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Mayer Y, Hershler LD, Bulk LY, Cook C, Belliveau G, Xie K, Jarus T. Promoting inclusion for disabled students in healthcare education: Using research-based theatre to enhance knowledge and empathy. Nurse Educ Pract 2024; 79:104085. [PMID: 39116670 DOI: 10.1016/j.nepr.2024.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
AIM This study explores and compares the impact of in-person and online versions of a Research-based Theatre production named "Alone in the Ring," aimed at increasing knowledge and fostering positive attitudes towards persons with disabilities in healthcare professions. The study examines changes in attitudes towards disabled persons in healthcare professions, levels of engagement in the play and knowledge about the experiences and challenges of disabled individuals in healthcare professions. It also investigates possible actions to increase inclusion for disabled persons in healthcare education and practice. BACKGROUND Disabled students face numerous barriers in healthcare education and practice, many of which are rooted in stigma and negative attitudes. Research-based Theatre promotes experiential learning to address these attitudes and stereotypes. The performance "Alone in the Ring" is based on a comprehensive study of the experiences of disabled students and clinicians in health professions, aiming to promote inclusion for students with disabilities in these fields. DESIGN This study uses a pre-test and post-test design with two comparison groups. METHOD The study employed an explanatory sequential mixed method design to explore the impact of online versus in-person Research-based Theatre teaching in healthcare education. Participants were graduate health students (N = 198); 100 watched the in-person version and 98 watched the online version. Surveys were administered before and after the performance. Participants were also invited to share their experiences in semi-structured interviews and their responses were analyzed using thematic analysis. RESULTS Results indicated that students generally felt more comfortable with disabled persons in healthcare professions in the post-survey compared to the pre-survey, with online participants reporting greater comfort and higher engagement than those in-person. Knowledge of disabled persons' experiences and challenges, as well as possible actions to increase belonging and inclusion, improved significantly for both groups from pre- to post-performance, with online participants showing a greater change. Qualitative data revealed that online theatre was perceived as authentic and beneficial for accessibility, engagement and emotional impact on students, though challenges included potential distractions and technological issues. Positive correlations were found between changes in knowledge, positive attitude and engagement, suggesting that increased engagement and a shift in attitudes can promote knowledge and awareness of the inclusion of disabled persons in healthcare professions. CONCLUSION These results support the use of online theatre-based academic teaching that experientially engages students, increases empathy and can promote more inclusive healthcare educational settings for disabled persons.
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Affiliation(s)
- Yael Mayer
- Department of counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel; Research-based Theatre Collaborative, The University of British Columbia, Vancouver, Canada; Occupational Science and Occupational Therapy department, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
| | - Laen Dov Hershler
- Research-based Theatre Collaborative, The University of British Columbia, Vancouver, Canada; Department of Language and Literacy Education, Faculty of Education, The University of British Columbia, Vancouver, Canada
| | - Laura Yvonne Bulk
- Research-based Theatre Collaborative, The University of British Columbia, Vancouver, Canada; Occupational Science and Occupational Therapy department, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Christina Cook
- Research-based Theatre Collaborative, The University of British Columbia, Vancouver, Canada; Educational and Counselling Psychology, and Special Education, Faculty of Education, Vancouver, Canada
| | - George Belliveau
- Research-based Theatre Collaborative, The University of British Columbia, Vancouver, Canada; Department of Language and Literacy Education, Faculty of Education, The University of British Columbia, Vancouver, Canada
| | - Kathy Xie
- Occupational Science and Occupational Therapy department, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Tal Jarus
- Research-based Theatre Collaborative, The University of British Columbia, Vancouver, Canada; Occupational Science and Occupational Therapy department, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Reyes Ramos MJ, Costa Abós S. Patient Safety Culture: Nurses' Perspective in the Hospital Setting. Healthcare (Basel) 2024; 12:1010. [PMID: 38786420 PMCID: PMC11121312 DOI: 10.3390/healthcare12101010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure.
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Affiliation(s)
- Maria José Reyes Ramos
- Facultat d’Infermeria, Universitat de Barcelona, 08907 Barcelona, Spain
- Fundació Sanitària Mollet, 08100 Mollet del Vallès, Spain
| | - Silvia Costa Abós
- Facultat d’Infermeria, Universitat de Barcelona, 08907 Barcelona, Spain
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Lozada-Tequeanes AL, Théodore FL, Kim-Herrera E, García-Guerra A, Quezada-Sánchez AD, Alvarado-Casas R, Bonvecchio A. Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e55509. [PMID: 38592753 PMCID: PMC11005909 DOI: 10.2196/55509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. OBJECTIVE This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. METHODS NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children's age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants' experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. RESULTS Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was "good," "useful," and "helpful" for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. CONCLUSIONS While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. TRIAL REGISTRATION ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896.
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Affiliation(s)
| | - Florence L Théodore
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Edith Kim-Herrera
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Armando García-Guerra
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Amado D Quezada-Sánchez
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Rocio Alvarado-Casas
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Anabelle Bonvecchio
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
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Rosenberg T, Kirkegaard J, Tveden MG, Hyldig N, Dieperink KB, Steffensen NH, Ulriksen SB, Lund T. Making decisions for follow-up chemotherapy based on digital patient reported outcomes data in patients with multiple myeloma and other M protein diseases - A mixed method study. Eur J Oncol Nurs 2024; 68:102455. [PMID: 37984313 DOI: 10.1016/j.ejon.2023.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To test if Patient Reported Outcomes (PRO) data can replace physical on-site consultation in determining if patients with multiple myeloma, AL amyloidosis, or plasma cell leukemia are ready for their next bortezomib treatment without dose reduction. METHODS We developed an online questionnaire addressing common side effects to bortezomib and an algorithm stratifying patients according to their responses and asked them to complete the questionnaire the day before attending the clinic. Applying a mixed-method study design of PRO data, time registrations, and interviews with patients and healthcare professionals, we tested the usability of electronic PRO data forming the basis of decision-making on whether patients are physically fit for the next treatment with an unchanged dose. RESULTS The questionnaire and the associated algorithm were able to identify patients who were physically fit for treatment without need for further consultation, with a positive predictive value of 98 %. The method proved to be feasible for all groups of patients regardless of age and educational level. Patients and healthcare professionals found the online questionnaire to be advantageous and flexible. CONCLUSION The use of PRO data to evaluate patients prior to bortezomib treatment is safe and feasible. Patients prefer to report their side effects themselves as it provides them with more freedom during their treatment.
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Affiliation(s)
- Tine Rosenberg
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark.
| | - Jannie Kirkegaard
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark
| | - Michael Gundesen Tveden
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
| | - Nana Hyldig
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org) Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Karin Brochstedt Dieperink
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org) Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
| | - Nanna Hanneberg Steffensen
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark
| | - Stine Brøgger Ulriksen
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark
| | - Thomas Lund
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
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Enoch J, Ghulakhszian A, Sekhon M, Crabb DP, Taylor DJ, Dinah C. Exploring patient acceptability of emerging intravitreal therapies for geographic atrophy: A mixed-methods study. Eye (Lond) 2023; 37:3634-3642. [PMID: 37170013 PMCID: PMC10174603 DOI: 10.1038/s41433-023-02571-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND/OBJECTIVES The acceptability of emerging intravitreal therapies for patients with Geographic Atrophy (GA) is currently unknown. This study therefore aimed to investigate the extent to which regular intravitreal injections may be acceptable to GA patients. SUBJECTS/METHODS Thirty UK-based individuals with GA secondary to age-related macular degeneration (AMD), recruited from two London-based hospitals, were interviewed in April-October 2021 regarding acceptability of new GA treatments. Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. The Theoretical Framework of Acceptability (TFA) informed framework analysis of the qualitative data. RESULTS Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had foveal centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41-79%)) would accept the treatment, despite awareness of potential drawbacks. Eight participants (27% (95% CI: 10-43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0-26%) would be unlikely to accept treatment. Reducing the frequency of injections from monthly to every other month increased the proportion of participants who considered the treatments acceptable. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. Misunderstandings of potential benefits indicate the need for appropriately-designed patient education tools to support decision-making. CONCLUSIONS Our study suggests a majority of participants would be positive about intravitreal treatment for GA, in spite of potential burdens.
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Affiliation(s)
- Jamie Enoch
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Arevik Ghulakhszian
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Mandeep Sekhon
- Population Health Research Institute, St George's, University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Christiana Dinah
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK.
- Department of Brain Sciences, Imperial College, London, UK.
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Tomás-Vecina S, Reyes-Ramos MJ. [Challenges and initiatives in the prevention of healthcare associated infections: Expert consensus study]. J Healthc Qual Res 2023; 38:376-389. [PMID: 37925298 DOI: 10.1016/j.jhqr.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION The objective of the project was to identify new strategies, agreed upon by experts, that help reduce the prevalence of Health Care Related Infections (HAIs) given the increase in their prevalence as a result of the pandemic and improve patient safety. MATERIAL AND METHODS The project was developed in three phases. The first two are framed in a sequential explanatory mixed model. Phase 1 consisted of a quantitative study (anonymous survey) to find out the perception of healthcare professionals about HAIs, risk factors, preventive measures, protocols, disinfection products and approaches. Phase 2 consisted of a qualitative exploratory study in which a panel of 15 experts analyzed the results, using focus group techniques, integrating both phases through the elaboration of metainferences. Phase 3 consisted of a qualitative descriptive study where, through nominal group techniques, agreed proposals for strategies to prevent HAIs were prepared. RESULTS The panel of experts defined a total of 51 proposals for new strategies: 15 in hand hygiene, 13 in surface cleaning, 13 in the use of devices, and 10 in HAI prevention training. Of all of them, 13 were agreed upon as preferable (medium-high viability and high impact) and 7 as recommendable (low viability and high impact). CONCLUSIONS In the prevention of HAIs, experts recommend applying different strategies simultaneously, which include innovative, technological and humanization aspects, both in data collection, intervention and training, prioritizing those with the greatest impact. and feasibility.
