Is verbatim transcription of interview data always necessary?

Co-creating a Choosing Wisely leaflet supporting the reduction of imaging usage in low back pain management - A multi-method study

OBJECTIVE

The objective was to co-create an information resource in the form of a leaflet, to be distributed in clinical settings, websites or social media targeting people with low back pain.

METHODS

This multi-method study was conducted in four stages: literature search, input from practice consultants, program theory development, and think-aloud interviews with people experiencing low back pain. Each stage was followed by a consensus meeting in which the steering group refined the leaflet based on the emerging knowledge.

RESULTS

The literature search highlighted patients' need for easy-to-understand information about their back pain diagnosis, management strategies, social activities, work and solutions for supported self-management strategies. Practice consultants emphasized concise, relatable content. The program theory identified potential mechanisms for content creation, development, and implementation of the leaflet, such as addressing patient concerns, reducing diagnostic uncertainty, insights into management options, and validation. Think-aloud interviews with 18 people living with low back pain informed the iteration of the leaflet, enhancing language clarification and content comprehension.

CONCLUSIONS

We co-created a new Choosing Wisely leaflet, created with end-users in mind, specifically focused on reducing unnecessary imaging for low back pain.

PRACTICE IMPLICATIONS

This leaflet may support clinical settings in delivering evidence-based approaches and supporting self-management.

Development of a clinical decision-support tool for management of adolescent knee pain (The MAP-Knee tool)

BACKGROUND

Adolescent knee pain was historically viewed as a self-limiting condition. Still, it may severely impact health-related quality of life and physical activity, and almost half of adolescents may continue to experience pain into adulthood. Currently, no tool is available to support the consultation and shared decision-making process when an adolescent suffering from non-traumatic knee pain presents at clinical practice. By supporting shared decision-making and tailoring management strategies, such a tool could optimize treatment delivery and improve the prognosis of this common condition.

OBJECTIVES

This study aimed to develop a clinical decision-support tool (The MAP-Knee Tool) to improve the management of adolescents with non-traumatic knee pain.

DESIGN

Development study with end-user testing.

METHOD

This multi-step study consisted of five steps ((1-4) initial development and (5) end-user testing with adolescents with or without non-traumatic knee pain and medical doctors). It ended with the first version of the MAP-Knee Tool for the six most common non-traumatic knee pain conditions. The tool includes four components: 1) tool for diagnosing, 2) credible explanations of the diagnoses based on two systematic literature searches and an Argumentative Delphi process with international experts, 3) prognostic factors based on an individual participant data meta-analysis, and 4) option grid including an unbiased presentation of management options based on the available evidence.

RESULTS

We included seven children/adolescents (8-15 years old) and seven medical doctors for the end-user testing. All four components were revised accordingly, and the text was condensed as the initial draft was too comprehensive.

CONCLUSIONS

We developed a clinical decision-support tool for clinicians and adolescents with non-traumatic knee pain based on a multi-step process, including end-user testing to support the consultation in clinical practice.

Developing a Dyadic Immersive Virtual Environment Technology Intervention for Persons Living With Dementia and Their Caregivers: Multiphasic User-Centered Design Study

BACKGROUND

Persons living with dementia and their caregivers experience frequent emotional health challenges. Across the illness spectrum, engaging in shared pleasant activities is an important feature of well-being for persons living with dementia-caregiver dyads. Under the umbrella of virtual reality, immersive virtual environment technology (IVET) offers artificial sensory experiences and shows promise in this population. IVET development benefits from a user-centered design approach, and as an emerging field, preliminary testing of safety, usability, and engagement for person living with dementia-caregiver dyads is required.

OBJECTIVE

We aimed to develop a preliminary IVET intervention for psychosocial health among person living with dementia-caregiver dyads. In doing so, we highlight design considerations and user preferences to ensure the safety and usability of technology-based interventions in the context of dementia.

METHODS

We engaged 10 clinicians, 8 caregivers, and 3 persons living with dementia in 5 rounds of focus groups to evaluate the safety and usability of preliminary intervention features. Following prototype development, we engaged caregivers and persons living with dementia (n=9 dyads) in beta testing workshops to observe real-time user interaction with the intervention and guide refinements. Rapid data analysis was used to extract themes relevant to intervention development.

RESULTS

The following themes emerged from focus groups to inform prototype development: (1) designing flexibly to allow users to tailor the intervention experience to their own environmental context and circumstance, (2) designing with the dyad's clinical and relational needs in mind, and (3) accounting for illness and aging-related challenges in design. The following themes emerged from workshops to inform prototype refinements: (1) increasing user support through more feedback and (2) increasing variety of visual and auditory feedback.

CONCLUSIONS

Using user feedback throughout the development process, we developed a prototype of an IVET intervention, Toolkit for Experiential Well-Being in Dementia (the Isle of TEND), tailored to the needs of persons living with dementia and their caregivers. Our prototype uses specific design features to promote safety, usability, and engagement in the context of dementia. Future feasibility testing of the intervention is warranted.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/52799.

Patients' perspectives about sharing information with providers on social needs during pregnancy: a qualitative study

BACKGROUND

There is increasing interest in addressing adverse social determinants of health (SDoH) as a part of clinical care, yet there is limited understanding about the perspectives of patients, including pregnant and postpartum individuals from marginalized groups, that can be used to inform collection and use of information about patients' social needs. This study examines the perceptions of patients regarding barriers to and facilitators of sharing information about social needs during pregnancy with their obstetric providers.

METHODS

In this qualitative study, we conducted exploratory semi-structured telephone and in-person interviews with pregnant and postpartum patients of an ambulatory obstetrics and gynecology clinic serving a large and racially diverse population primarily covered by Medicaid. Researchers recruited English-speaking pregnant and postpartum individuals 18 years or older during their clinic visits. We asked about experiences of and preferences for sharing social needs information with healthcare providers and receiving support to address those needs. We used deductive and reflective thematic analysis to categorize verbatim transcripts of the patients' interviews into codes and themes.

RESULTS

Twenty-two pregnant (6 to 37 weeks of gestation) and 4 postpartum (1 to 1.5 months postpartum) patients participated in interviews. Their median age was 28 years (range: 18 to 38); 54% identified as Black, 19% White, 12% Latinx, 8% Asian, and 8% multiracial. We delineated two subthemes relating to perceived barriers to sharing information about social needs with providers: process barriers (never/inconsistently asked; limited time during appointments; inadequate ways to capture information about pregnancy-related social needs); and expectation discordancy barriers (skepticism about providers' intentions to help; perceiving the clinician role as limited to physical health). Additionally, we defined two subthemes that facilitate patients' sharing social needs information with providers: relational facilitators (good relationships with providers; providers demonstrate effective interpersonal skills; pregnancy as opportune time to build relationships with providers); and process facilitators (ensured privacy and confidentiality; receiving more than a list of resources).

CONCLUSIONS

Health systems should consider the perspectives of patients to inform processes around the collection and use of information about SDoH to increase equity, improve patient-centered care during pregnancy, and improve maternal and infant outcomes.

The phenomenographic outcome space of nurse educators' conception of nursing students collaboration in clinical skills lab

AIM

This study aimed to understand the variety of nurse educators' conceptions of nursing students' collaboration in clinical skills lab activities.

BACKGROUND

Collaborative learning has gained attention in nurse education as an educational approach that supports learning and professional development. However, research is deficient concerning nurse educators in faculty-based education and their conceptions of student collaboration.

METHOD

The study adopted a phenomenographic approach. A purposeful sampling of nurse educators teaching in a skills lab setting was conducted at five universities in Sweden. Individual interviews with sixteen nurse educators were performed between November 2023 and February 2024. The interviews were analysed following phenomenographic procedures.

RESULTS

Four different description categories were identified: the purpose of collaboration, the didactic activities for collaboration, the student's intrapersonal skills, and the group activity skills. The outcome space presents the purpose of collaboration as the most complex descriptive category.

CONCLUSION

The educational purpose of collaboration should be settled by the faculty of nurse education and aligned to the collaborative requirements in the nursing profession. Introducing didactic activities specifically contextualized to the nursing profession and including peer observations and feedback in a formative manner may facilitate the development of collaboration.

Patient preference with regard to negative pressure wound therapy and participation in wound care: a qualitative study

OBJECTIVE

To explore the experiences and preferences of patients with wounds treated with negative pressure wound therapy (NPWT) regarding shared decision-making and patient participation.

METHOD

Semi-structured interviews were conducted with adult patients treated with NPWT. Interview topics included shared decision-making and patients' active participation in wound treatment. Thematic analysis was applied to identify themes.

RESULTS

The interview cohort comprised ten patients. Four themes emerged: (1) Having a wound makes patients uncertain and thus influences their quality of life; (2) NPWT influences patients' daily lives; (3) Patients consider professional treatment decisions most important in the decision-making processes; (4) Self-management of wounds is accepted by patients only for low-complexity and well-healing wounds under supervision. Participants emphasised their worries about the future and the impact of the wound/treatment on their families. After being thoroughly informed, participants preferred that health professionals decide on the treatment choice. In addition, participants and/or their relatives did not want to actively participate in complex wound care. As well as expressing a need for qualified wound care professionals, participants reported that they did not want to be or feel responsible for the wound treatment.

