and Remote Australia About Traumatic Brain Injury From Family Violence: A Qualitative Study

INTRODUCTION

Indigenous women experience high rates of family violence-related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence-related traumatic brain injury (TBI), including impacts on life, as well as decision-making processes about healthcare access and engagement.

METHODS

Purposeful sampling was used to complete semi-structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence.

RESULTS

Three themes were conceptualised based on the data and research aims: interweaving of the past and the present-ways women experience brain injury; factors that inform decision-making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long-term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers.

CONCLUSIONS

The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow-up support, co-designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided.

PUBLIC OR PATIENT CONTRIBUTION

Indigenous women shared their views and experiences of TBI from family violence as well as decision-making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research.

'Too young to sit at home': a qualitative study conducted among employees with young-onset dementia and their relatives

OBJECTIVES

Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives.

METHOD

Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets.

RESULTS

A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives.

CONCLUSION

The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.

"It is something you live with, like an organ in your body" a qualitative study on the lived experiences of people suffering from chronic low back pain in Lebanon

PURPOSE

This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage.

METHOD

Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0).

RESULTS

The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain.

CONCLUSION

This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.

Coping with the long-term impact of civil strife: A grief-centered analysis of Tamil Sri Lankan communities affected by ethnopolitical conflict

Limited research has examined coping mechanisms in response to chronic war-related stressors, as opposed to war-exposure trauma. The current study sought to investigate the types of losses experienced by communities affected by the Sri Lankan conflict, how participants responded to their losses, and what coping mechanisms they employed. Data consisted of interviews from two independent investigations conducted following the end of the conflict in Northern Sri Lanka (total N = 103). Interview transcripts were analyzed using a directed content analysis approach. Participants most frequently described experiencing material loss and loss of loved ones. Relatedly, participants commonly reported experiencing ambiguous loss, that is, living with the uncertainty of their loved one's death. These losses were particularly pronounced by gender, with women experiencing higher rates of loss. Common coping strategies included support-seeking, including informal support from social networks and religion, and formal mental health services. Additionally, participants described a range of longer term coping strategies from establishing a future-oriented cognitive style to a sense of helplessness and resignation. The findings shed light on how conflict-affected groups cope with profound loss. We provide recommendations for how such findings can inform grief-related clinical interventions.

[Experts' perspectives on the need and potentials of (cross-indication) mobile rehabilitation in the care of younger people with complex health impairments: A qualitative study]

INTRODUCTION

In the German rehabilitation system, gaps in care exist that particularly affect people with complex impairments under 60 years of age. Home-based rehabilitation, an outreach form of outpatient rehabilitation, could bridge this gap by providing access to rehabilitation for this group of patients. Corresponding facilities so far barely exist in Germany. In view of the likely complexity and the associated problems of this group of people, needs-based care may also require a cross-indication approach in order to adequately address rehabilitation needs across different organ systems. The aim of this study is to assess 1) the general need for home-based rehabilitation and associated potentials, 2) attitudes towards a cross-indication approach, and 3) indication and allocation criteria for this approach from an expert perspective.

METHODS

Data was collected from 08/2022 to 10/2022 through semi-structured individual telephone interviews with experts in the field of rehabilitation. Data were analyzed using qualitative content analysis according to Kuckartz and Rädiker.

RESULTS

A total of n = 22 experts were interviewed. The experts see a high need for home-based rehabilitation for people with complex health impairments under the age of 60 in order to counteract existing care gaps within current rehabilitative offers. The potentials offered by home-based rehabilitation include, amongst others, flexibility, participation orientation and involvement of the social environment (e.g., of relatives). A cross-indication approach is considered relevant by the majority of the experts, especially in order to meet more complex needs (e.g., in the case of multimorbidity) in a holistic and needs-based manner.

CONCLUSION

The results demonstrate the relevance of this topic and the necessity of expanding (cross-indication) home-based rehabilitation in Germany. According to the experts, (cross-indication) home-based rehabilitation can help to ensure the participation of a group of patients with complex and severe impairments under the age of 60.