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Affiliation(s)
- S Tomás-Vecina
- Fundación por la Investigación, Docencia e Innovación en Seguridad del Paciente (FIDISP), Barcelona, España; Unidad de Calidad y Seguridad del Paciente, Badalona Serveis Assistencials, Badalona, Barcelona, España.
| | - M J Reyes-Ramos
- Fundación por la Investigación, Docencia e Innovación en Seguridad del Paciente (FIDISP), Barcelona, España; Calidad, Docencia e Investigación, Fundación Sanitaria Mollet, Mollet, Barcelona, España
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Bulndi LB, Bayes S, Adama E, Ireson D. North-central Nigerian women's experiences of obstetric fistula risk factors and their perceived treatment services: An Interpretive Description. Women Birth 2023; 36:454-459. [PMID: 36868989 DOI: 10.1016/j.wombi.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND An obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women's bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations. AIM This study aimed to uncover North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services. DESIGN Qualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services. SAMPLE A purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible. RESULTS Four themes emerged from North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers. CONCLUSION The findings from this study highlighted the depth of women's experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women's voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities. TWEETABLE ABSTRACT Reproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities.
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Affiliation(s)
- Lydia Babatunde Bulndi
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Australia.
| | - Sara Bayes
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Australia; School of Nursing, Midwifery, and Paramedicine (Melbourne), Australian Catholic University, 115 Victoria Parade, Fitzroy, Vic 3065, Australia
| | - Esther Adama
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Australia
| | - Deborah Ireson
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Australia
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Hawley-Hague H, Gluchowski A, Lasrado R, Martinez E, Akhtar S, Stanmore E, Tyson S. Exploring the delivery of remote physiotherapy during the COVID-19 pandemic: UK wide service evaluation. Physiother Theory Pract 2023:1-15. [PMID: 37610255 DOI: 10.1080/09593985.2023.2247069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION During the Coronavirus (Covid-19) pandemic, physiotherapists changed rapidly to working remotely. Research demonstrates the benefits of remote physiotherapy, but little is known about its implementation in practice. PURPOSE Explore the take-up and delivery of remote physiotherapy during the pandemic in the United Kingdom. METHODS Sequential mixed methods evaluation with physiotherapists leading remote physiotherapy delivery. Two-stage approach included online survey (2020) and semi-structured interviews with documentary/data analysis (2021). RESULTS There were 1620 physiotherapists who completed the survey. The most used devices were telephone (n = 942,71.0%) and the AttendAnywhere platform (n = 511, 38.5%). Remote consultations were frequently used for initial assessment (n = 1105, 83%), screening/triage (n = 882, 67%), or to review, monitor, and progress treatment (n = 982-1004, 74%-76%). Qualitative survey responses reflected respondents' response to COVID-19 and delivery of remote physiotherapy. Twelve remote physiotherapy leads were then purposively sampled across clinical areas. Three main themes emerged from interviews: response to Covid-19, delivery of remote physiotherapy, and future of remote physiotherapy. CONCLUSION Remote physiotherapy was safe, feasible, and acceptable for those who accessed it. There were patients for which it was deemed unsuitable across clinical areas. In practice, it should be combined with in-person consultation based on patients' needs/preferences. Further research should explore post-pandemic maintenance of remote delivery.
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Affiliation(s)
- Helen Hawley-Hague
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ashley Gluchowski
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Reena Lasrado
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ellen Martinez
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Shehnaz Akhtar
- Community Podiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sarah Tyson
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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Lamptey R, Amoakoh-Coleman M, Djobalar B, Grobbee DE, Adjei GO, Klipstein-Grobusch K. Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study. PLoS One 2023; 18:e0286974. [PMID: 37450431 PMCID: PMC10348576 DOI: 10.1371/journal.pone.0286974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. AIM We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). RESEARCH DESIGN AND METHODS A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings. RESULTS In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour. CONCLUSIONS The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.
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Affiliation(s)
- Roberta Lamptey
- Polyclinic/ Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Babbel Djobalar
- Internal Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Obeng Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Office of Research Innovation and Development, University of Ghana, Legon, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bulndi LB, Ireson D, Adama E, Bayes S. Women's views on obstetric fistula risk factors and prevention in north-central Nigeria: an interpretive descriptive study. BMJ Open 2023; 13:e066923. [PMID: 37321805 PMCID: PMC10277036 DOI: 10.1136/bmjopen-2022-066923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE Obstetric fistula, also known as vesicovaginal fistula or rectovaginal fistula, is an abnormal opening between the vagina and rectum caused by prolonged obstructed labour that causes substantial long-term harm to women. It is most prevalent in low resource settings and although preventative measures have been proposed, they have not, to date, taken women's own views into account. The objective of this study was to explore the views of North Nigerian women on obstetric fistula risk factors and prevention. DESIGN This study was conducted using Interpretive Description methodology, which is a qualitative approach underpinned by Symbolic Interactionism. A semistructured questionnaire was used to explore the views of 15 women living with obstetric fistula about risk factors and prevention of the condition. Data were collected in one-to-one in-depth interviews conducted between December 2020 and May 2021. All interviews were audio-recorded and transcribed verbatim, and a thematic approach to data analysis was employed. SAMPLING AND SETTING The setting for this study was a fistula repair centre in north-central Nigeria. The sample was formed of a purposively selected 15 women who had experienced obstetric fistula at a repair Centre in north-central Nigeria. RESULTS Four core themes emerged from women's views on obstetric fistula risk factors and prevention: (1) Women's autonomy, (2) Economic empowerment, (3) Infrastructure/transportation and (4) Provision of skilled healthcare services. CONCLUSION The findings from this study highlight previously unknown women's views on obstetric fistula risk factors and prevention in north-central Nigeria. Analysis of insights from women's voices directly affected by obstetric fistula demonstrated that in their views and experiences, giving women autonomy (decision-making power) to choose where to birth safely, economic empowerment, enhancement of transportation/infrastructure and provision of skilled healthcare services may mitigate obstetric fistula in Nigeria.
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Affiliation(s)
- Lydia Babatunde Bulndi
- The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Deborah Ireson
- The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Esther Adama
- The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Sara Bayes
- The Centre for Evidence-Informed Nursing, Midwifery and Health Care Practice: A JBI Affiliated Group, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, 8-14 Brunswick Street, Fitzroy, Melbourne, Victoria, Australia
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Louise Lowe P, Jakimowicz S, Levett-Jones T. Using a mixed methods grounded theory methodology to explain neonatal nurses' professional quality of life. Nurse Res 2023; 31:17-24. [PMID: 36601810 DOI: 10.7748/nr.2023.e1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nurse researchers are constantly seeking novel methods of maintaining philosophical congruence while advancing their knowledge of the human condition using paradigmatically diverse means. AIM To provide an overview of the research philosophies underpinning the mixed methods grounded theory (MM-GT) methodology, illustrate its optimal use and introduce a quality-appraisal tool being developed with reference to extant literature. DISCUSSION The utility of MM-GT has been effectively demonstrated in the nursing and health literature. Yet, there are examples of how it has been under-used and sub-optimally applied. This article includes a two-phase MM-GT study protocol guided by a pragmatic research philosophy and best practice recommendations that aims to explain neonatal nurses' professional quality of life. CONCLUSION Optimal use of MM-GT's five essential components - purposive sampling, constant comparative methods with iterative coding and analysis, theoretical saturation, memoing and theory development - combine to produce high-quality, defensible research outputs and new nursing theory. IMPLICATIONS FOR PRACTICE Research outputs, such as publication and presentation, expounding the multifactorial influences affecting neonatal nurses' professional quality of life will not only benefit the neonatal nursing community but also contribute to the corpus of nursing and midwifery research and enhance the health, well-being and retention of nurses and midwives more broadly.
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Affiliation(s)
- Patricia Louise Lowe
- Faculty of Nursing and Midwifery, University of Technology Sydney, Ultimo, NSW, Australia
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Gazi MAI, Masud AA, Sobhani FA, Dhar BK, Hossain MS, Hossain AI. An Empirical Study on Emergency of Distant Tertiary Education in the Southern Region of Bangladesh during COVID-19: Policy Implication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4372. [PMID: 36901382 PMCID: PMC10001728 DOI: 10.3390/ijerph20054372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Many fields have been affected by COVID-19, including education. The pandemic has prompted a change in education due to the requirement for social distancing. Campuses are now closed in many educational institutions across the globe, and teaching and learning are now conducted online. Internationalization has significantly slowed down. A mixed-method study was designed for this research, with the goal of ascertaining the impact of COVID-19 on Bangladeshi students enrolled in higher education during and after the pandemic. A questionnaire with 19 questions on a Google form was used to collect quantitative data using a 4-point Likert scale and was conducted on 100 students from different universities in the southern part of Bangladesh, such as Barisal University, Patuakhali Science and Technology University, and Bangabandhu Sheikh Mujibur Rahman Science and Technology University. For collecting qualitative data, six quasi-interviews were conducted. A statistical package for Social Science (SPSS) was used to analyze both quantitative and qualitative data. The quantitative results demonstrated that during the COVID-19 pandemic, pupils continuously received teaching and learning. The current study's findings revealed a significant positive correlation between the COVID-19 pandemic and teaching, learning, and student achievement and a significant negative correlation between the COVID-19 pandemic and student goals. The study also revealed that the COVID-19 pandemic had a detrimental effect on students enrolled in higher education programs at the universities. The qualitative judgment showed that students faced many problems when joining classes, such as poor Internet connection and insufficient network and technological facilities, etc. Some students live in rural areas and have slow Internet speeds, which sometimes prevented them from joining class. The findings of the study can help policy makers in higher education to review and adopt a new policy in higher education in Bangladesh. It can also help education instructors in universities to develop a proper study plan for their students.