CONCLUSION

Shared decision-making and active patient participation are underused and underexposed topics in wound care. Patients' recognition of the importance of their personal preferences can facilitate shared decision-making.

Identifying Patient, Care Partner, and Clinician Needs for Functional Recovery Following Hospitalization When Dementia is Present

OBJECTIVES

Persons with dementia are frequently hospitalized, which threatens their ability to return to and live at home. Current post-acute paradigms tend to default to short-term rehabilitation in a nursing home. Still, alternative post-acute care models are crucial for veterans with dementia to recover at home. This study aims to identify the needs of veterans with dementia, care partners, and rehabilitation clinicians in relation to home-based models of care to inform the implementation and adaptation of models to the post-acute context.

DESIGN

Qualitative study.

SETTING AND PARTICIPANTS

Participants included veterans with dementia with recent history of hospitalization, care partners, and rehabilitation clinicians.

METHODS

Semi-structured interviews were conducted across 3 groups (veterans with dementia, care partners, and rehabilitation clinicians) and analyzed using a rapid qualitative approach guided by the Practical, Robust Implementation and Sustainability Model (PRISM).

RESULTS

Participants included 11 veterans with dementia, 13 care partners, and 23 rehabilitation clinicians. We identified 3 themes from the interviews: (1) collaborative decision making and planning are crucial to high-quality care, (2) follow-through is necessary to ensure needs are met when transitioning from hospital to home, and (3) alternative care options, including technology use, are important when optimizing transitions of care.

CONCLUSION AND IMPLICATIONS

Alternative options for home care after hospital discharge may enhance patient-and family-centered outcomes. Future research must identify evidence-based models that can be collaboratively adapted or developed to provide effective, safe, and feasible post-acute care to optimize independence in the home and quality of life.

Utilizing Aboriginal Participatory Action Research-Dadirri-Ganma to Co-Design the Deadly Dental Home

This study aimed to co-design a "Deadly Dental Home" for Australian Aboriginal and Torres Strait Islander people (herein referred to as First Nations). Participatory Action Research-Dadirri-Ganma methods utilized respectful listening (Dadirri), self-reflective knowledge sharing (Ganma), and Yarning to design a model of care for the community. Consumers of dental services, community leaders, healthcare providers, and dental service leaders designed a culturally safe and holistic approach to dental care, bringing together First Nations and Western perspectives. A "Deadly Dental Home" is a dental service that arranges continuously available, comprehensive, coordinated, and culturally appropriate dental care. The expression "deadly" carries a sense of empowerment and positivity within First Nations cultures, representing strength, praise, resilience, and excellence. The research emphasized the integration of cultural needs into dental services. Key themes included Reaching Mob, Dental Care Delivery, and Care Across the Life Journey. Continuous and culturally responsive dental care tailored to different life stages from infancy through elderhood included hands-on education and prevention strategies. The need for a culturally competent workforce, a welcoming dental environment, and flexible appointment scheduling was necessary to foster trust and accessibility. The Deadly Dental Home model promotes a comprehensive approach to care extending beyond traditional dental treatment to address broader health determinants. Continued community engagement, partnership with dental services, and research are essential to refining and implementing this model, ensuring it effectively addresses the unique needs of First Nations people.

Knowledge and awareness of healthcare systems and the uptake of diabetic services among Chinese people diagnosed with type 2 diabetes in the UK

OBJECTIVES

Diabetes poses a significant public health challenge. The Chinese community has unique cultural characteristics that can influence their understanding of the diabetes healthcare system and engagement with services. This study aims to explore the knowledge and awareness of the diabetes healthcare system and the uptake of healthcare services in the UK Chinese population.

DESIGN

This study adopted a qualitative design. Three focus group discussions (FGDs) were conducted on Zoom with 22 Chinese participants with self-reported type 2 diabetes living in the UK. Participants ranged from 24 to 85 years (mean age = 66 years, SD = 17.1). A purposive sample was recruited through study adverts in Chinese community centres and snowball sampling. Data were analysed using Braun and Clarke's thematic analysis (TA).

RESULTS

This paper discusses 4 themes: Awareness and understanding of diabetes, healthcare access and utilisation, attitudes towards diabetes prevention programmes and Chinese medicine vs. Western medicine. Limited knowledge and awareness of diabetes was highlighted, with cultural factors impacting this. Factors which impacted healthcare access and utilisation were linguistic/ communication challenges, and trust and perception of the NHS. Participants were unaware of diabetes prevention programmes and highlighted that these were culturally inappropriate. Generational preferences were noted in the way participants wished to receive diabetes education. The western medical system was viewed as medication focused, therefore the older Chinese community trusted familiar natural methods of illness management.

CONCLUSION

These findings highlight the importance of ensuring diabetes education is culturally appropriate. Generational differences in education preference should be recognised by healthcare professionals to increase healthcare engagement. These findings demonstrate the important need to educate UK healthcare professionals with the unique sociocultural contexts for this ethnic group. This study uncovers gaps in awareness and service uptake, highlighting the need for co-development of interventions that promote health equity and improve diabetes management within this population.

Breastfeeding transition in Oman: A generation shift or a product of social development? A qualitative study on three generations of Omani mothers

BACKGROUND

Exclusive breastfeeding is essential for infant health, yet its practice varies across generations and cultures. Although the health benefits of breastfeeding have been well known for decades, the utilization of infant formula feeding worldwide and in Oman, in particular, continues to rise, most likely as a result of a lack of social support and the time limit faced by working mothers. Little is known about the factors affecting Omani mothers' breastfeeding experiences and practices. Therefore, this study aims to gain an in-depth understanding of the experiences of breastfeeding practices among three generations of Omani mothers.

METHODS

This qualitative study investigated exclusive breastfeeding practices among three generations of Omani mothers. Participants were recruited using a selective approach followed by a snowball technique, resulting in a total of 50 women, which included 17 first-generation mothers, 18 grandmothers, and 15 great-grandmothers. Participants were characterized by varying ages and socio-demographic backgrounds. Semi-structured face-to-face interviews were conducted in Arabic, and data collection continued until data saturation was reached. Data were analyzed using qualitative content analysis methodology, ensuring robustness and credibility.

RESULTS

The analysis yielded two main categories reflecting the mothers' experiences, three representing the grandmothers' experiences, and two concerning the great-grandmothers' experiences. While overarching themes like the significance of breastfeeding emerged across all generations, disparities were seen concerning challenges, beliefs, and support systems. Mothers highlighted contemporary hurdles such as work-life balance and societal pressures, whereas grandmothers emphasized inherited practices and cultural norms. Great-grandmothers reflected on the evolution of societal and familial dynamics impacting breastfeeding traditions. Despite these differences, a shared commitment to breastfeeding and recognition of its importance for maternal and child well-being was evident across generations.

CONCLUSION

The findings underscore the importance of societal support, healthcare provider education, and workplace policies in promoting exclusive breastfeeding. Targeted interventions are needed to address barriers to breastfeeding and empower women to make informed feeding choices. By addressing these challenges, societal institutions can contribute to achieving higher rates of exclusive breastfeeding and improve maternal and child health outcomes in Oman.

Bridging the gap: challenges and opportunities of assistive technology loan library systems for individuals with intellectual disabilities in the United States

PURPOSE

In an increasingly technology-driven world, this study explores the accessibility of assistive technology for individuals with intellectual disabilities through assistive technology loan libraries. Assistive technology refers to devices or systems that enhance the ability of individuals with and without disabilities to function and undertake activities of daily living.

MATERIALS AND METHODS

The study, grounded in the Social Determinants of Health framework, employed multiple methods including both qualitative (interviews) and quantitative (questionnaire) methods, involving 19 participants comprising assistive technology professionals and users.

RESULTS

Key findings from the study underscore the pivotal role of assistive technology loan libraries, which lend various assistive devices to individuals, enabling them to try these technologies before making a long-term commitment. However, challenges, such as a restricted variety of devices and extended waiting periods for access were highlighted. The research points to a need for improved training for both staff at the loan libraries and the users of the technology. It also suggests that policy enhancements are required to better align with rapid technological advancements and address the uneven regional distribution of these technologies.

CONCLUSIONS

Participants in the study highlighted the importance of expanding the range of assistive devices available in these libraries and improving the efficiency of the service they provide. The study advocates for targeted efforts to enhance the effectiveness and accessibility of assistive technology loan libraries, highlighting their critical role in empowering individuals with intellectual disabilities.