A surgical activity model of laparoscopic cholecystectomy for co-operation with collaborative robots

BACKGROUND

Laparoscopic cholecystectomy is a very frequent surgical procedure. However, in an ageing society, less surgical staff will need to perform surgery on patients. Collaborative surgical robots (cobots) could address surgical staff shortages and workload. To achieve context-awareness for surgeon-robot collaboration, the intraoperative action workflow recognition is a key challenge.

METHODS

A surgical process model was developed for intraoperative surgical activities including actor, instrument, action and target in laparoscopic cholecystectomy (excluding camera guidance). These activities, as well as instrument presence and surgical phases were annotated in videos of laparoscopic cholecystectomy performed on human patients (n = 10) and on explanted porcine livers (n = 10). The machine learning algorithm Distilled-Swin was trained on our own annotated dataset and the CholecT45 dataset. The validation of the model was conducted using a fivefold cross-validation approach.

RESULTS

In total, 22,351 activities were annotated with a cumulative duration of 24.9 h of video segments. The machine learning algorithm trained and validated on our own dataset scored a mean average precision (mAP) of 25.7% and a top K = 5 accuracy of 85.3%. With training and validation on our dataset and CholecT45, the algorithm scored a mAP of 37.9%.

CONCLUSIONS

An activity model was developed and applied for the fine-granular annotation of laparoscopic cholecystectomies in two surgical settings. A machine recognition algorithm trained on our own annotated dataset and CholecT45 achieved a higher performance than training only on CholecT45 and can recognize frequently occurring activities well, but not infrequent activities. The analysis of an annotated dataset allowed for the quantification of the potential of collaborative surgical robots to address the workload of surgical staff. If collaborative surgical robots could grasp and hold tissue, up to 83.5% of the assistant's tissue interacting tasks (i.e. excluding camera guidance) could be performed by robots.

Qualitative Evaluation of a Novel Security Role to Reduce Occupational Violence in Inpatient Hospital Settings

Background: Occupational violence (OV) is a priority issue that significantly affects the safety of nurses, leading to staff burnout and poor retention issues. Security personnel are common in inpatient settings, yet there is limited research on their role, function, and impacts. The study aims to qualitatively evaluate a novel security role to reduce OV in inpatient settings. Methods: This qualitative study was conducted in a tertiary hospital in Brisbane, Queensland. A novel security role (Ambassador) was piloted in three inpatient wards over 6 months in 2020 to mitigate OV risk. Semi-structured in-depth interviews were conducted. All interviews were audio recorded. Interview transcripts were transcribed. Deductive analysis based on the Consolidated Framework for Implementation Research (CFIR) was used to identify the experiences and perceptions of the participants. Findings: 17 participants were interviewed. Five themes were identified including program characteristics, internal drivers, external drivers, individual experience, and implementation process. An Ambassador proactively engages with patients and visitors and employs behavioral strategies to de-escalate or redirect persons of concern. Participants considered Ambassadors to be important members of the health care team who supported the provision of patient and family-centered care. Successful implementation was said to require collaboration between clinical and security services and a small agile project team with authority and autonomy. Conclusion/Application to practice: This study provides many insights into the successful implementation of a novel security role in acute hospital settings. More research is needed on the effectiveness, appropriateness, feasibility, and cost of different security models.

Consideration of Climate Change on Environmental Impact Assessment in Tanzania: Challenges and Prospects

The potential of the environmental impact assessment (EIA) process to respond to climate change impacts of development projects can only be realized with the support of policies, regulations, and actors' engagement. While considering climate change in EIA has become partly mandatory through the EU revised Directive in Europe, African countries are still lagging. This paper assesses Tanzanian policies, laws, regulations, and EIA reports to uncover consideration of climate change impacts, adaptation, and mitigation measures, drawing from the transformational role of EIA. The methodology integrates content analysis, interpretive policy analysis, and discourse analysis. The analyses draw from environmental policy, three regulatory documents and three EIA reports in Tanzania using a multi-cases study design. The aim was to understand how considering Climate Change issues in EIA has played out in practice. Results reveal less consideration of climate change issues in EIA. The policy, laws, and regulations do not guide when and how the EIA process should consider climate change-related impacts mitigation and adaptation. The practice of EIA in the country is utterly procedural in line with regulations provisions. Consequently, environmental impact statements only profile the climatology of the study area without conducting a deeper analysis of the historical and future climate to enhance the resilience of proposed projects. The weakness exposed in the laws and regulations contributes to the challenges of responding to the impacts of climate change through the EIA process. It is possible to address climate change issues throughout the project life cycle, including design, approval, implementation, monitoring, and auditing, provided the policy and regulations guide how and when the EIA process should consider climate change issues. Additionally, increasing stakeholders' awareness and participation can enhance the EIA process's potential to respond to the impacts of climate change.

Examining tools for assessing the impact of chronic pain on emotional functioning in children and young people with cerebral palsy: stakeholder preference and recommendations for modification

PURPOSE

To firstly identify tools for assessing the impact of chronic pain on emotional functioning in children and young people with cerebral palsy (CP), and secondly identify suggestions to improve their relevance, comprehensiveness, comprehensibility and feasibility for the CP population. Improving assessment of the impact of pain on emotional functioning can enhance quality of life by improving access to interventions for pain-related physical disability, anxiety and depression.

METHODS

Ethics approval was granted through the Women's and Children's Health Network Human Research Ethics Committee (2022/HRE00154). A mixed methods study with people with lived experience and clinicians, and guided by the Consensus-based Standards for Measurement Instruments (COSMIN), was undertaken. An online survey identified the highest rated tools for validation and/or modification for young people with CP and chronic pain. Focus groups and interviews investigated content validity and feasibility of the tools identified as highest rated.

RESULTS

The Fear of Pain Questionnaire for Children-SF (FOPQ-C-SF) and Modified Brief Pain Inventory (mBPI) were the highest rated for pain coping and multidimensional assessment (respectively) from the online survey (n = 61) of eight tools presented. Focus group and interview data (n = 30), including 58 unique modification suggestions, were coded to six categories: accessibility, comprehensibility, feasibility, relevance, presentation and comprehensiveness.

CONCLUSION

Potential modifications have been identified to improve the appropriateness and feasibility of the FOPQ-C-SF and mBPI for children and young people with CP. Future research should implement and test these modifications, prioritising the involvement of people with lived experience to ensure their needs are met alongside clinicians.

Exploring service provider perspectives on service user engagement across service components in coordinated specialty care programs for psychosis

Engagement in services is a core element to successful outcomes for service users and programs. In coordinated specialty care (CSC) programs, designed for individuals experiencing first-episode psychosis, engagement has only been measured programmatically and not by service component. This qualitative study sought to explore provider perspectives on service user engagement in service components of CSC. Semistructured interviews were conducted with 20 service providers from five community-based early intervention programs for psychosis in the United States. Interviews were recorded and transcribed verbatim, and thematic analysis was used to analyze the data collected. Provider participants described barriers and facilitators that contribute to disengagement or engagement in four service components within early intervention programs: individual psychotherapy, family education and support, medication management, and vocational services. Barriers identified included substance use, stigma, trauma, and external pressures. Identified barriers to engagement in CSC were both unique to individual components and cut across them. By better understanding the complexity of barriers and their intersections within and across CSC components, there can be more effective policy and program development to reduce disengagement and hopefully increase positive outcomes for service users. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An ethnography of mealtime care for people living with dementia in care homes

Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28 h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes.

Formal and informal hospital emergency management practices: managing for safety and performance amid crisis

Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. In order to manage staff, space, supplies, and system- related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information. Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities-imaginative planning, recombinant teaming, and transformational exchange-through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.

Shaping understandings through reflexive practice: Learnings from participatory research on aging with multiple sclerosis

BACKGROUND

Participatory research has gained traction as an approach to unlock perspectives when creating scientific knowledge and to facilitate societal changes. By conducting research with people, participatory research strives to engage individuals' perspectives in designing, conducting, and disseminating the research. Nevertheless, few studies have unpacked how understandings of the studied phenomenon are shaped among diverse research partners and, concurrently, how different perspectives are combined. Nested within an overall participatory mixed methods study on aging with multiple sclerosis (MS), this qualitative study explores how understandings of aging with MS are shaped in encounters between university researchers, older adults with MS, and employees in a patient association.

METHODS

The study was collaboratively conducted in Denmark by three research partners: a group of older adults with MS, employees in a patient association, and university researchers. Data on how different understandings of aging with MS were represented and shaped during the three-year research process was generated through field notes, meeting minutes, focus group interviews, and individual interviews. The collected data was analyzed through a thematic network analysis.

RESULTS

The study demonstrates how different understandings of aging with MS were represented among the research partners when the research was initiated. These understandings were shaped prior to -and, therefore, outside-the research setting, drawing from the research participants' lived experiences, professional backgrounds, and organizational cultures or situated in larger societal narratives. Through a process centered on reflexivity among the engaged research partners, the understandings of what it means to age with MS was shaped and re-shaped and eventually merged into a more dynamic understanding of later life with MS where different perspectives could co-exist.

CONCLUSION

The findings demonstrate that research partners, including older adults with MS and employees from a patient association, brought diverse understandings to the study. Reflexive practices enabled these perspectives to co-exist, enhancing engagement and transparency, and fostering a dynamic understanding of later life with MS. This highlights the value of reflexivity in evolving complex understandings within participatory research.

Implementation of medication for opioid use disorder treatment during a natural disaster: The PROUD-LA study

BACKGROUND

The impacts of climate change-related extreme weather events (EWEs) on Medication for Opioid Use Disorders (MOUD) implementation for Medicaid beneficiaries are relatively unknown. Such information is critical to disaster planning and other implementation strategies. In this study we examined implementation determinants and strategies for MOUD during EWEs.

METHODS

The Louisiana-based Community Resilience Learning Collaborative and Research Network (C-LEARN) utilized Rapid Assessment Procedures-Informed Community Ethnography (RAPICE), involving community leaders in study design, execution, and data analysis. We conducted qualitative semi-structured interviews with 42 individuals, including MOUD Medicaid member patients and their caregivers, healthcare providers and administrators, and public health officials with experience with climate-related disasters. We mapped key themes onto updated Consolidated Framework for Implementation Research domains.

RESULTS

MOUD use is limited during EWEs by pharmacy closures, challenges to medication prescription and access across state lines, hospital and clinic service limits, overcrowded emergency departments, and disrupted communications with providers. MOUD demand simultaneously increases due to the stress associated with displacement, resource loss, the COVID-19 pandemic, and social determinants of health. Effective implementation strategies include healthcare system disaster plans with protocols for clear and regular patient-provider communication, community outreach, additional staffing, and virtual delivery of services. Providers can also increase MOUD access by having remote access to EHRs, laptops and contact information, resource lists, collaborative networks, and contact with patients via call centers and social media. Patients can retain access to MOUD via online patient portals, health apps, call centers, and provider calls and texts. The impact of EWEs on MOUD access and use is also influenced by individual characteristics of both patients and providers.

CONCLUSIONS

The increasing frequency and severity of climate-related EWEs poses a serious threat to MOUD for Medicaid beneficiaries. MOUD-specific disaster planning and use of telehealth for maintaining contact and providing care are effective strategies for MOUD implementation during EWEs. Potential considerations for policies and practices of Medicaid, providers, and others to benefit members during hurricanes or major community stressors, include changes in Medicaid policies to enable access to MOUD by interstate evacuees, improvement of medication refill flexibilities, and incentivization of telehealth services for more systematic use.

Optimizing Patient Engagement in Treatment for Opioid Use Disorder: Primary Care Team Perspectives on Influencing Factors

BACKGROUND

Opioid use disorder (OUD) care engagement rates in primary care (PC) settings are often low. Little is known about PC team experiences when delivering OUD treatment and potential factors that influence their capacity to engage patients in treatment. Exploring PC team experiences may inform needed supports that can optimize OUD care delivery and improve outcomes for patients with OUD.

OBJECTIVE

We explored multidisciplinary PC team perspectives on barriers and facilitators to engaging patients in OUD treatment.

DESIGN

Qualitative study using in-depth interviews.

PARTICIPANTS

Primary care clinical teams.

APPROACH

We conducted semi-structured interviews (n = 35) with PC team members involved in OUD care delivery, recruited using a combination of criterion and maximal variation sampling. Data collection and analysis were informed by existing theoretical literature about patient engagement, specifically that patient engagement is influenced by factors across individual (patient, provider), interpersonal (patient-provider), and health system domains. Interviews were professionally transcribed and doubled-coded using a coding schema based on the interview guide while allowing for emergent codes. Coding was iteratively reviewed using a constant comparison approach to identify themes and verified with participants and the full study team.

KEY RESULTS

Analysis identified five themes that impact PC team ability to engage patients effectively, including limited patient contact (e.g., phone, text) in between visits, varying levels of provider confidence to navigate OUD treatment discussions, structural factors (e.g., schedules, productivity goals) that limited provider time, the role of team-based approaches in lessening discouragement and feelings of burnout, and lack of shared organizational vision for reducing harms from OUD.

CONCLUSIONS

While the capacity of PC teams to engage patients in OUD care is influenced across multiple levels, some of the most promising opportunities may involve addressing system-level factors that limit PC team time and collaboration and promoting organizational alignment on goals for OUD treatment.

Learning community participation: A valuable opportunity for transferring actions and behaviors within the nursing learning and working context?

AIM/OBJECTIVE

Indicating how community participation transfers to application within the nursing learning and working context.

BACKGROUND

Preparing nurses to drive advances in health care requires the integration of working and learning. Learning communities are therefore recommended to connect students, educational programs and health care organizations.

DESIGN

A multiple case study with three hospital learning communities was conducted during the 2019-2020 academic year, partly during the COVID-19 pandemic.

METHODS

The main data were collected by conducting three group interviews and 21 individual interviews with members. A hybrid thematic analysis approach was used.

RESULTS

Seven themes originated from the analysis: learning community features, learning community preconditions, learning community needs, impetus, application, research context and meaningfulness. Individual members applied acquired knowledge, skills and attitudes later or in other situations. Depending on the case, collective application manifested as inventing, consulting or reusing, but this seemed less sustainable in the research context at the time.

CONCLUSIONS

Application within the nursing learning and working context occurs and is sustained at the individual level even when there are no organized learning community sessions in times of crisis. Framing and facilitators' support can be used to encourage collective application.

Designing an implementation science clinical trial to integrate hypertension and cardiovascular diseases care into existing HIV services package in Botswana (InterCARE)

BACKGROUND

Despite success in HIV treatment, diagnosis and management of hypertension (HTN) and cardiovascular disease (CVD) remains suboptimal among people living with HIV (PLWH) in Botswana, with an overall HTN control of only 19% compared to 98% HIV viral suppressed. These gaps persist despite CVD primary care national guidelines and availability of free healthcare including antihypertensive medications. Our study aims to develop and test strategies to close the HTN care gap in PLWH, through integration into HIV care, leveraging the successful national HIV care and treatment program and strategies.

METHODS

The InterCARE trial is a cluster randomized controlled hybrid type 2 effectiveness-implementation trial at 14 sites designed to enroll 4652 adults living with HIV and HTN plus up to 2326 treatment partners. Primary outcomes included effectiveness (HTN control) and implementation outcomes using the Reach Effectiveness Adoption Implementation and Maintenance framework, with explanatory mixed methods used to understand variability in outcomes. InterCARE trial's main strategies include healthcare worker HTN and CVD care training plus long-term practice facilitation, electronic health record (EHR) documentation of key indicators and use of reminders, and use of treatment partners to provide social support to people living with HIV and HTN. InterCARE started with formative research to identify contextual factors influencing care gaps using the Consolidated Framework for Implementation Research. Results were used to adapt initial and develop additional implementation strategies to address barriers and leverage facilitators. The package was pilot tested in two clinics, with findings used to further adapt or add strategies for the clinical trial.

DISCUSSION

If successful, the InterCARE model can be scaled up to HIV clinics nationwide to improve diagnosis, management, and support in Botswana. The trial will provide insights for scale-up of HTN integration into HIV care in the region.

TRIAL REGISTRATION

ClinicalTrials.gov reference NCT05414526. Registered 18 May 2022, https://clinicaltrials.gov/study/NCT05414526?term=NCT05414526.&rank=1 .

A landscape evaluation of caffeine citrate availability and use in newborn care across five low- and middle-income countries

Apnoea of prematurity (AOP) is a common complication among preterm infants (< 37 weeks gestation), globally. However, access to caffeine citrate (CC) that is a proven safe and effective treatment in high-income countries is largely unavailable in low- and-middle income countries, where most preterm infants are born. Therefore, the overall aim of this study was to describe the demand, policies, and supply factors affecting the availability and clinical use of CC in LMICs. A mixed methods approach was used to collect data from diverse settings in LMICs including Ethiopia, Kenya, Nigeria, South Africa, and India. Qualitative semi-structured interviews and focus group discussions were conducted with 107 different health care providers, and 21 policymakers and other stakeholders from industry. Additional data was collected using standard questionnaires. A thematic framework approach was used to analyze the qualitative data and descriptive statistics were used to summarize the quantitative data. The findings indicate that there is variation in in-country policies on the use of CC in the prevention and treatment of AOP and its availability across the LMICs. As a result, the knowledge and experience of using CC also varied with clinicians in Ethiopia having no experience of using it while those in India have greater knowledge and experience of using it. This, in turn, influenced the demand, and our findings show that only 29% of eligible preterm infants are receiving CC in these countries. There is an urgent need to address the multilevel barriers to accessing CC for managing AOP in Africa. These include cost, lack of national policies, and, therefore, lack of demand stemming from its clinical equivalency with aminophylline. Practical ways to reduce the cost of CC in LMICs could potentially increase its availability and use.

COVID-19 Disruptions to Social Care Delivery: A Qualitative Study in Two Large, Safety-Net Primary Care Clinics

BACKGROUND

Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs.

OBJECTIVE

To describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting.

DESIGN

We used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration.

SETTING

Two safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs.

PARTICIPANTS

Six physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews.

RESULTS

Four major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences.

CONCLUSIONS

The COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.

Factors affecting the prevention of unwanted pregnancies among young adolescents in secondary schools in the Eastern Province of Rwanda: An explorative qualitative study

INTRODUCTION

The escalating number of teenage pregnancies, especially in the Eastern province of Rwanda, continues to raise concerns regarding the sexual and reproductive health of adolescents in the country. Recent statistics indicate that 5% of adolescent girls between the ages of 15 and 19 have given birth and 4% are currently pregnant with their first child. This highlights the critical need for comprehensive sexual and reproductive health education tailored for adolescents. However, there is limited evidence on factors affecting adolescents' efforts to prevent unwanted pregnancies and sexually transmitted infections in the Eastern Province of Rwanda, and the support systems available to adolescents in secondary schools, including the role of parents in promoting their sexual and reproductive health to minimize the risky sexual practices.

METHODS

An explorative qualitative study utilizing focus group discussions was conducted to garner the perspectives of 118 adolescents enrolled in six twelve-year-basic-education schools from three districts of the Eastern Province of Rwanda. Thematic analysis was employed to identify themes related to the impact of various factors on adolescents' sexual and reproductive health as they navigate through the physical and emotional changes from puberty to adolescence.

RESULTS

Adolescents are aware of the potential consequences of engaging in unprotected sexual intercourse which include the risk of unplanned pregnancy, sexually transmitted infections, HIV/AIDS, and emotional distress. Female participants emphasized that young girls who do not receive adequate support upon becoming pregnant prematurely may encounter depression, discontinue their education, face the harsh reality of extreme poverty, and struggle significantly in assuming the responsibilities of parenthood as young single mothers. Adolescents highlighted the lack of parental guidance concerning sexual and reproductive matters as a significant obstacle in their pursuit of a healthy and safe sexual and reproductive health during adolescence.

CONCLUSION

Inadequate parental engagement still hinders adolescents in navigating the physical bodily, mental, and emotional changes during adolescence. This affects their capacity to make well-informed decisions to prevent adverse consequences such as unintended pregnancies, substance misuse, sexually transmitted infections, and HIV/AIDS resulting from unsafe sexual practices. Since this study was qualitative, quantitative data necessary for a precise evaluation of the extent of the problem related to the absence of parental involvement in educating adolescents on sexual and reproductive health needs further research.

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study

INTRODUCTION

Contraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake.

METHODS

A qualitative exploratory study was conducted among women of reproductive age (15-49 years) and men (15-60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14.

RESULTS

We found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out.

CONCLUSIONS

This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees.

TRIAL REGISTRATION

This study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number-SS809ES.