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Affiliation(s)
| | - Abdullah Al Masud
- Department of Management Studies, University of Barishal, Barishal 8254, Bangladesh
| | - Farid Ahammad Sobhani
- School of Business and Economics, United International University, Dhaka 1212, Bangladesh
| | - Bablu Kumar Dhar
- Mahidol University International College, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Mohammad Sabbir Hossain
- Department of Finance and Banking, Patuakhali Science and Technology University, Patuakhali 8602, Bangladesh
| | - Abu Ishaque Hossain
- Department of Business Administration, The International University of Scholars, Dhaka 1213, Bangladesh
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Bell DJ, Vigors B, Duthie CA, Bartram DJ, Hancock A, Odeyemi I, Penny C, Haskell MJ. Developing a tool to assess the health-related quality of life in calves with respiratory disease: content validation. Animal 2023; 17:100702. [PMID: 36680850 DOI: 10.1016/j.animal.2022.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Bovine respiratory disease (BRD) is a major welfare and productivity issue for calves. Despite the extensive negative impacts on calf welfare and performance, BRD remains challenging to detect and treat effectively. However, the clinical signs of disease are only one aspect of the disease that is experienced by the individual. The assessment of emotional experience in animals is not straightforward, but it is increasingly recognised that the quality of behaviour and demeanour of an individual is a reflection of their internal emotional state. The aim of the present study was to complete the content validation stage of the development process for a health-related quality of life (HRQOL) tool. This was based around indicators from an existing conceptual framework containing twenty-three indicators in two domains (clinical signs and behavioural expression). The content validation stage involves engaging with key stakeholders. For this study, this took the form of a survey and discussions with focus groups, which are standard methods in this field. A survey and stakeholder focus groups were conducted to assess the usefulness of each indicator and its relevance for inclusion within a HRQOL tool. In the survey, participants were asked to rate the usefulness of each of the indicators using a 4-point scale which were then dichotomised into 'useful' and 'less useful'. Based on the 'useful' result, each indicator within the domains was ranked. A similar approach was taken with the responses from the focus groups. Focus group participants were asked to select indicators that they felt were of use and the result of this was used to rank each of the indicators. The ranks of the indicators from both the survey and the focus groups along with the transcripts from the focus groups were used to determine the indicators from each domain to include within the HRQOL tool. Indicators within the clinical signs domain that were included were nasal discharge, cough, respiratory effort, ocular appearance (discharge and vibrancy), body and head posture and ear carriage. For the domain of behavioural expression, the indicators included were movement to feed, responsiveness, spatial proximity, volume of feed intake, motivation at feed and vigour. The next stage will be to validate the construction of the HRQOL tool through its use in practice. The inclusion of indicators that allow the experiential aspects of disease to be recorded in health assessments will likely increase the ability of farmers and others to detect respiratory disease in calves.
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Affiliation(s)
- D J Bell
- SRUC (Scotland's Rural College), West Mains, Road, Edinburgh EH9 3JG, United Kingdom.
| | - B Vigors
- SRUC (Scotland's Rural College), West Mains, Road, Edinburgh EH9 3JG, United Kingdom
| | - C-A Duthie
- SRUC (Scotland's Rural College), West Mains, Road, Edinburgh EH9 3JG, United Kingdom
| | - D J Bartram
- Outcomes Research, Zoetis, Loughlinstown, County Dublin D18 T3Y1, Ireland
| | - A Hancock
- Outcomes Research, Zoetis, Loughlinstown, County Dublin D18 T3Y1, Ireland
| | - I Odeyemi
- Outcomes Research, Zoetis, Loughlinstown, County Dublin D18 T3Y1, Ireland
| | - C Penny
- Zoetis UK Ltd., First Floor, Birchwood Building, Springfield Drive, Leatherhead KT22 7LP, United Kingdom
| | - M J Haskell
- SRUC (Scotland's Rural College), West Mains, Road, Edinburgh EH9 3JG, United Kingdom
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Schick-Makaroff K, Wozniak LA, Short H, Davison SN, Klarenbach S, Buzinski R, Walsh M, Johnson JA. How the Routine Use of Patient-Reported Outcome Measures for Hemodialysis Care Influences Patient-Clinician Communication: A Mixed-Methods Study. Clin J Am Soc Nephrol 2022; 17:1631-1645. [PMID: 36283760 PMCID: PMC9718041 DOI: 10.2215/cjn.05940522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient-reported outcome measures invite patients to self-report aspects of their quality of life and have been reported to enhance communication with clinicians. We aimed to examine how routine use of patient-reported outcome measures in in-center hemodialysis units influenced patient-clinician communication. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A concurrent, longitudinal, mixed-methods approach was used. We used data from a cluster randomized controlled trial of 17 hemodialysis units in northern Alberta that introduced a patient-reported outcome measures intervention. Patient-clinician communication was assessed using a modified Communication Assessment Tool. Using interpretive description, we explored patients' and nurses' perceptions of communication pertaining to routine patient-reported outcome measure use. Through purposeful sampling, we interviewed ten patients and eight nurses and conducted six observations in the dialysis units, which were documented in field notes. We reviewed 779 patient responses to open-ended survey questions from randomized controlled trial data. Qualitative data were thematically analyzed. RESULTS Overall, patient-reported outcome measure use did not substantively improve patient-clinician communication. There was a small positive change in mean total Communication Assessment Tool scores (range, 1-5) from baseline to 12 months in patient-reported outcome measure use units (0.25) but little difference from control group units that did not use patient-reported outcome measures (0.21). The qualitative findings provide in-depth insights into why patient-reported outcome measure use did not improve patient-clinician communication. The purpose of patient-reported outcome measure use was not always understood by patients and clinicians; patient-reported outcome measures were not implemented as originally intended in the trial, despite clinician training; there were challenges using patient-reported outcome measures as a means to communicate; and patient-reported outcome measure use was perceived to have limited value. CONCLUSIONS While patient-reported outcome measures use did not improve patient-clinician communication, qualitative data suggest implementation challenges, including limited clarity of purpose and perceived limited value, that may have limited the effectiveness of the intervention.
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Affiliation(s)
- Kara Schick-Makaroff
- Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa A. Wozniak
- Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Hilary Short
- Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sara N. Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Jeffrey A. Johnson
- Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Kirkegaard J, Lundholm BW, Rosenberg T, Lund T, Gundesen MT, Dieperink KB. Home is best. Self-administration of subcutaneous Bortezomib at home in patients with multiple myeloma - A mixed method study. Eur J Oncol Nurs 2022; 60:102199. [PMID: 36162259 DOI: 10.1016/j.ejon.2022.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the perspectives of patients and healthcare professionals of self-administration of subcutaneous (SC) injection of Bortezomib in the homes of patients with Multiple Myeloma (MM), and to assess organizational aspects. METHODS A prospective, clinical, parallel mixed-method design with a qualitative core and a quantitative supplementary component was conducted at a single hematological centre in Denmark. Qualitative data were obtained from individual, semi-structured interviews with patients (n = 10) and a focus group interview with healthcare professionals (n = 5); data were analyzed using a hermeneutic approach. Quantitative data were acquired from time registrations performed by patients and nurses and descriptively analyzed applying a micro-costing approach, using cost data per individual. RESULTS In general, patients and healthcare professionals were pleased with self-administration as patient empowerment increased. Qualitative findings yielded three themes: "Home is best", "Everyone is different", and "Safety first". Quantitative data were confirmative and revealed self-administration to be time saving for patients and nurses. In a Danish context, delivery of the medicine to the patient's home was slightly more expensive than administration at the hospital. CONCLUSIONS Self-administration of SC Bortezomib in the homes of patients with MM is advantageous for patients and healthcare professionals. It is feasible, safe, and timesaving. These advantages come with a negligible increase in expenses.
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Affiliation(s)
- Jannie Kirkegaard
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th floor, 5000, Odense C, Denmark
| | - Birgitte Wolf Lundholm
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th floor, 5000, Odense C, Denmark
| | - Tine Rosenberg
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark.
| | - Thomas Lund
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
| | - Michael Tveden Gundesen
- Department of Hematology, Odense University Hospital, Kloevervaenget 10, 12th floor, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
| | - Karin Brochstedt Dieperink
- Research Unit of Oncology, The Academy of Geriatric Cancer Research Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark; Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000, Odense C, Denmark
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16
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Tan K, Fredrickson B, Santos H, Wood W, Schwartz T, Mayer D. Psychological processing among caregivers of allogeneic bone marrow transplant recipients: Qualitative findings from a longitudinal study. J Psychosoc Oncol 2022; 41:321-336. [PMID: 35959854 PMCID: PMC9922335 DOI: 10.1080/07347332.2022.2107467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe caregiver psychological processing during the 12 weeks after transplant and the potential role of positive emotions in caregiving experiences. METHODS We conducted a longitudinal qualitative descriptive study and interviewed 11 BMT caregivers monthly for 12-weeks post-transplant about their experiences and psychological processing. We analyzed 38 interviews using directed content analysis based on guiding theories and inductive in vivo coding to develop themes. RESULTS The majority of participants appraised caregiving as a challenge that needed to be met. Caregivers described feeling positive emotions throughout the time after transplant (gratitude, interest, and hope). We identified two new themes: mirroring (caregiver feelings reflecting patient status) and emotion regulation (hiding negative emotions and displaying positive emotions when with the patient). IMPLICATIONS Findings provide further evidence that interventions focused on emotion regulation and positive emotion experiences during caregiving to reduce the negative effects of caregiving related stress may be promising.
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Affiliation(s)
- Kelly Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina At Chapel Hill, NC, USA
- School of Medicine, University of North Carolina At Chapel Hill, NC, USA
| | - Barbara Fredrickson
- Department of Psychology & Neuroscience, University of North Carolina At Chapel Hill, NC, USA
| | - Hudson Santos
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - William Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina At Chapel Hill, NC, USA
- School of Medicine, University of North Carolina At Chapel Hill, NC, USA
| | - Todd Schwartz
- School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, NC, USA
- School of Nursing, University of North Carolina At Chapel Hill, NC, USA
| | - Deborah Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina At Chapel Hill, NC, USA
- School of Nursing, University of North Carolina At Chapel Hill, NC, USA
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A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38. [PMID: 36284927 PMCID: PMC9549591 DOI: 10.7196/sajcc.2022.v38i2.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
Background
Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child
mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In
recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted
in December 2019 at the University Hospital Mahajanga.
Objectives
This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved
their learning objectives.
Methods
In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their
learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were
conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities.
Results
Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs
and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi-disciplinary efforts are needed to advance ETAT+ implementation in Madagascar.
Conclusion
Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of
care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to
contexts in Madagascar.
Contributions of the study
This study aims to evaluate an updated Malagasy version of the Emergency Triage Assessment and Treatment Plus (ETAT+). The training met the
participants’ needs and was adapted to the clinical realities in Madagascar relating to transmitted knowledge, skills and competencies.