Smoke-Free Home: Developing an Aboriginal Health Promotion and Social Marketing Campaign in Western Sydney, Australia

ISSUE ADDRESSED

This brief report describes the development of a social marketing campaign, 'Aboriginal Smoke-free Home', developed in direct response to a community-identified necessity to advocate for improved messaging concerning smoke-free homes among Aboriginal and Torres Strait Islander families residing on Darug Country in the Mount Druitt and Blacktown regions of Western Sydney, NSW. The campaign's launch in early 2020 demanded considerable adaptability to address challenges arising from COVID-19 outbreaks.

METHODS

In consultation and collaboration with Aboriginal community members and organisations, Western Sydney Local Health District co-developed a social marketing strategy including an animated video and static smoke-free advertisements. The strategy followed a five-phased iterative approach. Campaign engagement and reach data were collected from Facebook analytics and advertising agency reports. The onset of the COVID-19 pandemic demanded flexibility in the campaign launch, prompting a shift towards a more prominent social media presence and the integration of COVID-19 messaging.

RESULTS

Social media and localised multimedia approaches for campaign dissemination were undertaken from community members' input and feedback. Paid advertising has a greater potential for increasing audience reach.

CONCLUSIONS

Despite the challenges of COVID-19, the Aboriginal Smoke-free Home campaign reached an extensive audience. The study findings demonstrate the strength of working in partnership and the benefit of working in response to community-identified needs in health promotion. SO WHAT?: Limited research exists on social marketing approaches for Aboriginal health promotion programs. This study focuses on the successes and challenges in design and implementation and unveils preliminary numerical reach findings, highlighting diverse approaches. Further investigation is needed, and a campaign evaluation is in progress.

Defining Health Movements and Health Needs Across the Life Course: A Qualitative Study

BACKGROUND

In an effort to improve population health, communities are being enabled to take charge of their health through the Movements for Health (M4H) programme in Singapore. The present study seeks to understand what characterises a health movement and explores health narratives which resonate over the different life stages.

METHODS

A multi-component qualitative formative study was undertaken. Focus group discussions (FGDs, n = 12) and one semi-structured interview (altogether involving n = 52 individuals) were carried out with government and community implementation stakeholders, alongside go-along interviews (n = 24, involving 11 volunteers, 13 programme participants) and e-diaries (n = 37, with 22 programme participants and 15 volunteers).

RESULTS

Themes are reported in bold, with subthemes in italics. Health movement building was defined as an evolving process marked by co-creation, emotional investment and framed by a shared understanding founded on explicit theory. Furthermore, health movements were characterised as taking root in the community, needing a shared 'cause' to be self-sustaining. They should be able to garner momentum and be replicable, and thus ultimately far-reaching and inclusive of all walks of life. Themes cross-cutting life stages include concerns about chronic illness, which are not limited to seniors. Positive role modelling is crucial in encouraging hesitant participants towards healthier behaviours. Additionally, the importance of building supportive, emotional connections with implementers was emphasised. Priority areas for changing health behaviours and informing health literacy planning across various life stages have also been identified. For youths, mental health struggles, such as mood regulation issues, are prevalent and often exacerbated by parental invalidation. Adults tend to deprioritize social health due to responsibilities like breadwinning and childminding, coping through social connections forged among programme participants. Seniors expressed trepidation regarding their physical health, fearing a loss of independence and verbalising how limited mobility affects their ability to exercise and socialise.

CONCLUSION

The present study has provided insights into the early phases of the novel M4H community-led programmatic approach. Our findings defined health movements and health needs across the life course, whilst expanding on related theoretical and applied community development traditions.

PATIENT OR PUBLIC CONTRIBUTION

This study mixes participatory data (i.e. go-along interviews) with other qualitative data to provide insights into the co-creation process of health movement building. The study also adopted a user-centred approach, and the content appropriateness of the programmes was fed back to the community-level implementers (i.e. Community Movement Champions [CMCs]) and the M4H administrating committee to inform future programming. Future CMCs have taken up the recommendations extracted from stakeholder engagement, where components on sleep, mental health, etc., have been added. Community coaches and commissioning stakeholders are involved in authorship.

Investigating the influence of language teachers' constructivist self-efficacy on their practice of constructivism in Ghanaian language and culture instruction

The education system in Ghana is undergoing a transition from a behaviorist instructional philosophy to a constructivist one, aiming to produce learners who can actively contribute to nation-building. Nonetheless, given the heavy demands on teachers regarding this abrupt shift into constructivist teaching, there is a need to examine teachers' sense of efficacy in relation to the enactment of the core principles of this novel instructional philosophy-i.e., social, cognitive, and critical constructivism- laid down in the newly introduced standards-based curriculum. An explanatory sequential mixed method was used to obtain data from basic school teachers in the Sunyani-West Municipal of Bono Region, Ghana. Using adapted teacher self-efficacy and constructivist learning environment scales, quantitative data were gathered from 104 teachers. Qualitative data were also gathered from 15 conveniently sampled language teachers to augment the quantitative findings. Using partial least squares structural equation modelling, a significant positive association was discovered between teachers' efficacy and the practice of social and cognitive constructivism. Nonetheless, teachers' efficacy did not statistically predict their practice of critical constructivism. The qualitative results showed that sociocultural concerns probably accounted for the insignificant association between efficacy and critical constructivism. It was therefore concluded that sociocultural norms designed for bringing up a child in Ghana tend to inhibit the enactment of critical constructivism. The study recommends that the National Council for Curriculum and Assessment, in partnership with the Ghana Tertiary Education Commission, should update teacher professional development programs in universities and colleges of education to incorporate constructivist principles, particularly critical pedagogy, aiming to produce competent teachers capable of fostering learners' autonomy, critical thinking, and problem-solving skills as outlined in the Standards-Based Curriculum (SBC).

Incorporating Best-Worst Scaling (BWS) Questions into Focus Groups to Improve Understanding of Patient Preferences and Refine BWS Attributes

BACKGROUND AND OBJECTIVE

Best-worst scaling (BWS) is a stated preference elicitation method used for prioritizing attributes of healthcare interventions. Best-worst scaling attribute development is commonly based on literature review, qualitative work, and methodological/clinical expert input. There is limited research incorporating BWS in focus groups as part of the attribute development process. We sought to explore how incorporating BWS questions using the list of potential attributes in focus groups could be used to improve understanding of patient preferences and refine the list of potential BWS attributes as part of the attribute development process.

METHODS

We administered BWS questions on healthcare priorities for inflammatory bowel disease in five focus groups with Canadian patients with inflammatory bowel disease to (1) understand the "what," "how," and "why" of participant choices and (2) note how participants understand the attributes and the language they use to refine the list of potential BWS attributes. A list of 20 potential attributes was used to generate the BWS questions. We coded most/least important choices ("what") and used a thematic analysis to derive subthemes indicating "how" and "why" participants made their choices. We coded how participants understood the attributes/BWS questions and language used when discussing the attributes.

RESULTS

Across the 36 participants, the most frequently chosen most/least important attributes were summarized. Three subthemes explaining the "how" and "why" of participant choices were identified: perceived gain; influence of individual experiences; current health state and personal circumstances. Participants identified challenges understanding specific attributes and BWS questions, and provided suggestions for modifications to attribute language/descriptions. Administering BWS questions in focus groups provided: (1) insight into the assumptions participants made when completing the BWS questions; (2) clarity in language and attribute descriptions, and challenges participants had when completing the BWS questions that can be used to refine the list of potential attributes as part of the attribute development process; and (3) understanding of which attributes were most/least important and why to identify potential attributes to remove during the next steps of the attribute development process.

CONCLUSIONS

Best-worst scaling questions conducted within focus groups can stimulate discussions around relative importance and prioritization of attributes. Through open dialogue, this method can unveil unforeseen responses or identify areas that are unclear and enable a transparent approach to refine the list of potential attributes as part of the attribute development process.

Evaluation of a notes-based rapid qualitative analysis method to facilitate implementation

BACKGROUND

Qualitative methodologies offer a nuanced approach to understanding stakeholder perspectives, preferences, and context in implementation research. However, traditional qualitative data analysis can be time consuming and create barriers to responsive implementation of interventions. Rapid qualitative methods that yield timely, actionable results have emerged to expedite the evidence-to-practice gap, but often require all analysts to have implementation science expertise and resources for interview transcription. This study describes a novel rapid qualitative method to identify participant-driven social care recommendations in real time.

METHODS

Caregivers of pediatric patients were enrolled onsite at two primary care clinics and one emergency department affiliated with a large urban pediatric healthcare system. A semi-structured interview guide was developed using the Health Equity Implementation Framework and Integrated Behavioral Model in partnership with multidisciplinary implementation stakeholders. Telephone interviews explored 60 caregivers' experiences with and perceptions of receiving social resources from healthcare. For traditional analysis, NVivo12 was used to code the first 10 verbatim transcripts to generate themes in an integrated inductive/deductive approach. In the rapid approach, a summary notes template designed to capture implementation-related data was completed immediately following the same 10 interviews. A secondary analyst used the templates to create participant-level summaries and identify implementation-related themes. Themes found in each method were quantified and mapped onto each other using an analytic matrix to compare the number and consistency of themes.

RESULTS

Themes generated in both methods mapped consistently onto each other; 92.8% of themes found in traditional analysis were accounted for within our rapid method. The quantity of themes was similar between the two methods: the traditional approach generated 69 themes and 22 subthemes, while our rapid approach generated 72 themes and 21 subthemes.

CONCLUSIONS

Our interview notes-based rapid qualitative method was successful in producing themes consistent with the traditional approach in both content and quantity. This approach is also pragmatic, as it does not require analysts to have deep implementation science expertise and saves transcription costs. By balancing rigor with time to actionable results, this rapid method provides a tool for implementation researchers to generate qualitative findings on an accelerated timeline to inform policy and practice.

CLINICAL TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov, #NCT05251311, https://www.

CLINICALTRIALS

gov/study/NCT05251311 , on September 30, 2021.

Student nurses' learning of practical skills in hospital placements: Perspectives of registered nurse mentors

AIM/OBJECTIVE

To gain insights into the perspectives of registered nurse mentors on the practical skill learning of second-year student nurses during hospital placement by examining the mentors' experiences and expectations.

BACKGROUND

Clinical placement is a cornerstone of bachelor nursing programmes. It is a vital platform for students to transfer, apply, and enhance practical nursing skills learned. During clinical placement, registered nurse mentors play a crucial supervisory role in student nurses' practical skill learning. However, a gap exists in understanding the mentors' perspectives on practical skill learning during placements in hospital environments.

DESIGN

We used a qualitative, exploratory, and descriptive research design. Ten registered nurse mentors responsible for student supervision at two hospitals in southern Norway were included. Ten individual interviews were conducted. Ten interviews were audio-recorded and transcribed. A systematic text condensation analysis was performed.

RESULTS

The following four categories were identified: 'experiences vs. expectations in practical skill knowledge', experiences vs. expectations of engagement', 'experiences of attitudes' and 'experiences and expectations of emotions'.

CONCLUSION

This study deepened our understanding of issues concerning student nurses' practical skill learning during clinical placement from the perspective of registered nurse mentors. The results emphasise the complexity of learning practical skills and are associated with categories including knowledge, attitudes, engagement, and emotions. These results underscore the multifaceted nature of practical skill learning and highlight the need for comprehensive strategies to effectively address these areas in nursing education, setting the stage for future investigations and potential policy changes in this domain.

TWEETABLE ABSTRACT

Registered nurse mentors' perspectives towards student nurses' practical skills.

Understanding the contribution of primary and community services to health system resilience during the COVID19 Pandemic in Aotearoa, New Zealand: a qualitative interview study

BACKGROUND

The COVID-19 pandemic exposed critical gaps in health system preparedness. This study, guided by a critical ecological model, examines the experiences of primary health and community services in Aotearoa New Zealand during the pandemic, focusing on their response to older people and their unpaid caregivers. The study aims to identify effective strategies for health system resilience. It addresses the question, what can we learn from the experiences of organisations supporting older people and caregivers during COVID-19, to prepare for other similar (emergency health) situations?

METHODS

A multidisciplinary research team conducted cross-sectional qualitative research through semi-structured telephone interviews with service providers (SPs) delivering primary or community home-based services to older people and caregivers across Aotearoa New Zealand. SPs included national organisations, Māori, Pacific, or rural providers and dementia services. Data were collected between July and October 2020. Notes were taken during interviews using a Rapid Appraisal Procedure grid, which were later revised and validated by participants. Data were analysed using a hybrid deductive-inductive thematic analysis, following COREQ guidelines.

RESULTS

Twenty staff (Chief Executive Officers and representatives) from national organisations (N = 4), Māori (N = 3), Pacific (N = 5), rural (N = 4), and regional dementia (N = 4) SPs were interviewed. SPs demonstrated resilience through collaboration, adapting delivery models, and upskilling staff. Key challenges involved inconsistent identification of vulnerable clients, limited access to aged residential care, and barriers relating to digital access which disproportionately affected older adults and staff, and clients in rural areas. Workforce shortages, and unclear public policy concerning travel across regions further complicated service delivery, highlighting the interaction between policy, community, interpersonal, and individual factors.

CONCLUSIONS

Aotearoa New Zealand managed COVID-19 effectively, but the pandemic exposed areas for improvement in health system resilience. The government demonstrated absorptive resilience through swift actions, including lockdowns and clear communication, while SPs exhibited adaptive resilience by modifying service protocols. Knowledge gained from this study can contribute to transformative resilience. Long-term strategic changes are necessary to improve emergency planning, such as developing a unified framework to inform a 'Priority List', enhancing workforce capacity, and addressing digital exclusion. These steps can strengthen health system robustness and preparedness for future crises.

VRx@Home protocol: A virtual reality at-home intervention for persons living with dementia and their care partners

INTRODUCTION

Virtual reality (VR) technology is increasingly used by researchers and healthcare professionals as a therapeutic intervention to improve the quality of life of persons living with dementia (PLwD). However, most VR interventions to date have mainly been explored in long-term or community care settings, with fewer being explored at home. Setting is important, given that the majority of PLwD live at home and are cared for by their family care partners. One of the challenges affecting PLwD and care partner relationships is barriers in communication, which can lead to social isolation and poor quality of life for both parties. Thus, the goal of the proposed project is to explore whether an immersive, multisensory VR intervention can facilitate communication between PLwD and their care partners and, in turn, enhance personal relationships and improve well-being.

METHODS AND ANALYSIS

Thirty dyads comprised of PLwD and their family/friend care partners will participate in this at-home intervention. Their interactions will be recorded as they experience a series of 360° videos together (eg, concert, travel) either using a VR headset (PLwD) with a paired tablet (care partner) or using only a tablet together. The two conditions will allow us to compare immersive VR technology to more common non-immersive tablet-based technology. The study will begin with at-home training and baseline data collection. The intervention will then take place over a 4-week period, with the two conditions (VR vs tablet-only) experienced 2 weeks each. A comprehensive set of measures will be employed to assess the quality and quantity of dyadic interactions, such as verbal/non-verbal language (eg, informativity, gestures) and self-reported measures of well-being and quality of life.

ETHICS AND DISSEMINATION

Ethical approval for the study was granted by the University Health Network (#21-5701). Findings will be shared with all stakeholders through peer-reviewed publications and presentations.

CLINICAL REGISTRATION

This study has been registered on clinicaltrials.gov (NCT06568211).

Promising images of love: a qualitative-ethnographic study about the mediatised memories of weddings

Background

Digital and electronic media play a central role in weddings, capturing everything from the preparation to the ceremony itself and beyond. These media make specific moments of the wedding day memorable. But how do couples manage their wedding photos and videos, and what role do these media play in evoking memories of the event's religious and secular dimensions? These questions are explored within the theoretical framework of mediatisation and memory processes. This paper argues that the mediatization of weddings evokes emotions that strengthen the impact of these memories. Media shape how these events are recalled, leading to a partial homogenization of memories, where cultural and religious differences, as well as sexual orientation, become less prominent.

Methods

This interdisciplinary qualitative-ethnographic research is based on twenty-seven semi-structured video recorded interviews conducted in Italy, Germany, and Switzerland with homo- and heterosexual married couples from different cultural-religious backgrounds. The couples shared their wedding album or video and developed their wedding narrative by looking at the photographs and videos.

Results

Taking photos during the wedding becomes an important part of the ritual, independent of any cultural or religious background, gender and sexual orientation. The ceremony itself is emphasized in the photos and the videos. This homogenisation of the rite of passage equally occurs in the photographic representations of weddings and in turn influences how the wedding is remembered. The findings further confirm that heterosexual marriage representations reinforce gender stereotypes. The brides/wives of heterosexual couples are significantly more invested in the production and reception of wedding media, whereas homosexual couples participated in the conversation rather equally.

Conclusions

The homogenization of representation and memory becomes part of the rite of passage's cultural-collective memory that connects the individual couples. The mediatisation of weddings strengthens the feeling of belonging to a community that transcends cultural-religious identities.

Owner expectations regarding antimicrobial prescription for canine acute diarrhea: A prospective observational study from the capital of Denmark

Acute diarrhea is a common condition in dogs. Most cases are mild and self-limiting and according to guidelines, antimicrobial treatment is only indicated in dogs with severe systemic disease. However, antimicrobials are still prescribed in 50-65 % of mild cases. Multiple factors have been shown to influence the antimicrobial prescription decision, including perceived pressure from pet owners. This study aimed to investigate dog owners' expectations regarding antimicrobial prescription for dogs with acute diarrhea and the attending veterinarians' perceived owner expectation. To investigate this, a structured telephone interview with owners and a post-consultation questionnaire for the attending veterinarians were conducted. Ninety-nine unique dog-consultations were included with a 91 % owner response rate (n = 90), in these cases 63 % of veterinarians responded (n = 57). Only 6/90 (7 %) owners expressed an expectation of antimicrobial prescription. Of these, two expressed dissatisfaction that antimicrobials were withheld. In 5/57 cases, the attending veterinarian perceived an expectation to prescribe antimicrobials. Three cases aligned with an actual owner expectation, the latter two were pure perception. Eighty percent of owners expressed satisfaction with the consultation in general (n = 72/90), while 16 % (14/90) and 4 % (4/90) expressed minor or major dissatisfaction with non-treatment related issues, respectively. In this study, very few dog owners expressed an expectation of antimicrobials for treatment of acute diarrhea. Likewise, the veterinarians perceived an expectation in only a minority of cases, however, the actual and perceived expectation did not always align. In conclusion, this study suggests that an overall high owner satisfaction is feasible despite a non-antimicrobial approach.