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Jarus T, Mayer Y, Gross E, Cook C, Bulk LY, Hershler LAD, Nichols J, Zaman S, Belliveau G. Bringing disability experiences front stage: Research-based theatre as a teaching approach to promote inclusive health education. NURSE EDUCATION TODAY 2022; 115:105408. [PMID: 35633604 DOI: 10.1016/j.nedt.2022.105408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite efforts to promote inclusion of people living with disabilities in health and human service education and professions, students and clinicians living with disabilities continue to face powerful barriers, arising most notably from the stigma and negative attitudes of their peers. Increased awareness of these lived experiences are needed to affect attitudinal changes and reduce barriers to participation in those professions. To achieve this, information (stories) must be presented to learners in a way that promotes emotional engagement and highlights these issues from multiple perspectives. The following study measures the impact of a Research based Theatre play, based on the collected experiences of people living with disabilities in health and human service professions, as a teaching approach for knowledge and attitudinal change among audiences. METHOD This mixed-methods study (pre and post surveys, groups and individual interviews) aimed at measuring the impact (knowledge and attitudinal change) incurred among audience members. In total, a 174 students, faculty, staff, and clinicians in health and human service professions across two major Canadian cities completed the surveys before and after witnessing the play. Of these, 20 participants also participated in follow-up interviews. Two-way repeated measures ANOVA was used to compare the pre and post surveys while thematic content analysis was used for the interviews. RESULTS Two main themes emerged from combined analysis of both the quantitative and qualitative data. First, quantitative data revealed a significant change in participants' attitudes towards people living with disabilities which was corroborated by interview participants who expressed more comfort in their interactions with students and clinicians living with disabilities. Second, learners also reported meaningful and statistically significant change in their knowledge about the experiences of health and human service professionals living with disabilities. CONCLUSIONS The results of this study support applying Research-based Theatre as a teaching approach that can promote knowledge and attitudinal change among audiences and increase the inclusion and equity of people living with disabilities in health and human service education. Future research in this area might investigate Research-based Theatre's pedagogical impact using a randomized control design and measuring longer term impact.
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Affiliation(s)
- Tal Jarus
- Occupational Science and Occupational Therapy department, The University of British Columbia, Canada; Research-based Theatre Collaborative, The University of British Columbia, Canada.
| | - Yael Mayer
- Occupational Science and Occupational Therapy department, The University of British Columbia, Canada; Research-based Theatre Collaborative, The University of British Columbia, Canada
| | - Elisabeth Gross
- Occupational Science and Occupational Therapy department, The University of British Columbia, Canada
| | - Christina Cook
- Department of Language and Literacy Education, The University of British Columbia, Canada; Research-based Theatre Collaborative, The University of British Columbia, Canada
| | - Laura Yvonne Bulk
- Occupational Science and Occupational Therapy department, The University of British Columbia, Canada; Research-based Theatre Collaborative, The University of British Columbia, Canada
| | - Laen A D Hershler
- Department of Language and Literacy Education, The University of British Columbia, Canada; Research-based Theatre Collaborative, The University of British Columbia, Canada
| | - Jennica Nichols
- Research-based Theatre Collaborative, The University of British Columbia, Canada; School of Population and Public Health, The University of British Columbia, Canada
| | - Shahbano Zaman
- Occupational Science and Occupational Therapy department, The University of British Columbia, Canada
| | - George Belliveau
- Department of Language and Literacy Education, The University of British Columbia, Canada; Research-based Theatre Collaborative, The University of British Columbia, Canada
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Fairman CM, Owens OL, Kendall KL, Steele J, Latella C, Jones MT, Marcotte L, Peddle-McIntyre CMJ, McDonnell KK. Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer. Pilot Feasibility Stud 2022; 8:102. [PMID: 35585562 PMCID: PMC9114285 DOI: 10.1186/s40814-022-01065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. Methods Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. Discussion This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. Trial registration Record not yet public
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Affiliation(s)
- C M Fairman
- Department of Exercise Science, University of South Carolina, Columbia, USA.
| | - O L Owens
- College of Social Work, University of South Carolina, Columbia, USA
| | - K L Kendall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - J Steele
- Faculty of Sport, Health, and Social Science, Solent University, Southampton, UK
| | - C Latella
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - M T Jones
- Department of Exercise Science, University of South Carolina, Columbia, USA.,Department of Kinesiology, The University of Alabama, Tuscaloosa, USA
| | - L Marcotte
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - K K McDonnell
- College of Nursing, University of South Carolina, Columbia, USA
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Patients' Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106106. [PMID: 35627641 PMCID: PMC9140490 DOI: 10.3390/ijerph19106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen’s d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients’ perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.
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Dieterich-Hartwell R, Gilman A, Hecker V. Music in the Practice of Dance/Movement Therapy. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Reel CD, Allen RS, Lanai B, Yuk MC, Potts DC. Bringing Art to Life: Social and Activity Engagement through Art in Persons Living with Dementia. Clin Gerontol 2022; 45:327-337. [PMID: 34100338 DOI: 10.1080/07317115.2021.1936737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Bringing Art to Life (BATL) program was created as an art therapy intervention to increase social engagement, intergenerational engagement, and creative expression among persons living with dementia (PWD) in an adult day service. This is an evaluation of BATL program efficacy. METHODS A modified behavioral observation tool was used to quantify meaningful engagements as recorded in ethnographic field notes and test the hypotheses that: 1) engagements increase across art therapy sessions, and 2) engagements were more social than activity or art related. RESULTS The increase in engagement across session was not significant. However, social engagements (M = 9.61, SD 4.6) were more prevalent than art engagements (M = 5.23, SD = 3.1) in each session (t(99) = 9.52,). A thematic analysis of social interactions recorded in the ethnographic field notes revealed themes related to reminiscence. CONCLUSIONS The quantitative and qualitative data supported the BATL program as effective in engaging participants in social interaction and art activities. Specifically, quantitative data showed participants were engaged in conversations around reminiscence and discussion of creative expression with students. CLINICAL IMPLICATIONS Intergenerational social interaction between PWD and college students is a critical and meaningful part of the BATL program, and the intervention created a safe space with focused activity through engagement with art, and this facilitated PWD in self-expression, including humor, advice, and legacy.
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Affiliation(s)
- Candice D Reel
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - Rebecca S Allen
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - Bailey Lanai
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - M Caroline Yuk
- Psychology Department, The University of Alabama, Tuscaloosa, USA
| | - Daniel C Potts
- Psychology Department, The University of Alabama, Tuscaloosa, USA
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Thaher YAY, Jaaron AAM. The impact of sustainability strategic planning and management on the organizational sustainable performance: A developing-country perspective. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 305:114381. [PMID: 34991031 DOI: 10.1016/j.jenvman.2021.114381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
The purpose of this article is to comprehensively describe the impact of sustainability strategic planning and management (SSPM) on organisational sustainable performance in a developing country context. A mixed method approach was adopted; data were collected using an interview and a survey targeting 126 organisations operating in the foremost polluting Palestinian manufacturing private sectors. The analyses were conducted employing thematic analysis and Partial Least Squares Structural Equation Modelling (PLS-SEM). The results from data analysis confirm that SSPM had a positive effect on the three dimensions of organisational sustainable performance (i.e. social, ecological and economic). Furthermore, the paper has developed a framework to facilitate integrating SSPM into the business model of manufacturing organisations in a developing country context. This paper is considered among the very few studies exploring the 'questioned' impacts of SSPM on organisational sustainable performance in a developing country.
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Affiliation(s)
- Yousef A Y Thaher
- Faculty of Graduate Studies, An-Najah National University, Nablus, West Bank, 97200, Palestine.
| | - Ayham A M Jaaron
- Department of Management and Entrepreneurship, The Centre for Enterprise and Innovation, Leicester Castle Business School, De Montfort University, Leicester, LE2 7BY, UK.
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Chamane N, Thompson R, Goldstone S, Mashamba-Thompson TP. Designing and Piloting of a Mobile Learning Curriculum for Quality Point-Of-Care Diagnostics Services in Rural Clinics of KwaZulu-Natal, South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:728309. [PMID: 36304058 PMCID: PMC9580687 DOI: 10.3389/frph.2021.728309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The use of mobile technology has been reported to help improve access to education for people in remote areas. However, there is limited evidence of its adoption in resource-limited settings. The aim of this study was to utilize stakeholder generated ideas to design and pilot a mobile learning curriculum, with the purpose of facilitating training to improve the quality of point-of-care diagnostics services in KwaZulu-Natal (KZN) rural clinics. Methods Nominal Group Technique was employed to enable collaboration with stakeholders in designing and piloting of a POC diagnostics curriculum. Stakeholders were selected from 11 KZN districts to participate in a clinic-based piloting of the curriculum using an online application. The application was designed in collaboration with a teacher training institute in Durban. Moodle was used as an established reliable online learning management system. During piloting, quantitative and qualitative data were generated and analyzed using descriptive statistics and content analysis. Findings and Conclusion Guided by the Nominal Group Technique results, five delivery modes for curriculum content through Mobile Learning were generated. An interactive course page was created on the Moodle site, titled: Quality HIV Point of Care Diagnostics Curriculum Delivery for Nurses in Rural Areas. The course content consisted of three teaching units, activities, an online quiz and an online survey. An analytic-algorithm built into the online course enabled monitoring of participation and assessment outcomes automatically. At piloting, 64% of the invited representative clinics were able to access the course, with 47% meeting the course completion requirements. All the participants achieved the set pass mark of 75% with an average of 87%. The activity completion report showed that topics presented through images, videos and simple text were accessed more than those presented as attachments of national documents. Despite poor network coverage and limited access to mobile technology, exacerbated by Covid-19 related restrictions, Point of care diagnostics Mobile Learning curriculum was well-received in participating rural clinics. Recommendations relating to course improvement and access, included extending collaboration with specialists in eHealth systems development and with South African cell phone network providers.