Factors influencing the ability of family caregivers of Alzheimer's patients within Iranian families to continue and persist in their caregiving roles: a qualitative study

BACKGROUND

Understanding the motivations driving family members to continue caring for individuals with Alzheimer's disease is crucial for enhancing social support programs within community health systems. This study specifically explores the factors influencing Iranian family caregivers' ability to persist in their caregiving roles.

METHODS

This qualitative study was conducted using conventional content analysis with 22 participants in 2022 in Babol (a city in northern Iran). The inclusion criteria for the study included caregivers of Alzheimer's patients who had been the primary caregivers for at least one year for patients with a confirmed diagnosis of Alzheimer's disease. The sampling method was purposive, ensuring maximum variation in social position, demographic status, and stages of Alzheimer's disease after the onset of symptoms. In this research, data were collected from caregivers of Alzheimer's patients through semi-structured interviews and in-depth individual interviews. The data were analyzed using MAXQDA software.

RESULTS

One category and four subcategories were identified to explain the continuity of the caring role in family caregivers of Alzheimer's patients. The category was "on the Fence of the Caring Role." The subcategories included Commitment to Care (Being Determined, Being Indebted, Feeling Dutiful), Coercion to Care (Giving in to the Caring Role Due to Family Requirements, Patient Care Due to Financial Problems), Socio-Cultural Beliefs and Concerns (Spiritual and Religious Tendencies, Social Stigma and Social Fears), and Attachment and Love for the Patient (Feeling Pity, Feeling Nostalgia for Kinship).

CONCLUSION

Family caregivers are deeply engaged in their roles, often feeling trapped by various pressures. Recognizing these dimensions can inform policymakers and health practitioners in developing targeted interventions, such as respite care programs, financial support, and community resources, aimed at alleviating caregiver burden and enhancing the quality of care for patients. By addressing the complexities of the caregiver experience, effective strategies can be implemented to support both patients and their caregivers, ultimately improving health outcomes within the community.

Understanding Primary Care Providers' Experience with Lifestyle Behavior Change Recommendations and Programs to Prevent Chronic Disease

Prescribing lifestyle behavior change is a recommended strategy for both primary and secondary prevention of disease. Programs that support and encourage lifestyle behavior change are available to patients but are underutilized. The purpose of this study was to understand primary care providers (PCPs) experiences and barriers they experience with referring patients to lifestyle behavior change programs at one academic health care system. In-depth semi-structured interviews were conducted with 7 academic PCPs between November 2020 and January 2021. Qualitative analysis identified major themes. Four themes emerged: (1) guideline awareness and adherence, (2) barriers to lifestyle behavior change recommendations, (3) provider role with respect to lifestyle behavior change recommendations, and (4) suggestions to improve utilization of behavior change support. Specific strategies for improvement include revising referral process, educating providers about programs already offered, integrating a team-based approach, and systemizing healthy lifestyle behaviors interventions. The lessons identified through this study highlight the need for systematic prioritization of lifestyle behavior change to decrease certain barriers that providers face when attempting to integrate lifestyle change consistently into their practice.

Oral Health Recovery: Randomized Evaluation of an Oral-Behavioral Health Integration Approach

INTRODUCTION

This study implemented a single-session oral health education and referral program in behavioral health settings serving people with psychiatric disabilities. The program was led by peer specialists ("peers")-lay community behavioral health workers with personal experience of mental health challenges who are trained and certified to support others.

METHODS

Investigators collaborated with peers, state government, and clinical leadership to design and implement the program. Randomized parallel assignment was used to compare 2 arms: (1) group viewing of an oral health educational video (VC) and (2) a peer-led 1-time class providing education and motivation to access dental care (the Oral Health Recovery Group; OHRG). In both arms, peers followed up with participants to encourage accessing dental care and reinforce at-home care goals. Oral health knowledge, at-home care, motivation, appointment scheduling, and utilization were assessed at baseline, postintervention, and 2 mo. Qualitative interviews assessed barriers and facilitators.

RESULTS

More than half of participants reported oral pain in the previous year. Pre-/postintervention survey results did not significantly improve in either arm or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC reported meeting a dental at-home care goal because of the program. Ten (27%) in OHRG and 9 (36%) in VC reported making a dental appointment because of the program. Most were satisfied with the program. Interviewed participants were comfortable with peers in this role, yet access barriers remained.

CONCLUSIONS

Single-session oral health interventions were implemented in behavioral health settings. The fact that surveys did not significantly improve suggests that more intensive interventions may be needed. Nevertheless, peers successfully scheduled dental appointments for vulnerable patients. Given that dental appointments were scheduled after only a 1-time class and light-touch peer navigation, oral health integration in behavioral health settings shows promise as a financially sustainable approach that merits further research.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by staff in behavioral health settings who wish to consider peer-led financially sustainable approaches to providing oral health education and linkages to dental care for their clients.

Genedrive kit for detecting single nucleotide polymorphism m.1555A>G in neonates and their mothers: a systematic review and cost-effectiveness analysis

Background

Neonates with suspected sepsis are commonly treated with gentamicin, an aminoglycoside. These antibiotics are associated with high risk of ototoxicity, including profound bilateral deafness, in people with the m.1555A>G mitochondrial genetic variant.

Objective

This early value assessment summarised and critically assessed the clinical effectiveness and cost-effectiveness of the Genedrive MT-RNR1 ID Kit for identifying the gene m.1555A>G variant in neonates and mothers of neonates needing antibiotics or anticipated to need antibiotics. Following feedback from the scoping workshop and specialist assessment subgroup meeting, we also considered the Genedrive MT-RNR1 ID Kit for identifying the m.1555A>G variant in mothers prior to giving birth.

Data sources

For clinical effectiveness, we searched three major databases in October 2022: MEDLINE, EMBASE and CINAHL (Cumulative Index to Nursing and Allied Health Literature). For cost-effectiveness, in addition to the three mentioned databases we searched Cochrane and RePEc-IDEAS.

Study selection

Study selection and risk-of-bias assessment were conducted by two independent reviewers (Ryan PW Kenny and Akvile Stoniute for clinical effectiveness and Hosein Shabaninejad and Tomos Robinson for cost-effectiveness). Any differences were resolved through discussion, or by a third reviewer (Nick Meader).

Study appraisal

Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. One study (n = 751 neonates recruited) was included in the clinical effectiveness review and no studies were included in the cost-effectiveness review. All except one outcome (test failure rate: low risk of bias) were rated as being at moderate risk of bias. The study reported accuracy of the test (sensitivity 100%, 95% confidence interval 29.2% to 100%; specificity 99.2%, 95% confidence interval 98% to 99.7%), number of neonates successfully tested (n = 424/526 admissions), test failure rate (17.1%, although this was reduced to 5.7%), impact on antibiotic use (all those with a m.1555A>G genotype avoided aminoglycosides), time taken to obtain a sample (6 minutes), time to genotyping (26 minutes), time to antibiotic treatment (55.18 minutes) and the number of neonates with m.1555A>G (n = 3).

Limitations

The economic component of this work identified key evidence gaps for which further data are required before a robust economic evaluation can be conducted. These include the sensitivity of the Genedrive MT-RNR1 ID Kit for identifying the gene m.1555A>G variant in neonates, the magnitude of risk for aminoglycoside-induced hearing loss in neonates with m.1555A>G, and the prevalence of the m.1555A>G variant. Other potentially important gaps include how data regarding maternal inheritance may potentially be used in the clinical pathway.

Conclusions

This early value assessment suggests that the Genedrive MT-RNR1 ID Kit has the potential to identify the m.1555A>G variant and to be cost-effective. The Genedrive MT-RNR1 ID Kit dominates the current standard of care over the lifetime, as it is less costly and more effective. For a 50-year time horizon, the Genedrive MT-RNR1 ID Kit was also the dominant strategy. For a 10-year time horizon, the incremental cost-effectiveness ratio was estimated to be £103 per quality-adjusted life-year gained. Nevertheless, as anticipated, there is insufficient evidence to conduct a full diagnostic assessment of the clinical effectiveness and cost-effectiveness of the Genedrive MT-RNR1 ID Kit in neonates directly or in their mothers. This report includes a list of research priorities to reduce the uncertainty around this early value assessment and to provide the additional data needed to inform a full diagnostic assessment, including cost-effectiveness modelling.

Study registration

This study is registered as PROSPERO (CRD42022364770).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135636) and is published in full in Health Technology Assessment; Vol. 28, No. 75. See the NIHR Funding and Awards website for further award information.

The regional development and implementation of home-based stroke rehabilitation using participatory action research

PURPOSE

This study aims to overcome the challenges experienced in the regional development and implementation of home-based stroke rehabilitation (HBSR) and to understand the change process needed.

MATERIALS AND METHODS

Using participatory action research (PAR), participants and researchers collaboratively produced knowledge and took action to improve the offered HBSR. Different methods for data generation and analysis were used, depending on the aim of the PAR phase and the participants' stages of change. The Consolidated Framework for Implementation Research (CFIR) was used to select implementation strategies and to evaluate the implementation process.

RESULTS

Developing and implementing HBSR resulted in multiple products that promoted the implementation of a regional stroke network and affiliated work arrangements. Work arrangements were embodied in a stroke care pathway, follow-up tool, and expertise requirements. Evaluating the PAR process identified participants being able to take the lead, being facilitated by others, and making progress visible, as implementation facilitators. Collaborating within a primary care project can be challenging but is considered essential and has a positive impact on multiple levels. Also, the implementation of HBSR calls for multiple implementation strategies reflecting multiple CFIR constructs.

CONCLUSION

This study highlights the complexity and achievements of developing and implementing HBSR using PAR.

Connected digitally and dedicated loyally: the features and impact of internal online events on employee outcomes

Purpose

The purpose of this study is to investigate the role and features of internal online events (IOE) in organizations and measure their impact on employee outcomes (communication satisfaction and loyalty in active and passive forms).

Design/methodology/approach

The study conducted a mixed-method process – first, which involved three semistructured interviews in India, Russia and France, and the data were analyzed through a qualitative coding procedure. Subsequently, a survey was conducted among employees regarding their perceptions of IOE. One hundred eighty-four fully completed questionnaires were collected, and the results were analyzed using structural equation modeling.

Findings

The analysis of qualitative data revealed common patterns in IOEs in the organizations across India, Russia and France. The quantitative analysis showed the significant impact of IOEs on perceived communication satisfaction. Which in turn primarily stimulates the development of active employee loyalty rather than passive loyalty.

Research limitations/implications

This study acknowledges that the samples were limited to only a few geographical regions of India, Russia and France. Also, the research is subject to sampling limitations due to snowball approach.

Practical implications

Internal communication (IC) managers can use this research findings to develop more effective IOEs to address organizational goals and create synergy-based positive outcomes (such as loyalty) within the employees of the organization.

Originality/value

Research contributes to exploring the role and characteristics of IOEs by applying engagement theory, emphasizing their capacity as a strategic IC channel to enhance employee involvement. Moreover, the study investigated the impact of IOEs on communication satisfaction and employee loyalty by applying affective events theory to communication.

'The world was going through what we go through everyday': The experiences of women with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) living with their partners during the COVID-19 lockdown in the United Kingdom

OBJECTIVES

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term debilitating illness characterised by profound and persistent fatigue (JAMA: The Journal of the American Medical Association, 313, 2015, 1101). The current study aims to explore the experiences of women with ME/CFS living with their partners during the COVID-19 pandemic in the United Kingdom.

DESIGN

The study adopted a qualitative design comprising semi-structured interviews with participants. Interviews were analysed using thematic analysis (TA).

METHODS

Participants were women with ME/CFS (n = 21) recruited through ME/CFS support groups in the United Kingdom. All participants were in romantic relationships and lived with their partners.

RESULTS

Data were organised into three themes: (1) lockdown disrupting routine, (2) reducing difference and (3) fear of getting COVID-19. People with ME/CFS found that lockdown disrupted their well-established routines. Although routines were disrupted by partners and increased working-from-home practices, participants found having partners at home helpful. People with ME/CFS believed that the changes induced by the pandemic reduced the differences between themselves and the outside world which, prior to lockdown, had felt prominent. They were fearful of getting COVID-19 as they believed this would make their ME/CFS worse. This meant that for people with ME/CFS, the lifting of the lockdown restrictions was an anxiety-provoking time, hence impacting symptoms. People with ME/CFS continued to adhere to government guidelines after national restrictions were eased.

CONCLUSIONS

This study outlines the experiences of women with ME/CFS during COVID-19, alongside the long-term impact this has had due to the changes that the pandemic imposed. These findings may have implications for those with long COVID.

SHOULD I STAY OR SHOULD I GO-A rapid qualitative study of principal deteriorating factors experienced by nurses relating to their intentions to leave their current position in a medical hospital department

BACKGROUND

High nurse turnover in hospitals is a worldwide problem with dire consequences for patient care such as increased mortality and a decrease in patient safety. A specific effort to retain nurses is urgently needed due to the many vacant nursing positions, especially across the Medical hospital departments.

AIM

To identify the principal deteriorating factors experienced by nurses relating to their intentions to leave the medical department at a university hospital.

METHODS

A rapid qualitative research methodology was used. Participants comprised 22 registered nurses employed in five university hospital medical department units. The Rigorous and Accelerated Data Reduction (RADaR) technique was therefore used for data collection through qualitative semi-structured interviews and analysis. COREQ was used for reporting the study.

RESULTS

The RADaR analysis detected a downward spiral of five principal deteriorating factors influencing nurses' intentions to leave their position in the medical department. The factors were resignations from several nursing colleagues combined with too few and inexperienced nurses present during shifts, additional tasks assigned, a management refraining from improving the problematic issues, leading to decisive consequences for patient care and a declining feeling of professional care.

CONCLUSIONS

The lack of nurses in the department caused missed nursing care, which affected the nurses' job satisfaction and intentions to leave their positions. Future research initiatives must focus on evaluating successful interventions to maintain the nurses in the positions. Further knowledge, is also needed, to investigate how we can change the downward spiral to a story of retention success.

Topics searched by first-time Indonesian fathers during pregnancy journey: An exploratory study

This study explores the topics searched by first-time Indonesian fathers during the pregnancy journey. Data were collected through semi-structured interviews with a representative sample of first-time expectant fathers in Indonesia. Thematic analysis was employed to identify common themes and patterns in fathers' search topics and reasons behind the searches. The results reveal that fathers predominantly focus on finding topics related to their partners' well-being with particular emphasis on health-related topics. Interestingly, the study highlights a lower engagement with topics related to cultural practices, traditions, and religion among first-time Indonesian fathers. Additionally, understanding the situation and finding the solutions to a problem is one of the main popular reasons for first-time fathers to seek a particular topic related to pregnancy. This study provides valuable insights into the topics searched and motivations of first-time Indonesian fathers during the pregnancy journey which have similarities and differences to fathers' practices in developed countries. The findings underscore the necessity for tailored intervention programs to promote paternal involvement during this transformative period which addresses the unique information needs of Indonesian fathers.

Transcribing in the digital age: qualitative research practice utilizing intelligent speech recognition technology

The digital revolution provides many opportunities for researchers to develop and evolve data collection methods. A key process in qualitative research data collection is the transcription of interviews, focus groups or fieldwork notes. Transcription is the process of converting audio, video or notes into accessible written format for qualitative data analysis. Transcribing can be time intensive, costly and laborious with decisions and methods of transcribing requiring transparency. The development of intelligent speech recognition technology can change how qualitative data is transcribed. This methods paper describes audio data transcribing, current challenges, opportunities and implications in using intelligent speech recognition technology for transcribing. An application of this methodology is presented.

Resistance training in women with myotonic dystrophy type 1: a multisystemic therapeutic avenue

Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.

"I feel like I'm walking on eggshells": a qualitative study of moral distress among Chinese emergency doctors

BACKGROUND

While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.

AIM

This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.

METHOD

Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method.

STUDY FINDINGS

This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.

CONCLUSION

The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners' and people living with Long COVID: a qualitative study

OBJECTIVES

To explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).

DESIGN

Qualitative descriptive study employing one-to-one semistructured virtual interviews analysed using the framework method.

SETTING

Four National Health Service Scotland territorial health boards.

PARTICIPANTS

11 people with Long COVID (1 male, 10 female; aged 40-65 (mean 53) and 13 GPs (5 male, 8 female).

RESULTS

Four key themes were identified: (1) The lived experience of Long COVID, describing the negative impact of Long COVID on participants' health and quality of life; (2) The challenges of an emergent and complex chronic condition, including uncertainties related to diagnosis and management; (3) Systemic challenges for Long COVID service delivery, including lack of clear pathways for access and referral, siloed services, limited resource and a perceived lack of holistic care, and (4) Perceptions and experiences of Long COVID and its management, including rehabilitation. In this theme, a lack of knowledge by GPs and people with Long COVID on the potential role of community rehabilitation for Long COVID was identified. Having prior knowledge of rehabilitation or being a healthcare professional appeared to facilitate access to community rehabilitation. Finally, people with Long COVID who had received rehabilitation had generally found it beneficial.