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Affiliation(s)
- Nkosinothando Chamane
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- *Correspondence: Nkosinothando Chamane
| | - Rowan Thompson
- Department of Mathematics, Science and Technology, Stadio School of Education Formerly the Embury Institute for Higher Education, Durban, South Africa
- Rowan Thompson
| | - Simon Goldstone
- Department of Digitally Enhanced Learning, Teaching and Assessment, Stadio School of Education Formerly the Embury Institute for Higher Education, Durban, South Africa
- Simon Goldstone
| | - Tivani Phosa Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Tivani Phosa Mashamba-Thompson
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Schick-Makaroff K, Wozniak LA, Short H, Davison SN, Klarenbach S, Buzinski R, Walsh M, Johnson JA. Burden of mental health symptoms and perceptions of their management in in-centre hemodialysis care: a mixed methods study. J Patient Rep Outcomes 2021; 5:111. [PMID: 34709470 PMCID: PMC8555046 DOI: 10.1186/s41687-021-00385-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background We aimed to describe (1) depressive and anxiety symptom burdens reported by adults on in-centre hemodialysis in Northern Alberta, Canada and (2) patients’ and nurses’ perceptions of managing such symptoms using routine patient-reported outcome measures (PROMs). Methods A longitudinal mixed methods approach was employed. Cluster randomized controlled trial data exposed the prevalence of positive screens (scores ≥ 3) for depressive (PHQ-2) and anxiety (GAD-2) symptoms. A descriptive qualitative approach was used to understand patients’ and nurses’ perceptions of managing these symptoms using the ESAS-r: Renal and EQ-5D-5L. Using purposeful sampling, patients and nurses were invited for interviews. Field notes were documented from 6 dialysis unit observations. Patients’ responses to open-ended survey questions and nurses’ electronic chart notes related to mental health were compiled. Thematic and content analyses were used. Results Average age of patients (n = 408) was 64.0 years (SD 15.4), 57% were male, and 87% were not working; 29% screened positive for depressive symptoms, 21% for anxiety symptoms, and 16% for both. From patient (n = 10) and nurse (n = 8) interviews, unit observations, patient survey responses (n = 779) and nurses’ chart notes (n = 84), we discerned that PROMs (ESAS-r: Renal/EQ-5D-5L) had the potential to identify and prompt management of mental health concerns. However, opinions differed about whether mental health was within kidney care scope. Nonetheless, participants agreed there was a lack of mental health resources. Conclusions Prevalence of depressive and anxiety symptoms aligned with existing literature. Tensions regarding mental health management highlight the need for systemic decisions about how routine PROM use, including mental health assessment, may be optimized to meet patients’ needs. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00385-z.
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Affiliation(s)
- Kara Schick-Makaroff
- 5-295 Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Lisa A Wozniak
- 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Hilary Short
- 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Sara N Davison
- 11-113L Clinical Sciences Building, Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | - Scott Klarenbach
- 11-107 Clinical Sciences Building, Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | | | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Marion Wing, Level 3, St. Joseph's Healthcare, 50 Charlton Ave. E., Hamilton, ON, L8N 4A6, Canada
| | - Jeffrey A Johnson
- 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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A philosophical perspective on the development and application of patient-reported outcomes measures (PROMs). Qual Life Res 2021; 31:1703-1709. [PMID: 34657279 DOI: 10.1007/s11136-021-03016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Questionnaires are a common method in healthcare and clinical research to collect self-reported data on patients' behaviour and outcomes rather than the clinician's perspective. As a consequence there is a plethora of questionnaires and rating forms developed to measure a range of concepts such as health-related quality of life and health status. Given that these measures have been developed within a nomothetic paradigm to enhance our understanding of peoples self-perceived health status by translating complex personal feelings and experiences into a simple numeric score, the patient's illness narrative is lost along the way. This commentary discusses the limitations of the nomothetic approach as completion of a questionnaire is a social and contextually orientated activity and that their development is best viewed within the philosophical tradition of pragmatism, based on sound qualitative methods and rigorous psychometric testing. The commentary discusses the philosophical orientation underpinning PROM development and argues the case for a pragmatic epistemology based on a mixed methods research paradigm which goes beyond the current practice of informing the content validity of a PROM in the early phase of its development but to work towards developing a more composite and holistic picture through mixed methods in the interpretation of a patient's PROM score. Therefore, it is argued that the quality of data obtained will be enhanced but, also importantly and rightly places the participant at the centre of the research.
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Goodman MS, Ackermann N, Pierce KA, Bowen DJ, Thompson VS. Development and Validation of a Brief Version of the Research Engagement Survey Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10020. [PMID: 34639323 PMCID: PMC8507896 DOI: 10.3390/ijerph181910020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
The Research Engagement Survey Tool (REST) examines the level of partner engagement in research studies. This study used mixed methods, including web-based surveys (N = 336), a modified Delphi process (N = 18), and cognitive response interviews (N = 16), with convenience sampling to develop and validate a short version of the REST. We conducted factor analysis and calculated internal consistency for the condensed REST. We validated the condensed REST against the comprehensive REST. All analyses were carried out on two scales (quality and quantity) based on Likert-type response options. We examined convergent validity with other measures theoretically associated with the REST (e.g., the Community Engagement Research Index and the Partnership Self-Assessment Tool). This study produced a 9-item condensed version of the REST. The condensed REST loads on 1 factor, has high internal consistency (Cronbach's alpha = 0.92 for the quantity scale; 0.94 for the quality scale), is significantly correlated (ρ = 0.97; p < 0.001 for both scales) with the comprehensive (32-item) REST, and has negligible, low, and moderate correlation with other measures (e.g., the Partnership Assessment In community-based Research, trust in medical researchers, and the Coalition Self-Assessment Survey). Use of the condensed REST will reduce participant burden and time to complete. This standardized and validated quantitative measure is useful to compare engagement across projects or within a project over time.
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Affiliation(s)
- Melody S. Goodman
- School of Global Public Health, New York University, New York, NY 10003, USA;
| | - Nicole Ackermann
- Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Kristyn A. Pierce
- School of Global Public Health, New York University, New York, NY 10003, USA;
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA;
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Alidina S, Tibyehabwa L, Alreja SS, Barash D, Bien-Aime D, Cainer M, Charles K, Ernest E, Eyembe J, Fitzgerald L, Giiti GC, Hellar A, Hussein Y, Kahindo F, Kenemo B, Kihunrwa A, Kisakye S, Kissima I, Meara JG, Reynolds C, Staffa SJ, Sydlowski M, Varallo J, Zanial N, Kapologwe NA, Mayengo CD. A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment. HUMAN RESOURCES FOR HEALTH 2021; 19:115. [PMID: 34551758 PMCID: PMC8458007 DOI: 10.1186/s12960-021-00652-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/01/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. METHODS We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania's Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. RESULTS Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention's success emerged: (1) the intervention's design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee-mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors' understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. CONCLUSIONS Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | | | - Danta Bien-Aime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Monica Cainer
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Kevin Charles
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | | | - Laura Fitzgerald
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Geofrey C. Giiti
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Yahaya Hussein
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Benard Kenemo
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Steve Kisakye
- D-Implement, Dalberg Advisors, Dar es Salaam, Tanzania
| | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cheri Reynolds
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Ntuli A. Kapologwe
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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Miller MJ, Morris MA, Magnusson DM, Putnam K, Cook PF, Schenkman ML, Christiansen CL. Psychosocial Factors Influence Physical Activity after Dysvascular Amputation: A Convergent Mixed-Methods Study. PM R 2021; 13:737-745. [PMID: 32936512 PMCID: PMC7873162 DOI: 10.1002/pmrj.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physical function is a common target of rehabilitation intervention to improve disability and physical activity after dysvascular lower-limb amputation (LLA); yet, the influence of psychosocial factors on physical activity is unclear. OBJECTIVE To identify psychosocial factors with potential to influence clinically relevant measures of physical activity, physical function, and disability in light of participants' narratives. DESIGN Convergent mixed-methods. SETTING General community. PARTICIPANTS Twenty participants with dysvascular LLA were enrolled if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and were between 45 and 88 years old. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Quantitative data included physical activity (activPAL; steps/d), physical function (Timed Up-and-Go; TUG), and disability (World Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0). Qualitative data were collected via semistructured interviews. RESULTS Higher steps/d was moderately correlated with better TUG time (r = -.58, P < .01), but was not correlated with WHODAS 2.0 score (r = -0.18; P > .10). Qualitative analysis of interviews, using an inductive, team-based, phenomenological approach, identified four themes: (1) perceptions of their prosthesis, (2) fear during mobility, (3) influence of LLA on life activities, and (4) positive outlook within social interactions. Mixed-methods analysis used an iterative approach to interpret and describe how psychosocial factors influence physical activity in four exemplar cases. CONCLUSIONS Physical activity in people with dysvascular LLA results from an interaction among perceptions of their prosthesis, fear during mobility, influence of LLA on life activities, and positive outlook within social interactions. The overlapping nature of these themes suggests that interventions targeting psychosocial factors may be associated with improved physical activity, physical function, and subsequent disability after dysvascular LLA.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Megan A Morris
- Adult and Child Consortium of Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Dawn M Magnusson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Kelly Putnam
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, CO, USA
| | - Margaret L Schenkman
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, CO, USA
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30
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Beckmann M, Dittmer K, Jaschke J, Karbach U, Köberlein-Neu J, Nocon M, Rusniok C, Wurster F, Pfaff H. Electronic patient record and its effects on social aspects of interprofessional collaboration and clinical workflows in hospitals (eCoCo): a mixed methods study protocol. BMC Health Serv Res 2021; 21:377. [PMID: 33892703 PMCID: PMC8063171 DOI: 10.1186/s12913-021-06377-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background The need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records. Methods eCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant observation, interviews, focus groups, time measurement, patient and employee questionnaires and a questionnaire to measure the level of digitalization. Furthermore, documents (patient records) as well as structural and administrative data are gathered. To analyze the interprofessional collaboration qualitative network analyses, reconstructive-hermeneutic analyses and document analyses are conducted. The workflow analyses, patient and employee assessment analyses and classification within the clinical adoption meta-model are conducted to provide insights into clinical workflows. Discussion This study will be the first to investigate the effects of introducing electronic patient records on interprofessional collaboration and clinical workflows from the perspective of healthcare professionals. Thereby, it will consider patients’ safety, legal and ethical concerns and quality of care. The results will help to understand the organization and thereby improve the performance of health services working with electronic patient records. Trial registration The study was registered at the German clinical trials register (DRKS00023343, Pre-Results) on November 17, 2020.
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Affiliation(s)
- Marina Beckmann
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
| | - Kerstin Dittmer
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Maya Nocon
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Carsten Rusniok
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Florian Wurster
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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Harhay MN, Klassen AC, Zaidi H, Mittelman M, Bertha R, Mannon RB, Lentine KL. Living Organ Donor Perspectives and Sources of Hesitancy about COVID-19 Vaccines. KIDNEY360 2021; 2:1132-1140. [PMID: 34337426 PMCID: PMC8323843 DOI: 10.34067/kid.0002112021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Living organ donation declined substantially in the United States during the COVID-19 pandemic due to concerns about donor and transplant candidate safety. COVID-19 vaccines might increase confidence in the safety of living organ donation during the pandemic. We assessed informational preferences and perspectives about COVID-19 vaccines among US living organ donors and prospective donors. METHODS We conducted a national survey study of organ donors and prospective donors on social media platforms between 12/28/2020-2/23/2021. Survey items included multiple choice, visual analog scale, and open-ended responses. We examined associations between information preferences, history of COVID-19 infection, influenza vaccination history and COVID-19 vaccine acceptance using multivariable logistic regression and performed a thematic analysis of open-ended responses. RESULTS Among 342 respondents from 47 US states and the District of Columbia, 35% were between 51-70 years old, 90% were non-Hispanic white, 87% were women; 82% were living donors (94% kidney) and 18% in evaluation to donate (75% kidney).The majority planned to or had received COVID-19 vaccination (76%), whereas 11% did not plan to be receive a vaccine, and 12% were unsure. Adjusting for demographics and donor characteristics, respondents who receive yearly influenza vaccinations had higher COVID-19 vaccine acceptance than those who do not (adjusted Odds Ratio [aOR] 5.06, 95% Confidence Interval [CI] 2.68-9.53). Compared to respondents who prioritized medical information sources (e.g., personal physicians and transplant providers), those who prioritized news and social media had lower COVID-19 vaccine acceptance (aOR 0.34, 95% CI 0.15-0.73). Low perceived personal benefit from vaccination and uncertainty about long-term safety were common themes among those declining COVID-19 vaccines. CONCLUSIONS Donor informational source preferences were strongly associated with the likelihood of accepting a COVID-19 vaccine. Vaccine guidance for organ donors who are unsure about COVID-19 vaccines could incorporate messaging about safety and benefits of vaccination for healthy people.
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Affiliation(s)
- Meera N. Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania,Division of Nephrology, Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania
| | - Ann C. Klassen
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Hasan Zaidi
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Rebecca Bertha
- American Living Organ Donor Fund, Philadelphia, Pennsylvania
| | - Roslyn B. Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
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Gustavson AM, LeDoux CV, Stutzbach JA, Miller MJ, Seidler KJ, Stevens-Lapsley JE. Mixed-Methods Approach to Understanding Determinants of Practice Change in Skilled Nursing Facility Rehabilitation: Adapting to and Sustaining Value With Postacute Reform. J Geriatr Phys Ther 2021; 44:108-118. [PMID: 33534337 PMCID: PMC8869848 DOI: 10.1519/jpt.0000000000000288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Postacute care reform is driving physical and occupational therapists in skilled nursing facilities (SNFs) to change how they deliver care to produce better outcomes in less time. However, gaps exist in understanding determinants of practice change, which limits translation of evidence into practice. This study explored what determinants impacted change in care delivery at 2 SNFs that implemented a high-intensity resistance training intervention. METHODS We used a mixed-methods, sequential explanatory design to explain quantitative findings using qualitative methods with a multiple-case study approach. Quantitative data were collected on therapists' attitudes toward evidence-based practice and aspects of intervention implementation. We conducted focus groups with therapists (N = 15) at 2 SNFs, classified as either high- (SNF-H) or low-performing (SNF-L) based on implementation fidelity and sustainability. RESULTS AND DISCUSSION Determinants of SNF rehabilitation practice change included the organizational system, team dynamics, patient and therapist self-efficacy, perceptions of intervention effectiveness, and ability to overcome preconceived notions. A patient-centered system, positive team dynamics, and ability to overcome preconceived notions fostered practice change at SNF-H. While self-efficacy and perception of effectiveness positively impacted change in practice at both SNFs, these determinants were not enough to overcome challenges at SNF-L. To adapt to changes and sustain rehabilitation value, further research must identify the combination of determinants that promote application of evidence-based practice. CONCLUSIONS This study is the first step in understanding what drives change in SNF rehabilitation practice. As SNF rehabilitation continues to face changes in health care delivery and reimbursement, therapists will need to adapt, by changing practice patterns and adopting evidence-based approaches, to demonstrate value in postacute care.
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Affiliation(s)
- Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Cherie V LeDoux
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - Julie A Stutzbach
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - Matthew J Miller
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco
- Division of Geriatrics, University of California, San Francisco
| | - Katie J Seidler
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora
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Doraiswamy S, Billah SM, Karim F, Siraj MS, Buckingham A, Kingdon C. Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study. Reprod Health 2021; 18:34. [PMID: 33563303 PMCID: PMC7871368 DOI: 10.1186/s12978-021-01098-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician–patient communication leading to informed-consent for the operation. Methods We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥ 80 births every month; and for physicians, was that they had performed CSs. Women aged ≥ 18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. Results In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician–patient communication in the context of labour situations, the OPTION5 mean scores were low (5–25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication. Conclusions Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.
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Affiliation(s)
| | - Sk Masum Billah
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Farhana Karim
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
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Jackman KMP, Hightow-Weidman L, Poteat T, Wirtz AL, Kane JC, Baral SD. Evaluating psychometric determinants of willingness to adopt sexual health patient portal services among black college students: A mixed-methods approach. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:190-197. [PMID: 31710578 PMCID: PMC7211543 DOI: 10.1080/07448481.2019.1660352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Objectives: To describe, using mixed-methods, perceptions of access to sexually transmitted infection test results via electronic personal health record (PHR) and correlates of willingness to adopt its use. Participants: Students at a mid-Atlantic historically black college. Methods: Focus-groups and interviews were conducted to explore themes on sexual health-related PHR-use (N = 35). Codes were operationalized into survey measures assessing beliefs in a cross-sectional sample (N = 354). Exploratory factor analysis identified latent factors among survey items. Multiple logistic regression models measured correlates of adoption willingness. Results: Three qualitative themes emerged on relative advantages, barriers, and functionality of PHRs. 57.6% of survey participants were willing to use PHRs for sexual health services. Reliable latent factors, centering on PHR convenience and functionality, were positively associated with adoption willingness. Conclusions: Data highlights interest among black college-age youth in adopting PHRs for comprehensive sexual health-related services. Adoption may be boosted with tailored designs responsive to expressed service needs.
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Affiliation(s)
- Kevon-Mark P Jackman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy C Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Madsen MN, Kirkegaard ML, Klebe TM, Linnebjerg CL, Villumsen SMR, Due SJ, Trøstrup J, Rossen CB, Birk HO, Elmengaard B, Mikkelsen LR. Inter-professional agreement and collaboration between extended scope physiotherapists and orthopaedic surgeons in an orthopaedic outpatient shoulder clinic - a mixed methods study. BMC Musculoskelet Disord 2021; 22:4. [PMID: 33397350 PMCID: PMC7784386 DOI: 10.1186/s12891-020-03831-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
Background Extended scope physiotherapists (ESP) are increasingly supplementing orthopaedic surgeons (OS) in diagnosing patients with musculoskeletal disorders. Studies have reported satisfactory diagnostic and treatment agreement between ESPs and OSs, but methodological study quality is generally low, and only few studies have evaluated inter-professional collaboration. Our aims were: 1) to evaluate agreement on diagnosis and treatment plan between ESPs and OSs examining patients with shoulder disorders, 2) to explore and evaluate their inter-professional collaboration. Methods In an orthopaedic outpatient shoulder clinic, 69 patients were examined independently twice on the same day by an ESP and an OS in random order. Primary and secondary diagnoses (nine categories) and treatment plan (five categories, combinations allowed) were registered by each professional and compared. Percentage of agreement and kappa-values were calculated. Two semi-structured focus-group interviews were performed with ESPs and OSs, respectively. Interviews were based on the theoretical concept of Relational Coordination, encompassing seven dimensions of communication and relationship among professionals. A thematic analysis was conducted.
Results Agreement on primary diagnosis was 62% (95% CI: [50; 73]). ESPs and OSs agreed on the combination of diagnoses in 79% (95% CI: [70; 89]) of the cases. Partial diagnostic agreement (one professional’s primary diagnosis was also registered as either primary or secondary diagnosis by the other) was 96% (95% CI: [91; 100]). Across treatment categories, agreement varied between 68% (95% CI: [57; 79]) and 100%. In 43% (95% CI: [31; 54]) of the cases, ESP and OS had full concordance between treatment categories chosen, while they agreed on at least one recommendation in 96% (95% CI: [91; 100]). Positive statements of all dimensions of relational coordination were found. Three themes especially important in the inter-professional collaboration emerged: Close communication, equal and respectful relationship and professional skills.
Conclusions In the majority of cases, the ESP and OS registered the same or partly the same diagnosis and treatment plan. Indications of a high relational coordination implying a good inter-professional collaboration were found. Our results support that ESPs and OSs can share the task of examining selected patients with shoulder disorders in an orthopaedic clinic. Trial registration ClinicalTrials.gov Identifier: NCT03343951. Registered 10 November 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03831-z.
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Affiliation(s)
| | | | | | | | | | - Stine Junge Due
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Jeanette Trøstrup
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Hans Okkels Birk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brian Elmengaard
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Lone Ramer Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lee M, Choi Y, Lee EY, Kim DA, Ho SH. Life Experiences with Using Community Care among People with Severe Physical Disabilities: A Comparative Analysis between South Korea and Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9195. [PMID: 33317015 PMCID: PMC7764412 DOI: 10.3390/ijerph17249195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/02/2022]
Abstract
This study identified the pathways chosen by people with severe physical disabilities (PWSPD) in South Korea and Japan in using community care throughout their life and compared their experiences while navigating these pathways from their perspective. A concurrent nested mixed-method design was adopted. Quantitative data analysis included pathway mapping of facilities and services used throughout their lives. For qualitative data, interpretative phenomenological analysis (IPA) was applied. Eleven South Korean (congenital 7, acquired 4) and nine Japanese (congenital 6, acquired 3) participants were surveyed and interviewed. Pathway mapping was conducted by classifying the participants into focus groups. South Korean participants took nine years more than the Japanese participants to reach independence and showed different pathway characteristics. Superordinate themes from the IPA provided insight into the differences in experiences between PWSPD of the two countries: (1) accessibility and continuity of medical services; (2) experience of vocational training; (3) way and degree of social support for independent living; (4) care planning for receiving comprehensive services. In developing a community care model for the PWSPD to accelerate their time to independence, the government should strive for accessibility and connectivity of medical services, strengthen vocational training, social support for independent living, and information provision for the PWSPD.
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Affiliation(s)
- Minyoung Lee
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (Y.C.); (E.Y.L.)
| | - Yeji Choi
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (Y.C.); (E.Y.L.)
| | - Eun Young Lee
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (Y.C.); (E.Y.L.)
| | - Dong-A Kim
- Division of Public Medical Rehabilitation, National Rehabilitation Center, Seoul 01022, Korea;
| | - Seung Hee Ho
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (Y.C.); (E.Y.L.)
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Intellectual Property Management in Publicly Funded R&D Program and Projects: Optimizing Principal–Agent Relationship through Transdisciplinary Approach. SUSTAINABILITY 2020. [DOI: 10.3390/su12239923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Large-scale, publicly funded research and development (R&D) programs are implemented to accelerate state-of-the-art science, technology, and innovation applications that are expected to solve various societal problems. The present study aims to build on the body of theory on the mechanisms that promote or impede the creation of intellectual property in such programs. Using a mixed methods approach and combining quantitative network analysis and qualitative semistructured interviews, we conducted a case study to investigate best practices in terms of intellectual property creation in a Japanese governmental research and development program. The results of the network analysis showed that the core/periphery structure in the co-inventor network of patents and joint application by a university and a startup promoted intellectual property creation. The results of the interview confirmed the significance of a reciprocal mindset, which the researchers in academia could acquire through collaboration with a startup. These results suggest that a knowledge logistics system for agile intellectual property management can be established by learning to acquire tacit knowledge on social implementation. Furthermore, we focus on the principal–agent relationship between knowledge producers and knowledge consumers as a factor that impedes the creation of intellectual property. We also discuss adverse selection and moral hazards caused by information asymmetry between knowledge producers and knowledge consumers and how to deal with them.
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The utility of the implementation science framework "Integrated Promoting Action on Research Implementation in Health Services" (i-PARIHS) and the facilitator role for introducing patient-reported outcome measures (PROMs) in a medical oncology outpatient department. Qual Life Res 2020; 30:3063-3071. [PMID: 33089474 PMCID: PMC8528793 DOI: 10.1007/s11136-020-02669-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE We evaluated the utility of the implementation science framework "Integrated Promoting Action on Research Implementation in Health Services" (i-PARIHS) for introducing patient-reported outcome measures (PROMs) into a medical oncology outpatient department. The i-PARIHS framework identifies four core constructs for implementation, including Facilitation, Innovation, Context and Recipients. METHODS A pilot study used the i-PARIHS framework to identify PROM implementation barriers and enablers to inform facilitation support strategies, such as training clinicians and staff, workflow support, technical support and audit and feedback. Pre- and post-implementation surveys were completed by 83 and 72 staff, respectively, (nurses, doctors and allied health), to assess perceived knowledge, enablers, barriers and utility of PROMs; and acceptability of the PROM intervention was also assessed post-implementation. RESULTS Important barriers included time constraints and previous experiences with technology. Enablers included good leadership support and a culture of learning. Facilitation strategies were used to overcome barriers identified in the i-PARIHS core domains. Compared to before the intervention, staff surveys showed improvement in perceived usefulness, perceived understanding and interpretation skills for PROMs. Staff perceptions about lack of time to use PROMs during visits remained a major perceived barrier post-implementation. CONCLUSION The i-PARIHS framework was useful for guiding the implementation of PROMs in routine oncology care. The four core i-PARIHS constructs (Facilitation, Innovation, Context and Recipients) identified factors that directly impacted implementation, with Facilitation having a particularly important role to overcome these barriers. Oncology clinics and health systems considering implementing PROMs should consider having a dedicated Facilitator available during PROM implementation.
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Irvine FE, Clark MT, Efstathiou N, Herber OR, Howroyd F, Gratrix L, Sammut D, Trumm A, Hanssen TA, Taylor J, Bradbury-Jones C. The state of mixed methods research in nursing: A focused mapping review and synthesis. J Adv Nurs 2020; 76:2798-2809. [PMID: 32896959 DOI: 10.1111/jan.14479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/31/2020] [Accepted: 07/14/2020] [Indexed: 12/29/2022]
Abstract
AIMS To consider the scope and quality of mixed methods research in nursing. DESIGN Focused mapping review and synthesis (FMRS). DATA SOURCES Five purposively selected journals: International Journal of Nursing Studies, Journal of Nursing Scholarship, Journal of Advanced Nursing, Worldviews on Evidence-Based Nursing, and Journal of Mixed Methods Research. REVIEW METHODS In the target journals, titles and abstracts from papers published between 2015-2018 were searched for the words or derivative words 'mixed methods'. Additional keyword searches were undertaken using each journal's search tool. We included studies that investigated nursing and reported to use a mixed methods approach. Articles that met the inclusion criteria were read in full and information was extracted onto a predetermined pro forma. Findings across journals were then synthesized to illustrate the current state of mixed methods research in nursing. RESULTS We located 34 articles that reported on mixed methods research, conducted across 18 countries. Articles differed significantly both within and across journals in terms of conformity to a mixed methods approach. We assessed the studies for the quality of their reporting as regard the use of mixed methods. Nineteen studies were rated as satisfactory or good, with 15 rated as poorly described. Primarily, a poor rating was due to the absence of stating an underpinning methodological approach to the study and/or limited detail of a crucial integration phase. CONCLUSIONS Our FMRS revealed a paucity of published mixed methods research in the journals selected. When they are published, there are limitations in the detail given to the underpinning methodological approach and theoretical explanation.
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Affiliation(s)
| | | | | | - Oliver R Herber
- Medical Faculty of the Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Fiona Howroyd
- Critical Care and Therapy Services, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Dana Sammut
- University of Birmingham, Birmingham, UK.,University Hospitals Birmingham, Birmingham, UK
| | | | - Tove A Hanssen
- UIT The Arctic University of Norway, Tromsø, Norway.,University Hospital of North Norway, Tromsø, Norway
| | - Julie Taylor
- University of Birmingham, Birmingham, UK.,Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
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Klingshirn H, Müller M, Beutner K, Hirt J, Strobl R, Grill E, Meyer G, Saal S. Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial. BMC Geriatr 2020; 20:270. [PMID: 32758147 PMCID: PMC7405353 DOI: 10.1186/s12877-020-01655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial. Trial registration German clinical trials register, DRKS00010037. Registered 12 February 2016.
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Affiliation(s)
- Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Katrin Beutner
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Julian Hirt
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,German Centre for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,German Centre for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377, Munich, Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Susanne Saal
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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Health-related quality of life in adult CHD surgical patients in a low middle-income country: a mixed-methods study. Cardiol Young 2020; 30:1126-1137. [PMID: 32633708 DOI: 10.1017/s1047951120001663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES This mixed-methods study aimed to assess health-related quality of life in young adults with CHD following surgery in a low middle-income country, Pakistan. Despite the knowledge that geographic, cultural and socio-economic factors may shape the way health and illness is experienced and managed and consequently determine a person's health-related quality of life, few health-related quality of life studies are conducted in low middle-income countries. This deficit is pronounced in CHD, so there is little guidance for patient care. METHODS The study utilised concurrent, mixed methods. Adults with CHD (n = 59) completed health-related quality of life surveys (PedsQLTM 4.0 Generic Core Scale, PedsQLTM Cognitive Functioning Scale and PedsQLTM 3.0 Cardiac Module). Semi-structured interview data were collected from a nested sub-sample of 17 participants and analysed using qualitative content analysis, guided by the revised Wilson-Cleary model of health-related quality of life. RESULTS The lowest health-related quality of life domain was emotional with the mean score (71.61 ± 20.6), followed by physical (78.81 ± 21.18) and heart problem (79.41 ± 18.05). There was no statistical difference in general or cardiac-specific health-related quality of life between mild, moderate or complex CHD. Qualitative findings suggested low health-related quality of life arose from a reduced capacity to contribute to family life including family income and gender. A sense of reduced marriageability and fear of dependency were important socio-cultural considerations. CONCLUSIONS CHD surgical patients in this low-income country experience poor health-related quality of life, and contributing factors differ to those reported for high-income countries. Socio-cultural understandings should underpin assessment, management and care-partnering with young adults with CHD following surgical correction.
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Gilljam BM, Nygren JM, Svedberg P, Arvidsson S. Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study. J Med Internet Res 2020; 22:e17673. [PMID: 32720907 PMCID: PMC7420525 DOI: 10.2196/17673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background For children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. Objective The aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. Methods A quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation. Results Pediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. Conclusions This study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.
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Affiliation(s)
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Miraglia Raineri A, Bonfigliuoli C, Camaiani F, Sarli L, Artioli G. Italian pilot version of DEMOQL-PROXY: Content and Face validity: a methodological bridge for a future Italian validation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:100-105. [PMID: 32573512 PMCID: PMC7975843 DOI: 10.23750/abm.v91i6-s.10011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The assessment of Quality of Life through validated tools allow to improve level of assistance for people suffering from Dementia. To our Knowledge in Italian language seem to be absent a tool to evaluate mild and moderate dementia, consequently underestimating and underrating needs of this specific target. We show an Italian pilot version of the DEMQOL-PROXY (specific for mild and moderate Dementia) testing some psychometric properties as: back-translation, content validity and face validity in Italian language. METHOD A back-translation by two bilingual authors was presented. Was enrolled an expert panel to test Content Validity composed by eight Medical Doctor and a panel of six participants was recruited to assess Face Validity (three professional caregivers and three family caregivers) related to patients with moderate Dementia (with 10 to 20 MMSE, mild and moderate Dementia). RESULTS Each item has a degree of agreement between experts of more than 70% and the Total CVI score is .90 (90% of agreement). So, in line with these results we can accept the version of items proposed. As regard Face Validity, the items of the instrument seem to be clear, without difficulty and there are no questions consiedered offensive or irritating. CONCLUSION The Italian version of the DEMQOL-PROXY showed good psychometric properties: its structure and the results it leads to are similar to the original version and to the other translations produced so far. For this reason, we consider this paper as a methodological bridge for a future complete Italian Validation.
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Affiliation(s)
| | | | | | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma, Italy .
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Sundelin R, Bergsten C, Tornvall P, Lyngå P. Self-rated stress and experience in patients with Takotsubo syndrome: a mixed methods study. Eur J Cardiovasc Nurs 2020; 19:740-747. [PMID: 32491953 PMCID: PMC7817986 DOI: 10.1177/1474515120919387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A relation to stress and stressful triggers is often, but not always, described in patients with Takotsubo syndrome. Few studies have focused on patients' self-rated stress in combination with qualitative experiences of stress in Takotsubo syndrome. AIMS The aim of this study was to describe stress before and after the onset of Takotsubo syndrome. METHODS Twenty patients were recruited from five major hospitals in Stockholm, Sweden between December 2014 and November 2018. A mixed methods design was used containing the validated questionnaire, perceived stress scale (PSS-14) filled in at baseline and at a 6 and 12-month follow-up, respectively. Qualitative interviews were made at the 6-month follow-up. RESULTS Self-rated stress, measured by the perceived stress scale, showed stress levels above the cut-off value of 25, at the onset of Takotsubo syndrome (median 30.5). Stress had decreased significantly at the 12-month follow-up (median 20.5, P = 0.039) but remained high in one third of the patients. Qualitative interviews confirmed a high long-term stress and half of the patients had an acute stress trigger before the onset of Takotsubo syndrome. The qualitative interviews showed that the patients had reflected on and tried to find ways to deal with stress, but for many this was not successful. CONCLUSION Patients with Takotsubo syndrome reported long-term stress sometimes with an acute stress trigger before the onset of Takotsubo syndrome. Stress decreased over time but remained high for a considerable number of patients. Despite reflection over stress and attempts to deal with stress many were still affected after 6 months. New treatment options are needed for patients with Takotsubo syndrome.
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Affiliation(s)
- Runa Sundelin
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Chatarina Bergsten
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Per Tornvall
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Patrik Lyngå
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
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Pham CT, Gibb CL, Fitridge RA, Karnon J, Hoon E. Supporting surgeons in patient-centred complex decision-making: a qualitative analysis of the impact of a perioperative physician clinic. BMJ Open 2019; 9:e033277. [PMID: 31874889 PMCID: PMC7008411 DOI: 10.1136/bmjopen-2019-033277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with comorbidities can be referred to a physician-led high-risk clinic for medical optimisation prior to elective surgery at the discretion of the surgical consultant, but the factors that influence this referral are not well understood. The aims of this study were to understand the factors that influence a surgeon's decision to refer a patient to the clinic, and how the clinic impacts on the management of complex patients. DESIGN Qualitative study using theoretical thematic analysis to analyse transcribed semi-structured interviews. SETTING Interviews were held in either the surgical consultant's private office or a quiet office/room in the hospital ward. PARTICIPANTS Seven surgical consultants who were eligible to refer patients to the clinic. RESULTS When discussing the factors that influence a referral to the clinic, all participants initially described the optimisation of comorbidities and would then discuss with examples the challenges with managing complex patients and communicating the risks involved with having surgery. When discussing the role of the clinic, two related subthemes were dominant and focused on the management of risk in complex patients. The participants valued the involvement of the clinic in the decision-making and communication of risks to the patient. CONCLUSIONS The integration of the high-risk clinic in this study appears to offer additional value in supporting the decision-making process for the surgical team and patient beyond the clinical outcomes. The factors that influence a surgeon's decision to refer a patient to the clinic appear to be driven by the aim to manage the uncertainty and risk to the patient regarding surgery and it was seen as a strategy for managing difficult and complex cases.
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Affiliation(s)
- Clarabelle T Pham
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine L Gibb
- Perioperative High Risk Clinic, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Fitridge
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jon Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth Hoon
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Hiltrop K, Heidkamp P, Kowalski C, Ernstmann N. Breast cancer patients' return to work (B-CARE): protocol of a longitudinal mixed-methods study aiming to explore medical and occupational rehabilitation of patients with breast cancer in Germany. BMJ Open 2019; 9:e033533. [PMID: 31874892 PMCID: PMC7008453 DOI: 10.1136/bmjopen-2019-033533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In recent years, research has been done on determinants of return to work (RTW) in cancer survivors and their long-term work outcomes. Nevertheless, little is known about the survivors' evaluation of these outcomes in terms of job satisfaction and voluntariness. Hence, B-CARE aims at filling the research gap by providing a longitudinal cohort study investigating medical and occupational rehabilitation including an evaluation by breast cancer survivors. METHODS AND ANALYSIS A mixed-methods approach, combining a quantitative survey with qualitative semi-structured interviews, is used to study breast cancer survivors 5-6 years after diagnosis. These data will be linked to data from prior waves of patients during hospitalisation and 10 and 40 weeks after hospital discharge as well as routine data from the German Statutory Pension Insurance Scheme and German Cancer Society if available. The actual survey focuses on determinants of medical rehabilitation use, RTW, subsequent employment patterns post care as well as the voluntariness of and satisfaction with job changes. ETHICS AND DISSEMINATION A positive vote from the ethics committee of the Medical Faculty of the University of Bonn has been obtained. Data protection regulations will be adhered to for all handled data. Personal identifiers of participants will be pseudonymised. Dissemination strategies include a workshop to discuss results among stakeholders such as representatives of the German Statutory Pension Insurance Scheme, social workers and self-help groups. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00016982); Pre-results.
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Affiliation(s)
- Kati Hiltrop
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Paula Heidkamp
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
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Bailey KM, Frost KM, Casagrande K, Ingersoll B. The relationship between social experience and subjective well-being in autistic college students: A mixed methods study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:1081-1092. [PMID: 31845592 DOI: 10.1177/1362361319892457] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This mixed methods study examined the relationship between the college social experience and subjective well-being in autistic students in the Midwestern United States. An online survey focused on social connectedness, social participation, social support, and subjective well-being. A semi-structured interview discussed transition, supports received, and social participation. Correlations and a hierarchical regression were used to examine the relationship between social experience variables and subjective well-being from the survey. Inductive thematic analysis was used to identify interview themes. Theme counts for students who reported higher and lower subjective well-being were examined. Social connectedness, time spent with friends, and perceived social support were positively correlated with students' subjective well-being, with social connectedness explaining unique variance. Common themes included challenges navigating a new social environment and the importance of family, friends, and professors in providing social support. Students with lower subjective well-being more frequently discussed struggles to make social connections and the trade-off between socializing and succeeding academically, whereas students with higher subjective well-being more frequently described college as providing opportunities to develop meaningful social connections. This study adds new perspectives on the college experience for autistic students and highlights the important role that social connections and support play in their subjective well-being.
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Sidebotham M, Walters C, Baird K, Gamble J. Simulated employment interviews: A collaborative approach to gaining understanding of the graduate midwife employment process. Women Birth 2019; 33:455-463. [PMID: 31708428 DOI: 10.1016/j.wombi.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/15/2022]
Abstract
Graduating midwives unsuccessful in gaining employment in their preferred model/location; or finding a job within a year of graduation are more likely to leave the profession. Obtaining post-graduate midwifery employment is competitive with midwifery students needing to confidently sell themselves to potential employers. Whilst midwifery students may be prepared with the requisite midwifery skills and knowledge, there is no guarantee of attaining a midwifery position upon graduation. Increasingly employers are requiring 'soft skills' including communication, teamwork, reflexivity and personal attributes of the individual to be able to effectively respond within different contexts. Demonstrating these skills within an employment interview requires confidence and knowledge in how to prepare. Designed with health service partners, simulated employment interviews were introduced into the final year of a Bachelor of Midwifery program as part of a suite of employability strategies connected to the student lifecycle. An exploratory evaluation study of students 'experiences of a simulated employment interview was undertaken. The simulated interview emulated real employment interviews with students receiving immediate written and oral feedback. Evaluation through surveys, focus groups and individual interviews provided rich data around the effectiveness of this approach. Students, health service partners and academics found the simulated employment interview provided a valuable learning experience, assisting students to reflect, explore and further develop skills sought by employers. Collaboration with health service partners created an authentic process enabling students to receive feedback relevant to the real world of practice. Students were able to work through anxiety, gain confidence and exposure to employers in preparation for employment interviews.
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Affiliation(s)
- Mary Sidebotham
- School of Nursing and Midwifery, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia; Transforming Maternity Care Collaborative, Southport, QLD, 4215, Australia.
| | - Caroline Walters
- School of Nursing and Midwifery, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia
| | - Kathleen Baird
- School of Nursing and Midwifery, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia; Transforming Maternity Care Collaborative, Southport, QLD, 4215, Australia; Women's & Newborn & Children's Services, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia; Transforming Maternity Care Collaborative, Southport, QLD, 4215, Australia
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Heuser C, Diekmann A, Ernstmann N, Ansmann L. Patient participation in multidisciplinary tumour conferences in breast cancer care (PINTU): a mixed-methods study protocol. BMJ Open 2019; 9:e024621. [PMID: 30962228 PMCID: PMC6500308 DOI: 10.1136/bmjopen-2018-024621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION A central instrument of multidisciplinary care is the multidisciplinary tumour conference (MTC). In MTCs, diagnosis and treatment of cancer patients are discussed, and therapy recommendations are worked out. As we found previously, patients participate in MTCs in some breast cancer centres in the state of North Rhine-Westphalia, Germany. However, studies on risks and benefits of patient participation have not provided substantiated findings. Therefore, the study's objective is to analyse differences between MTCs with and without patient participation. METHODS AND ANALYSIS This is an exploratory mixed-methods study. MTCs in six breast and gynaecological cancer centres in North Rhine-Westphalia, Germany, are examined. MTCs will be conducted with and without patient participation. First, interviews with providers concentrating on the feasibility of patient participation and quality of decision-making will be carried out, transcribed and analysed by means of content analysis. Second, videotaped or audiotaped participatory observations in MTCs will be executed. Video data or transcribed audio data from video and audio recordings will be coded using the established "Observational Assessment Rating Scale" for MTCs and analysed by comparing centres with and without patient participation. Third, all patients will fill out a questionnaire before and after MTC, including questions on psychosocial situation, decision-making and expectations before and experiences after MTC. The questionnaire data will be analysed by means of descriptive and multivariate statistics and pre-post-differences within and between groups. ETHICS AND DISSEMINATION Consultation and a positive vote from the ethics committee of the Medical Faculty of the University of Cologne have been obtained. For all collected data, relevant data protection regulations will be adhered to. All personal identifiers from patients and providers will be pseudonymised, except video recordings. Dissemination strategies include a discussion with patients and providers in workshops about topics such as feasibility, risks and benefits of patient participation in MTCs. TRIAL REGISTRATION NUMBER DRKS00012552.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
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