CONCLUSIONS

There are several patient, GP and service-level barriers to accessing community rehabilitation for Long COVID. There is a need for greater understanding by the public, GPs and other potential referrers of the role of community rehabilitation professionals in the management of Long COVID. There is also a need for community rehabilitation services to be well promoted and accessible to the people with Long COVID for whom they may be appropriate. The findings of this study can be used by those (re)designing community rehabilitation services for people with Long COVID.

'Counselling is not just providing information': perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya

BACKGROUND

Globally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs.

OBJECTIVE

For the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling.

DESIGN

We employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo.

SETTING

Health and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya.

PARTICIPANTS

We interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya.

RESULTS

Nutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers.

CONCLUSION

There is a disconnect between the caregivers' preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.

Voice and Communication in Transmasculine Individuals One Year Under Testosterone Therapy: A Qualitative Study

OBJECTIVES/HYPOTHESES

The purpose of this study was to investigate voice and communication difficulties in transmasculine individuals to develop evidence-based voice and communication training programs.

STUDY DESIGN

Qualitative study.

METHODS

Eight transmasculine individuals, who had received testosterone therapy (TT) for at least 1year, were included in this study. Semistructured interviews were conducted by two experienced voice clinicians. The software program NVivo was used for transcribing and coding the interviews. Data were processed using a thematic analysis.

RESULTS

The thematic analysis resulted in the identification of five major themes. Most transmasculine individuals experienced a pitch decrease during the first year of TT and encountered voice-related problems, with a higher incidence during the initial period. Additionally, some participants experienced increased satisfaction with how others attributed their gender after 1year of TT. However, others still experienced a discrepancy between external gender attribution, self-attribution, and their desired attribution by others. Many participants did not receive voice and communication training. In many cases, voice had a significant impact on their well-being and daily life.

CONCLUSIONS

It's difficult to generalize the results of the current study, since the population of transmasculine individuals is heterogeneous in terms of their subjective gender positioning, desired gender attribution, gender attribution received from others, and gender-related aspects of their vocal situation. Some clients may express dissatisfaction with specific aspects of their voice and communication and may require professional support. Therefore, clinical practice for transmasculine individuals should adopt an individualized approach based on a comprehensive examination of the client's perspective.

How do we explain painful non-traumatic knee conditions to adolescents? A multiple-method study to develop credible explanations

BACKGROUND

Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand "what's wrong with me". Our aim is to develop credible explanations about the condition for adolescents suffering from non-traumatic knee pain.

METHODS

This multiple-method study integrated findings from two systematic literature searches of qualitative and quantitative studies, an Argumentative Delphi with international experts (n = 16) and think-aloud interviews with adolescents (n = 16). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents' needs; we analysed feedback using thematic analysis. The explanations were tailored based on the adolescent end-users' input.

RESULTS

We screened 3239 titles/abstracts and included 16 papers exploring diagnostic uncertainty from adolescents' and parents' perspectives. Five themes were generated: (1) understanding causes and contributors to the pain experience, (2) feeling stigmatized for having an invisible condition, (3) having a name for pain, (4) controllability of pain, and (5) worried about something being missed. The Argumentative Delphi identified the following themes: (1) multidimensional perspective, (2) tailored to adolescents, (3) validation and reassurance, and (4) careful wording. Merging findings from the systematic search and the Delphi developed three essential domains to address in credible explanations: "What is non-traumatic knee pain and what does it mean?", "What is causing my knee pain?" and "How do I manage my knee pain?"

CONCLUSIONS

Six credible explanations for the six most common diagnoses of non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain.

SIGNIFICANCE

This study provides credible explanations for the six most common diagnoses of non-traumatic knee pain. Additionally, we identified three key domains that may need to be addressed to reduce diagnostic uncertainty in adolescents suffering from pain complaints. Based on our findings, we believe that clinicians will benefit from exploring adolescents' own perceptions of why they experience pain and perceived management strategies, as this information might capture important clinical information when managing these young individuals.

The Development of a New Patient-Reported Outcome Measure in Recessive Ataxias: The Person-Reported Ataxia Impact Scale

Autosomal recessive cerebellar ataxias (ARCAs) are inherited neurological disorders that can affect both the central and peripheral nervous systems. To assess the effects of interventions according to the perception of people affected, patient-reported outcome measures (PROMs) must be available. This paper presents the development process of the Person-Reported Ataxia Impact Scale (PRAIS), a new PROM in recessive ataxias, and the documentation of its content validity, interpretability, and construct validity (structural and discriminant). The development followed the PROMIS framework and the Food and Drug Administration guidelines. A mixed-method study design was used to develop the PROM. A systematic review of the literature, semistructured interviews, and discussion groups was conducted to constitute an item pool. Experts' consultation helped formulate items, and the questionnaire was sent online to be completed by people affected. Statistical analyses were performed to assess the structural and discriminant validity. A total of 125 people affected by recessive ataxia completed the questionnaire. The factor analysis confirmed the three components: physical functions and activities, mental functions, and social functions. The statistical analysis showed that it can discriminate between stages of mobility and level of autonomy. It showed very good levels of internal consistency (0.79 to 0.89). The Person-Reported Ataxia Impact Scale (PRAIS) is a 38-item questionnaire that assesses the manifestations and impacts of the disease according to the perception of people affected by recessive ataxia. It can be used in clinical and research settings.

Experiences and perspectives of colorectal cancer survivors and general practitioners on the delivery of survivorship care in general practice: a mixed methods study

BACKGROUND

Many colorectal cancer (CRC) survivors experience ongoing sequelae from their cancer treatment. Limited evidence exists regarding how CRC survivors and general practitioners (GPs) manage these sequelae in the community. This study aimed to explore the experiences and perspectives of CRC survivors and GPs on current approaches to monitoring and managing sequelae of CRC treatment.

METHODS

We conducted a mixed-methods study using cross-sectional national surveys and qualitative interviews with CRC survivors and GPs to explore: (1) treatment sequelae experienced by CRC survivors, (2) how these were monitored and managed by general practitioners, and (3) suggestions to improve ongoing management of the treatment sequelae. Survey responses were reported descriptively. Qualitative data were thematically analysed using an interpretive descriptive approach.

RESULTS

Seventy participants completed surveys: 51 CRC survivors and 19 GPs, and four interviews were conducted with GPs. CRC survivors experienced a range of treatment sequelae, but often did not discuss these with their GPs (experienced vs discussed: 86% vs 47% for fatigue/lack of energy, 78% vs 27% for psychological/emotional concern, 63% vs 22% for impaired sleep, 69% vs 29% for weight loss/gain, 59% vs 16% for sexual and intimacy concerns). GPs reported inadequate information transfer from cancer services and workload as major barriers to optimal care.

CONCLUSIONS

System-level changes that facilitate adequate information transfer from cancer services to GPs upon CRC treatment completion, as well as addressing time constraint issues essential for comprehensive monitoring and management of CRC treatment sequelae, could enhance the care of CRC survivors in the community setting.

Usefulness of pedagogical design features of a digital educational resource into nursing home placement: a qualitative study of nurse educators' experiences

BACKGROUND

The rapid advancement of technology-enhanced learning opportunities has resulted in requests of applying improved pedagogical design features of digital educational resources into nursing education. Digital educational resources refers to technology-mediated learning approaches. Efficient integration of digital educational resources into nursing education, and particularly into clinical placement, creates considerable challenges. The successful use of digital educational resources requires thoughtful integration of technological and pedagogical design features. Thus, we have designed and developed a digital educational resource, digiQUALinPRAX, by emphasizing pedagogical design features. The nurse educators' experiences of the usefulness of this digital educational resource is vital for securing improved quality in placement studies.

AIM

To obtain an in-depth understanding of the usefulness of the pedagogical design features of a digital educational resource, digiQUALinPRAX, in supporting nurse educators' educational role in nursing home placements in the first year of nursing education.

METHODS

An explorative and descriptive qualitative research design was used. Individual semi-structured interviews were conducted with six nurse educators working in first year of a Bachelor's of Nursing programme after using the digital educational resource, digiQUALinPRAX, during an eight-week clinical placement period in nursing homes in April 2022.

RESULTS

Two main categories were identified: (1) supporting supervision and assessment of student nurses and (2) supporting interactions and partnerships between stakeholders.

CONCLUSION

The pedagogical design features of the digiQUALinPRAX resource provided nurse educators with valuable pedagogical knowledge in terms of supervision and assessment of student nurses, as well as simplified and supported interaction and partnership between stakeholders.

Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research

BACKGROUND

A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort.

METHODS

Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis.

RESULTS

Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI.

CONCLUSIONS

Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.

Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure

BACKGROUND

Physical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial.

METHODS

A mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively.

RESULTS

Ten people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach.

FEASIBILITY

Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves.

CONCLUSIONS

It was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.

Implementing bedside handovers in mental health care: Insights from an experience-based co-design

OBJECTIVES

Bedside handovers have the potential to provide opportunities to increase patient involvement in mental health care. However, limited research has been conducted on this subject.

METHODS

In this study, we investigate the suitability of experience-based co-design as a method for designing bedside handover in mental health care.

RESULTS

The article discusses the goals of bedside handover, the preferred structure and content of the handover, its location and frequency, and the familiarization involved in it.

CONCLUSIONS

EBCD proved to be a suitable method of making recommendations for involving patients in nursing handover in a mental healthcare unit of a general hospital.

PRACTICE IMPLICATIONS

Nurses and mental health care patients agreed on the ISBARRT model to structure bedside handovers.

Locked down-locked in: experiences of families of young children with autism spectrum disorders in Delhi, India

Introduction

The onset of the COVID-19 pandemic and subsequent lockdowns in March 2020 disrupted the lives of families across India. The lockdown related restrictions brought forth a multitude of challenges including loss of employment, social isolation, school closures and financial burdens. Specifically, it also resulted in the restriction of health-care services for children with neurodevelopmental disabilities.

Methods

This qualitative study was conducted as a part of a larger trial in India to understand the experiences of families of young children with autism during the pandemic. In-depth interviews were carried out with 14 caregivers residing in New Delhi, India.

Results

Our findings identified pandemic and lockdown's universal impacts on family life and financial stability stemming from job loss, business closure, and salary deductions, affecting quality of life of families. Furthermore, COVID-19 pandemic's impact on autistic children was evident through limited access to essential services and financial challenges related service interruptions even after resumption of services. The lockdown's novelty also affected children's behavior, with both challenging behavioral changes and positive impacts. Primary caregivers, predominantly mothers, assumed additional responsibilities in household tasks, schooling, and therapy administration. While some these experiences were universally experienced, a few of these improved outcomes for autistic children. Despite challenges, parents expressed gratitude for their family's safety and well-being during the difficult time.

Discussions

These findings inform service provision for vulnerable families and offer implications for designing interventions such as credit schemes for families, guidance and resources for establishing and maintaining routines of children with autism, adopting flexible and adaptable approaches to service delivery, and special provisions for children with autism to be able to maintain their routines outside of home. Furthermore, the study highlights the need for comprehensive support, including educational resources and stress management counselling to empower parents in supporting essential care and routines for their children during such unprecedented times.

"Hair is your crown and glory" - Black women's experiences of living with alopecia and the role of social support

BACKGROUND

Alopecia is an autoimmune condition that results in hair loss, mainly from the scalp. There are three specific types of autoimmune alopecia: alopecia areata (AA; small patches of hair loss), alopecia totalis (AT; total hair loss from the scalp) and alopecia universalis (AU; total hair loss from the scalp and body). Whilst research has explored the experiences of White women living with alopecia, there is a lack of research exploring the impact of alopecia on women in the Black community. The current study aimed to explore Black women's experience of living with autoimmune types of alopecia with a focus on the cultural importance of hair within the Black community and the impact of social support.

PARTICIPANTS AND PROCEDURE

Seven Black women (age range: 37-68 years; mean age: 51 years) were recruited purposively through alopecia support group organisations and social media to participate in a semi-structured interview; four participants were diagnosed with AA, two participants were diagnosed with AU, and one participant was diagnosed with AT. One-to-one interviews were conducted online, and interpretative phenomenological analysis was used to guide data collection and analysis.

RESULTS

Participants discussed the significance of hair specifically within the Black community and the complex relationship between psychological wellbeing, coping and seeking support.

CONCLUSIONS

This novel area, specific to Black women's psychological experience of alopecia, acknowledges the influence of cultural and ethnic differences. The findings suggest that proactive awareness from health professionals and social support groups are needed due to the nuances of Black women's alopecia experience to provide better support and to enhance the quality of life for Black women to manage their alopecia.

Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study

INTRODUCTION

The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness.

METHODS

Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken.

RESULTS

Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media.

CONCLUSIONS

Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.

Applying Learning Principles Within Parent Education: Exploring Nurses' Practice and Parents' Experiences

Purpose

In parent-education practice nurses use Learning Principles (LPs) when helping parents to develop the knowledge and skills required to care for their children. LPs are basic precepts of learning, comprising people's beliefs, behaviors and reasoning processes. LPs underpin parents' active engagement, confidence building and decision-making, as information provided becomes usable knowledge. However, the ways nurses apply LPs in parent-education practice are poorly explained in healthcare. Likewise, descriptions of parents' learning experiences, associated with the use of LPs in nurse/parent-education interactions, are lacking. This study aimed to explore and describe nurses' perceptions and use of LPs, and parents' learning experiences in one healthcare organization.

Participants and Methods

Using an action research design, 25 nurses and 18 parent participants were purposively recruited across metropolitan Adelaide, Australia. Data were collected through observations and semi-structured interviews and thematically analyzed simultaneously June-December 2017.

Results

The LPs nurses used, and those important to parents' learning experiences created three overarching themes: 1) collaborative relationships, 2) deepening learning insights, 3) the learning environment. Despite their apparent use, nurses struggled to explicitly describe how they perceived LPs, believing their knowledge and use was sub-conscious - tacit. However, tacit knowledge hinders communication and explanation of LPs used within parent-education to other nurses. The member-checking of interview data helped to stimulate the nurses' metacognition (thinking about their thinking), unlocking their LPs awareness.

Conclusion

Nurses used LPs in practice but their knowledge was tacit. Through metacognition, nurses started to recognize the ways LPs influenced their practice and parents' learning capabilities. Increasing healthcare constraints, including time allowed for parent-education, require nurses to optimize their use of LPs. Future research should identify ways nurses can communicate their use of LPs, potentially enhancing parents' active learning experiences and concordance with health recommendations.

Experiences of colorectal cancer survivors in returning to primary coordinated healthcare following treatment

BACKGROUND

Advances in screening and treatments for colorectal cancer (CRC) have improved survival rates, leading to a large population of CRC survivors. Treatment for CRC can cause long-term side-effects and functioning impairments. General practitioners (GPs) have a role in meeting survivorship care needs of this group of survivors. We explored CRC survivors' experiences of managing the consequences of treatment in the community and their perspective on the GP's role in post-treatment care.

METHODS

This was a qualitative study using an interpretive descriptive approach. Adult participants no longer actively receiving treatment for CRC were asked about: side-effects post-treatment; experiences of GP-coordinated care; perceived care gaps; and perceived GP role in post-treatment care. Thematic analysis was used for data analysis.

RESULTS

A total of 19 interviews were conducted. Participants experienced side-effects that significantly impacted their lives; many they felt ill-prepared for. Disappointment and frustration was expressed with the healthcare system when expectations about preparation for post-treatment effects were not met. The GP was considered vital in survivorship care. Participants' unmet needs led to self-management, self-directed information seeking and sourcing referral options, leaving them feeling like their own care coordinator. Disparities in post-treatment care between metropolitan and rural participants were observed.

CONCLUSION

There is a need for improved discharge preparation and information for GPs, and earlier recognition of concerns following CRC treatment to ensure timely management and access to services in the community, supported by system-level initiatives and appropriate interventions.

Nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings: An interview study

AIM

To describe nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings.

DESIGN

A qualitative descriptive study design.

PARTICIPANTS

A total of 13 nurse leaders were recruited from four primary and specialized healthcare organizations in Finland.

METHODS

Data were collected through individual semi-structured interviews and analyzed using inductive content analysis.

RESULTS

Nurse leaders' experiences were categorized into seven main categories as follows: leadership, which concerns a leader's roles, style, and experience; organizational strategy and culture, which includes structure, policies, and intra-organizational culture; support strategies, including workplace and outside-of-work integration strategies; relationships and interactions, which considers interpersonal relationships and interactions; nurse competence requirements and development, which concerns both organizational and ward level competence demands, and support for competence development; language competence, which concerns challenges relating to language proficiency and development of language competence; and cultural diversity, which considers the importance of competence development brought about through experiences of being in a multicultural workplace.

CONCLUSIONS

Culturally and linguistically diverse nurses are important within healthcare systems. These nurses constitute additional human resources, bring diverse experiences and expertise, and add to organizational cultural capital. Nurse leaders require competencies that are suitable for leading a diverse workforce, utilizing its competencies, establishing staff members' needs, and ensuring their continuous development. Resourcing, planning, and structuring the integration process affects nurses' experiences of the organizational socialization process.

IMPACT

The findings of our study can offer guidance to healthcare organizations with regard to structural integration strategies at an institutional level. Leadership and management educators can benefit from the findings towards developing a curriculum that supports leaders' diversity, equity and inclusion, knowledge management and formal leadership competencies. Finally, nurse leaders may benefit from this study through being more aware towards supporting a multicultural, cohesive, and competent workforce through strong social capital.

Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study

BACKGROUND

The Hypoglycaemia - MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days.

OBJECTIVE

The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app.

METHODS

Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods.

RESULTS

A total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact.

CONCLUSIONS

The Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual's daily functioning. Despite suggested improvements, participants' responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact.