Thematic analysis of qualitative research data: Is it as easy as it sounds?

What knowledge and skills are needed for community volunteers to take on a signposting role in community-based palliative care? A qualitative study

Background

Community volunteers in palliative care (PC) have a unique position between healthcare professionals, community residents with care needs, and informal caregivers, offering complementary care and potentially playing a key signposting role. However, they need specific support in recognizing, describing, and communicating patient needs effectively, which can be transferred through training. The specific knowledge and skills required to take on this signposting role remain unclear.

Aims

To explore (1) experiences of communication and information sharing between community volunteers and healthcare professionals and (2) the desired and required knowledge and skills volunteers need to recognize, describe, and communicate PC needs to healthcare professionals.

Methods

A qualitative study design was used, conducting focus groups with community volunteers and healthcare professionals, and individual semi-structured interviews with community residents with PC needs and informal caregivers. Inductive thematic analysis was applied.

Results

Seven focus groups with 15 community volunteers and 20 healthcare professionals, and 10 interviews with 6 community residents with care needs and 4 informal caregivers were conducted. Findings revealed limited contact between volunteers and professionals and a lack of mutual awareness of each other's involvement, with professionals often distrusting volunteers as communication and collaboration partners. Perceived hierarchy made volunteers hesitant to communicate with professionals. Communication was typically one-directional, with volunteers sharing patient information. There were no established procedures for communication and information sharing. To fulfill their signposting role, volunteers need knowledge of PC needs and community resources, and strong relational, communication, and observation skills.

Conclusion

Volunteers need extensive skills to take on their signposting role. Training programs could boost volunteers' self-confidence by (1) increasing awareness and understanding of the community volunteer role and signposting function; (2) enhancing knowledge of PC, PC needs, and community services; (3) strengthening communication with resident's care needs, informal caregivers, and healthcare professionals. For the sake of patient care, it is important to improve communication, relationships, and collaboration between volunteers and professionals.

Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study

OBJECTIVES

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI).

DESIGN

A qualitative study nested within a controlled feasibility trial.

METHODS

Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis.

RESULTS

Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents.

CONCLUSION

Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

Constructing critical care nursing expertise: An integrative literature review

BACKGROUND

The lack of internationally uniform educational regulations and constantly intensifying competence requirements creates the need to enhance the understanding of the educational practices supporting the construction of critical care nursing competence.

AIMS

The aim of this review was to synthesise evidence on critical care nursing competency requirements and to learn more about the educational practices supporting the development of critical care nursing competence.

DESIGN

Integrative review.

METHODS

A systematic literature search was conducted in CINAHL, Scopus, and PubMed, focusing on peer reviewed studies of critical care nursing competence requirements. The review was guided by Cooper's method. Data evaluation was performed using the Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was used in the analysis and the PRISMA checklist for systematic reviews in reporting.

RESULTS

15 studies of quantitative, qualitative and mixed methods/Delphi research were included in the review. The development of competence in critical care nursing can be enhanced by supporting nurses' personal performance and by supporting the active, continuous and progressive achievement of core critical care nursing competencies.

CONCLUSION

To develop the best practices to meet the nursing care requirements of critically ill hospital patients, it is important to consider the personal characteristics of nurses' and support their professional self-confidence. Practices entailing the acquisition of extensive clinical experience, the completion of postgraduate critical care nursing education and the independent study of critical care nursing content are recommended. The development of expertise seems consistent when core competencies are achieved progressively upon the critical care nursing competence base to specialised and advanced competency levels.

Musculoskeletal First Contact Practitioners Undertaking a Higher Education Training Route-A Qualitative Exploration of Clinical Supervision Experiences

BACKGROUND

Musculoskeletal First Contact Practitioners (FCPs) are employed in primary care to assess patients and decrease workload for general practitioners. FCP training requirements are outlined in The Roadmap to Practice (RTP), which includes clinical supervision.

METHODS

In this qualitative study, 12 musculoskeletal FCPs who had completed FCP training at a specific English university participated in semi-structured interviews that explored their clinical supervision in primary care.

RESULTS

Thematic analysis identified three themes: operational factors, the role of personal and professional identity and the dynamics of learning. Participants reported variation in support and organisation provided in their places of work and the impact on their learning; specific barriers related to employment contracts were highlighted. Participants reflected on personal and professional factors that were inconsistently addressed, including cultural competence and the relevance of neurodiversity for both patients and professionals. Positive elements were raised relating to learning dynamics, including accessing supervision from more than one individual and representatives from more than one profession. The bidirectional learning opportunities offered from clinical supervision were highlighted, including supervisors who are not musculoskeletal specialists accessing musculoskeletal expertise from their mentees and the FCPs benefitting from supervisors who have extensive experience of managing complex consultations in primary care.

CONCLUSION

Clinical supervision experiences of FCPs in this study were typically positive. High-quality supervision is dependent on stakeholders fully understanding the role and is optimised by multi-professional involvement. Future studies could include evaluation of referral patterns and clinical outcomes of FCPs from varying employment frameworks.

Health inequity: Possibilities of initiating pulmonary telerehabilitation programs for adults with chronic obstructive pulmonary disorders in conflict and low-resourced areas; A mixed-method phenomenological study

OBJECTIVE

The "triple problems of COPD"-underdiagnosis, underrecognition, and underdevelopment of pulmonary rehabilitation programs-are global. Pulmonary telerehabilitation (PTR) may solve these problems. This study aims to explore the possibility of launching PTR programs for adults in an area of conflict and low resources.

METHODS

A mixed methods convergent design was used to understand outpatient Pulmonary Rehabilitation (PR) unavailability. The medical records of 70 patients with COPD in the Ministry of Health (MoH) chest unit were analysed quantitatively. thirteen patients who received in-hospital physiotherapy were questioned via a structured and validated questionnaire, and 12 healthcare professionals (HCPs) were interviewed. Quantitative data was analyzed descriptively, and inferentially by the SPSS, outlining the means, standard deviations and percentages, and the chi-square, respectively. Qualitative data was analyzed thematically using the NVivo software, and five themes and 25 subthemes were identified. A thematic framework and triangulation model were depicted accordingly.

RESULTS

Seventy patients with a mean age of 65.3 ± 1.65 years and a mean hospital stay of 4.89 ± 0.392 days were managed with no admission, Physiotherapy (PT) referral, or discharge criteria. Patients reported needing outpatient PR (4.38 ± 1.193) and a willingness to adopt (3.77 ± .832). Interviews with HCP highlighted the environmental and professional challenges, opportunities, and PTR traits. Quantitative and qualitative data triangulation led to the COPD Sequential Triad (CST) theory.

CONCLUSION

This study identified the national, institutional, and professional challenges and opportunities of launching PTR programs in conflict and low-resourced areas, including the conflict's consequences, insufficient resources, and absence of a structured healthcare system and clinical practice guidelines. Promoting health equity in such areas necessitates that the international community and institutions isolate the healthcare sector from conflicts and apply more effective strategies. The study also illustrated the characteristics of the intended PTR programs, including mHealth, therapeutic devices, and hybrid programs along with supporting professional organizations' guidelines.

United States Environmental Protection Agency's Perfluorooctanoic Acid, Perfluorooctane Sulfonic Acid, and Related Per- and Polyfluoroalkyl Substances 2024 Drinking Water Maximum Contaminant Level: Part 1 - Analysis of Public Comments

In March 2023, the EPA proposed a 4.0 ppt maximum contaminant level (MCL) for perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) (each) and a hazard index approach for four other PFAS. The EPA sought public feedback on the proposed MCL in early 2023 and received 1626 comment submissions via the PFAS docket website (Docket ID: EPA-HQ-OW-2022-0114). Final MCLs were promulgated on April 10, 2024. Our analysis of the PFAS docket identified 128 comments that had a reasonable degree of scientific merit, with 57 comments endorsing the regulations and 71 questioning the MCLs public health utility. Critics noted the lack of evidence for adverse health effects at low PFAS exposures, the rule's significant impact on the economy, and the EPA's selection of published papers which the Agency chose to support their views. Many well-substantiated comments highlighted that few, if any, adverse health effects were reported at doses as much as 100-1000 times above those associated with the proposed drinking water guidelines. We found that the comments which discussed the evidence linking PFAS exposures below 200 ppt in drinking water to adverse health effects were equivocal. Most of the well-documented science based comments indicated that the data did not justify setting a 4.0 ppt MCL. It was noted that the EPA MCL was quite different from drinking water standards in other countries (up to 8-140 fold lower). During the review, it became apparent that a 4.0 ppt MCL may have little effect on PFAS blood concentrations in most Americans since drinking water accounts for less than 20% of their total PFAS intake. Additionally, a significant portion of the American population consumes minimal amounts of tap water. Commenters noted that the financial burden for treatment and cleanup was much higher than what was reported in the justification for the final MCL which was submitted to the Office of Management and Budget (OMB) and eventually promulgated. It is possible that EPA underestimated the financial impact on the nation by up to 100 to 200-fold. Our analysis indicates that many, if not most, of the scientifically rigorous comments on the EPA's proposed MCL were not acknowledged or considered by the Agency. We conclude the article by offering sixteen recommendations for the EPA to consider if Congress or the courts choose to reopen the evaluation of these MCLs. These included convening an international expert panel, reevaluating the appropriateness of the LNT model for PFAS, ensuring adequate time for study quality assessment and cost-benefit analysis, considering an approach to implementing a series of MCLs, critically reevaluating scientific studies, adhering to EPA risk assessment guidelines, addressing SDWA compliance concerns, revisiting the Hazard Index approach, and ensuring thorough and transparent review of public comments.

Exploring factors affecting knowledge creation in under-researched healthcare topics: a case study of women's health research

BACKGROUND

Knowledge creation (KC) produces resources to synthesize policy evidence and contributes to breakthroughs in unresolved health problems by discovering the previously unknown. Nevertheless, few studies have attempted to analyze which factors contribute to KC. This study aims to investigate the factors hindering the active occurrence of KC by using women's health research as a representative example of an under-researched healthcare field in South Korea.

METHODS

The study adopted a qualitative approach to exploring factors influencing KC from researchers' perspectives. We conducted semi-structured interviews with 14 experts who have experience in planning women's health research, research policymaking or conducting research in South Korea. Data were analyzed using a qualitative thematic analysis according to Castleberry and Nolen.

RESULTS

Factors affecting KC across all three government-funded research processes were identified. Most of the identified factors were found to be barriers to KC, rather than enablers. The key influencing factors included a focus on urgent, politicized societal issues rather than ongoing health concerns, insufficient motivation and support for researchers, weak communication within interdisciplinary research teams, and challenges with expanding research networks.

CONCLUSION

To bridge the know-do gap in the health policy-making process, it is essential to produce sufficient high-quality knowledge that can serve as policy evidence. The findings of this study illuminate the conditions faced by under-researched topics and identify the factors necessary to enhance KC. We believe our findings will help reshape and invigorate discourse and research policies on KC in healthcare.

Understanding health care workers' mental health needs: insights from a qualitative study on digital interventions

IMPORTANCE

Health care workers (HCWs) face significant mental health challenges when delivering care and over the span of their careers. Despite growing recognition of these issues, barriers such as stigma, structural limitations, and individual obstacles continue to impede progress in supporting HCWs mental health needs. Digital mental health platforms continue to expand in health systems as they offer novel approaches to address these gaps, but more evidence is needed to understand their reception among HCWs.

OBJECTIVE

To examine the perceptions of HCWs regarding their mental health, explore barriers and facilitators to accessing mental health care, and assess their experiences with digital mental health interventions within the context of the pandemic.

DESIGN

A qualitative study using semi-structured interviews with HCWs who participated in a prior randomized controlled trial (RCT) assessing the impact of a digital mental health platform on anxiety and depression.

SETTING

A large, urban, academic health system.

PARTICIPANTS

A purposive sample of 64 HCWs, including physicians, nurses, technicians, administrative staff, and social workers, was recruited. Participants were selected from the upper and lower quartiles of anxiety and depression scores from the parent RCT to capture a range of mental health symptomatology.

OUTCOMES AND MEASURES

The study aimed to identify HCWs' attitudes toward mental health care, barriers to utilizing professional resources, and their experiences with the digital mental health platform at the local institution. A thematic content analysis was used to analyze the interview data.

RESULTS

Five major themes were identified: (1) the evolving mental health challenges during and after the pandemic, (2) individual barriers to accessing care, such as personal coping strategies and familial responsibilities, (3) structural barriers like workload and limited access to mental health clinicians, (4) experiences with digital mental health interventions, including text message-based assessments, and (5) recommendations for future digital health strategies to improve access and reduce stigma.

CONCLUSION

Digital mental health interventions provide a promising avenue to support HCWs by reducing stigma and improving access to mental health resources and clinicians. However, personalized and system-level changes are necessary to address the ongoing mental health challenges faced by the workforce.

Assessment of student well-being and identification of associated factors

OBJECTIVE

The current study assessed the well-being of PharmD students in the first through third professional years (PY) utilizing an internally developed survey.

METHODS

A survey was administered in Spring 2022 to students at one school, which contained five-point Likert scale items measuring factors of well-being (life balance, connectivity, inclusivity, and faculty support), in addition to background variables and an open-ended item asking what program changes would improve students' well-being. Descriptive statistics were examined along with ordinary least squares regression models with PY, gender, ethnicity, and residency (local versus non-local) examined as predictors. Open-ended responses were coded using a thematic analysis approach.

RESULTS

A total of 253 (75 % response rate) students completed the survey. The summation of, "life balance" items had the lowest mean (M = 2.84, SD = 0.77) and, "inclusivity" items (M = 3.60, SD = 0.88) had the highest mean. PY2 and PY3 students both had higher scores on the life balance items, PY2 students had higher scores on the faculty support items. Females had lower scores on the life balance items. Blacks/Hispanics had lower scores on items pertaining to inclusivity and connectivity. Students commented that improving faculty-student engagement, the scheduling or frequency of exams, and improving student-student engagement could improve well-being.

CONCLUSION

It is important to develop a methodical plan to assess and address student well-being. This study assessed multiple factors of well-being and found differences based on professional year, gender, and race/ethnicity. Based on the results of the study, relevant changes were made at our institution.

A proposed framework of strategies to overcome challenges to surgical quality assurance in oncology trials (SQA-Onc.)

INTRODUCTION

Randomised controlled trials (RCTs) with surgical interventions frequently lack a framework to ensure surgical quality. We aimed to investigate surgical quality assurance (SQA) in oesophagogastric oncology trials and to develop a translatable framework of strategies to overcome challenges in the design and implementation of SQA.

METHODS

Seventy-one peer-nominated, international, expert trial stakeholders included surgeons; oncologists; trial managers and trial methodologists. Semi-structured interviews were conducted with expert stakeholders examining challenges to SQA in oncology trials followed by a Delphi process to gain consensus on mitigating strategies. Relevant expert consensus strategies were selected for inclusion within a separate written survey and Delphi process in the active ADDICT RCT.

RESULTS

Expert consensus was reached for 59 strategies to overcome challenges to SQA in oncology trials. 19 of these strategies were selected for inclusion within the ADDICT survey and Delphi process, of which 14 (74 %) gained consensus amongst ADDICT trial stakeholders across two Delphi rounds, indicating their relevance within an active surgical oncology RCT. Prominent mitigating strategies included operative monitoring using photographs and/or videos with a structured objective assessment tool. Summarising the expert Delphi consensus allowed formulation of a framework of strategies to overcome challenges to SQA in oncology trials (SQA-Onc.) CONCLUSION: In this first international expert consensus within this area, agreement was reached for 59 strategies to overcome challenges to implementation of SQA. The proposed SQA-Onc. tool is intended to support SQA measures within future trials. Validating this framework within the next generation of RCTs should be the focus of future research.

Perceptions of Service Workload Among United States Pharmacy Faculty and Administrators: A Focus Group Study

OBJECTIVE

To explore the perceptions of service workload among pharmacy faculty and administrators in the United States using a qualitative method.

METHODS

A survey was distributed to solicit pharmacy faculty for 2 types of focus groups: administrative and nonadministrative faculty from accredited colleges and schools of pharmacy in the United States. Participants were selected to ensure institutional representation across demographic parameters, such as geographic location, funding status (public vs private), age of program (pre-1995 and post-1995), and program structure (3-year, 4-year, and 0-6). Based on the goal of balancing these parameters, participants were contacted to schedule their participation in semi structured interviews via focus groups. The interviews were transcribed and analyzed using an inductive thematic analysis approach.

RESULTS

A total of 9 focus groups were conducted with 17 administrators and 10 non administrator faculty members. Five major themes emerged from both faculty and administrators: assignment and allocation of service, definition of service, equity in service, transparency, and value for promotion. An additional theme, motivation for service, emerged from the administrator group. Subthemes varied between the 2 groups, highlighting differing perspectives on issues, such as flexibility in service assignments, recognition of clinical service, and the role of seniority in service allocation.

CONCLUSION

This study revealed the complexities and challenges of pharmacy faculty service workload. The findings emphasize the need for clearer workload guidelines, equitable distribution of service assignments, transparency in workload assignment and allocation, and formal recognition of service in promotion and tenure decisions.

Sensory experiences that impact tics: young person and parent perspectives

PURPOSE

Sensory dysregulation impacts multiple areas within the everyday lives of young people with tic disorders. Although research indicates contextual and emotional factors worsen sensory dysregulation and impact tic expression, there is a paucity of qualitative studies investigating the interplay between sensory experiences and tics in young people. Thus, the purpose of this study was to explore the sensory experiences that reduce or exacerbate tics from the perspectives of young people and their parent(s).

METHODS AND MATERIALS

A qualitative descriptive method was used. Semi-structured interviews were conducted with 10 young people with tic disorders and their parent(s). Thematic analysis was used to analyse the data.

RESULTS

Three overarching themes were identified: sensory experiences associated with tics; environmental contexts that reduce or exacerbate tics; and occupational participation as a method of focus and distraction.

CONCLUSIONS

This study highlights the sensory experiences that reduce or exacerbate tics are unique to the individual. This indicates the need for a holistic approach that considers personal, environmental and occupational factors that may assist young people to better understand their sensory needs, identity safe sensory environments and participate in meaningful occupations to reduce tics.

Prioritizing Hearing: Patient and Provider Perspectives on Rural Hearing Health Care and Patient Navigation

PURPOSE

Hearing loss is the third most prevalent chronic health condition among adults in the United States. Rural adults face disproportionately high rates of hearing loss and numerous systemic barriers to hearing health care (HHC). This study aims to explore experiences of hearing loss, identify factors that impact access, and assess the potential acceptability of a patient navigation program. Perspectives of patients experiencing hearing loss and rural health care providers are vital for designing an intervention that addresses barriers to HHC experienced in rural settings.

METHOD

As the first phase of a larger project guided by the PRECEDE-PROCEED planning model, a qualitative needs assessment was conducted using semistructured interviews with 21 adult primary care patients with hearing loss and 11 health care personnel from primary care clinics in rural Kentucky. Thematic analysis identified predisposing, enabling, and need factors perceived as influencing whether HHC is accessed by rural adults with hearing loss.

RESULTS

Analyses revealed that patients accessing HHC was perceived to be affected by predisposing (concerns about noise exposure and attitudes about HHC), enabling (connection to HHC and resources, lack of local HHC services, communication challenges, transportation challenges, and cost of care), and need factors (experience with hearing loss). Participants agreed that a patient navigator (PN) could increase access to HHC by providing social support and by connecting patients to education and resources.

CONCLUSIONS

Results from this analysis will inform the development of a patient navigation intervention for HHC for rural adults. PNs will receive specialized training to help patients meet stated needs and overcome commonly reported barriers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28620104.

Home-based care for umbilical cords of neonates by family caregivers in Mpumalanga province, South Africa

Background

Multiple substances have been applied to neonates' umbilical cords and have yielded detrimental results on neonates' health status.

Aim

The study aimed to explore and describe home-based care for umbilical cords of neonates by family caregivers.

Setting

The study was conducted at Waterval community, a village under Dr J.S Moroka local municipality in Nkangala district in the Mpumalanga province.

Methods

A qualitative exploratory, descriptive research study design was used to explore home-based care for neonates' umbilical cords. The target population was family caregivers who had been caring for the umbilical cords of neonates at home. Non-probability and purposive sampling were done, and individual in-depth interviews were used for data collection. The sample size of 18 participants was determined by data saturation. Thematic analysis was utilised to analyse the data.

Results

The following main themes emerged during data analysis: substances applied on the umbilical cord, beliefs associated with umbilical cord care, the effectiveness of health education provided on discharge from the community health centre and the healing process.

Conclusion

The findings of the study revealed that various harmful substances were applied to the umbilical cords of neonates, and these practices were influenced by cultural beliefs.

Contribution

The findings of the study brought to light that indeed, the application of substances that have not been recommended by the South African guidelines on neonates' umbilical cord does lead to delayed umbilical cord separation and healing and has the potential to cause neonatal infections.

Barriers and facilitators to scaling up medications for opioid use disorder in Kentucky: qualitative perspectives of treatment organization staff

BACKGROUND

Underutilization of medications for opioid use disorder (MOUD) remains a persistent obstacle to addressing the opioid epidemic. This study explores MOUD agency experiences with patient census growth as well as multi-level barriers and facilitators to expanding MOUD from the perspectives of agency staff.

METHODS

Semi-structured qualitative interviews were conducted with 66 employees representing 30 MOUD agencies in eight Kentucky counties in the United States from December 2022 to June 2023 as part of the HEALing (Helping to End Addiction Long-term®) Communities Study in Kentucky (HCS-KY). Interviews were conducted prior to the development of partnerships to implement strategies focused on expanding MOUD census and increasing MOUD retention. Facility administrators/directors, prescribers, and clinicians were prioritized for recruitment, but agencies could identify other staff to participate. Interviews were recorded and transcribed. A consensus-based approach to coding and thematic analysis was used.

RESULTS

Although some agencies had a fairly static number of patients, most described recent experiences with modest growth in MOUD census and the ability to provide same day/next day MOUD. Multi-level factors, including organizational, patient, and community factors, were perceived to impact MOUD census. Organizational characteristics impacting growth included the physical space of the clinic and staffing. Organizational policies in some agencies constrained treatment retention, while other agencies implemented innovations to better meet patients' needs. Patients often encountered numerous obstacles to treatment initiation and retention, including limited access to transportation, technology, stable housing, and childcare. These patient-level barriers often reflected community characteristics, while community stigma also impeded MOUD growth.

CONCLUSIONS

Although some degree of growth in MOUD has occurred, multiple barriers are impeding further increases in treatment initiation and retention. Overcoming some barriers would likely require policy changes related to financing and regulation, while other barriers would require community-level efforts to decrease stigma and greater community investment in infrastructure, such as transportation and housing.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .

Cancer genetic counseling via telegenetics and telephone: A qualitative study exploring the experience of patients and genetic counselors in an Australian cancer genetics context

The demand for direct-to-patient (DTP) telegenetics (genetics services delivered via videoconferencing) in genetic counseling practice has rapidly increased, particularly since the COVID-19 pandemic. Recent telegenetics literature is mostly quantitative and not in the Australian context. A qualitative interview study was conducted to address this gap. This research investigated the experiences of patients and genetic counselors (GCs), enrolled in a randomized controlled trial, using telegenetics and telephone for cancer genetic counseling appointments. Twenty-eight semi-structured interviews with patients (n = 22) and GCs (n = 6) were conducted following patient randomization to either a telephone or telegenetics genetic counseling appointment. The interviews explored participant's experiences of telegenetics and compared DTP telegenetics with telephone and in-person delivery. Codebook thematic analysis was used to develop topic summaries from the data. Patient and GC participants noted positive experiences of telegenetics; with key benefits reported as reduced travel time, time and cost saving, ease, convenience, efficiency, and comfortability. Technical issues and privacy concerns were highlighted as potential disadvantages of telegenetics. All but one patient felt sufficiently emotionally supported while using telegenetics. Telegenetics has both benefits and limitations; however, generally, this cohort found telegenetics to be a suitable and acceptable mode of delivery for genetic counseling with many advantages over in-person or telephone appointments. Further studies should be conducted to provide evidence for the long-term implementation of telegenetics, regardless of any future COVID-19 pandemic lockdown restrictions.

A thematic review of autism spectrum disorder research in Saudi Arabia: Insights into diagnosis, assessment, and language considerations

This study reviews the crucial role of language in Autism Spectrum Disorder (ASD) diagnosis and assessment in Saudi Arabia. Using tailored search strings, 206 relevant documents were retrieved from the Web of Science and Scopus databases. An increasing trend in ASD research in Saudi Arabia was observed through temporal analysis. Keyword analysis identified key themes including "autism," "language," "assessment," "diagnosis," "Saudi Arabia," and "children." The focus of research has shifted over the years, from pure clinical and diagnostic aspects to a more comprehensive approach that includes language and cultural factors in ASD evaluation. The findings underscore the need for culturally and linguistically sensitive assessment tools, acknowledging the impact of bilingualism on language development, and the importance of language difficulties in diagnostic decision-making. The study highlights the necessity for further research, especially longitudinal studies examining the influence of language and cultural factors on ASD outcomes. The findings are significant for clinical practice, emphasizing the need for linguistically sensitive approaches in ASD diagnosis and assessment. This research serves as a guide for future studies by identifying the gaps in existing literature and areas of focus. The study identifies crucial gaps in existing literature, particularly the need for longitudinal studies examining the influence of language and cultural factors on ASD outcomes. The findings underscore the importance of culturally and linguistically sensitive approaches in ASD diagnosis and assessment, providing a novel insight for future research and clinical practice in Saudi Arabia.

Assessing clinical associate students' views on learning opportunities and involvement during primary health care placements: a mixed methods study in Tshwane

BACKGROUND

The training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations.

METHODOLOGY

This cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions.

RESULTS

A total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in 'participation in patient education', where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff.

CONCLUSION

This study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.

Home-Based Nonimmersive Virtual Reality Training After Discharge From Inpatient or Outpatient Stroke Rehabilitation: Parallel Feasibility Randomized Controlled Trial

BACKGROUND

Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy.

OBJECTIVE

The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait.

METHODS

Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor.

RESULTS

NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups.

CONCLUSIONS

Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-019-3438-9.

Unraveling the personality traits of civil heroes in great disaster: a qualitative study

Introduction

Heroes are everywhere, and shine the brightest in the dark. Although the concept of heroism has been widely discussed in the fields of philosophy and social sciences, the personality traits of civil heroes emerging from great disasters has remained unexplored topic.

Methods

The qualitative research methodologies are conducted to dissect and elucidate the multifaceted personality traits of civil heroes, through semi-structured interviews with 50 eyewitnesses and participants in relief efforts following the Wenchuan Earthquake of China.

Results

Civil heroes are ordinary individuals who display profound loyalty to the nation and its people, uphold a steadfast belief in self-reliance, boldly confront risks and challenges, continually surpass themselves, and strive to accomplish remarkable feats. The personality traits encompass five dimensions (i.e., patriotism and love for the people, independence and self-improvement, relentless striving and perseverance, selflessness and fearlessness, and grounded in facts and innovation), which intricately intertwine and collectively shape the luminous image of civil heroes, serving as a potent catalyst for social progress and civilization.

Discussion

The research augments the theoretical framework and provides a more comprehensive and nuanced understanding of civil heroes, inspiring more individuals to dedicate themselves to societal welfare and foster a more harmonious and beautiful society.

Exploring College Students' Acceptance of and Behavioral Intentions Toward Different Sorghum-Based Foods

Sorghum is a nutritious, healthy, gluten-free whole grain, with the United States (U.S.) leading its production globally. While sorghum is consumed worldwide, it is mainly used for animal feed and biofuel in the U.S. Organoleptic characteristics and consumers' perceptions determine food acceptance and eating behavior. Therefore, this study aimed to investigate the acceptance of and eating and purchase intentions toward sorghum-based foods among college students in a southern university in the U.S. Eighty-three students participated in a series of sensory evaluations using two sets of four sorghum samples each and a 15 min break. Seven sensory attributes were evaluated with a nine-point hedonic scale, and a five-point scale was used for eating and purchase intentions. To assess the panelists' acceptance, the overall acceptance scale score (range: 1-9) was normalized (range: 0-100) and used for analyses. Spiced sorghum cookies (77.95 ± 14.23) had the highest acceptance, followed by sorghum shrimp grits (74.51 ± 19.42). Overall acceptance, eating intention, and purchase intention were strongly associated across all food items, although the strength differed by food type. Sorghum-based foods were accepted despite the participants' lack of exposure to sorghum and its null consumption. These outcomes will help to develop innovative sorghum-based foods to facilitate sorghum consumption and benefit consumer health in the U.S.

Perceived barriers to and facilitators of behavioural change towards a more active lifestyle in people with neuromuscular diseases: a qualitative study

OBJECTIVE

To explore perceived barriers to and facilitators of behaviour change towards a more active lifestyle in people with neuromuscular diseases.

DESIGN

A qualitative study.

SUBJECTS

Nineteen subjects (63% females, age range 28-73 years), representing 4 different neuromuscular diseases.

METHODS

Data from a randomized controlled trial were used. Subjects followed a physical activity programme including coaching sessions using motivational interviewing techniques. All sessions were audio-recorded, and thematic analyses were conducted on a random selection of 29 audio recordings, using the International Classification of Functioning, Disability and Health as a framework.

RESULTS

Barriers and facilitators were identified in the following domains: body functions and structures (i.e., neuromusculoskeletal, sensory and mental functions), activities and participation (i.e., undertaking multiple tasks and complex interpersonal interactions), environmental factors (i.e., products and technology for personal use in daily living, design/construction of buildings for public and private use, financial assets, climate, natural events, support and relationships) and personal factors (i.e., satisfaction with life, attitude toward health and disease, attitude toward intervention, exercise habits and methodical skills).

CONCLUSION

Identified barriers and facilitators could guide healthcare professionals to facilitate the discussion of physical activity behaviour and to address them in a personalized way during neuromuscular rehabilitation treatment.

Exploring the barriers to mental health help-seeking among African Migrants in Australia: A qualitative study

BACKGROUND

The health of African migrants in Australia is a largely under-researched topic despite the steadily increasing size of the population and its uniqueness. In particular, few studies have explored the mental health of African migrants in Australia or their utilization of mental health services.

AIMS

This study explored the barriers to mental health help-seeking among first-generation African migrants in Australia.

METHODS

In this qualitative study conducted using the hermeneutical phenomenological research approach, the purposive sampling method was used to recruit participants. In-depth interviews with participants were undertaken online via Zoom, Teams, and WhatsApp calls. Interviews were recorded and transcribed verbatim, utilizing a thematic analysis as the primary data analysis method.

RESULTS

African migrants were more inclined to seek support for mental health conditions from religious figures such as priests instead of seeking professional help. Religion and poor knowledge about mental illness were highlighted as barriers to mental health help-seeking. Participants also considered cultural beliefs, fear of stigma as well as the high cost of healthcare in Australia as significant barriers to mental health help-seeking among African migrants.

CONCLUSIONS

Findings reinforce the critical need for culturally competent mental health services tailored to the beliefs, values, religion, and experiences of African and other migrant communities in Australia. Given the strong attachment of many African migrants in Australia to their cultural and religious beliefs, such services are essential for practical support and intervention.

Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky

BACKGROUND

Efforts to scale up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, was a major focus of the HEALing Communities Study (HCS). The aim of this analysis is to describe the qualitative perspectives of partner organizations regarding the impacts of implementing OEND in a state that used a naloxone "hub with many spokes" model for scaling up this strategy.

METHODS

Small group (n = 20) and individual (n = 24) qualitative interviews were conducted with staff from 44 agencies in eight Kentucky counties that implemented OEND from April 2020 to June 2022. Interviews were conducted between 6 and 8 months after the end of the intervention. Initial deductive coding used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, and then additional inductive sub-coding focused on passages within the OEND Effectiveness code. Thematic analysis was then utilized to identify themes regarding the impacts of implementing OEND.

RESULTS

Participants identified multi-level impacts of implementing OEND. At the individual-level, participants described lives being saved, greater access to naloxone for individuals served by the agency, reduced stigma toward OEND by clients, and greater client-level self-efficacy to respond to overdoses. Organizational impacts included improved staff readiness for overdose response, enhanced clinical relationships between staff and clients, and reduced staff stigma. Participants described positive impacts on their organizational networks and clients' social networks. Community-level impacts included greater overall access and reduced stigma toward OEND.

CONCLUSIONS

These qualitative data revealed that staff from agencies involved in a community-wide effort to scale up OEND perceived multi-level benefits, including saving lives, reducing stigma, improving naloxone access, and enhancing staff and client readiness, while strengthening organizational and community networks.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939.

Adolescent's Mental Health in Context of Indirect Exposure to Terrorism: A Qualitative Study

The escalating indirect exposure to terrorism through media has contributed to rising mental health issues among adolescents. The terrorist attack on Army Public School Peshawar (APSP) in Pakistan has received immense media coverage and the violence shown has touched the lives of natives. The current study adopts an Interpretative phenomenological analysis to explore the impact of indirect exposure to terrorism through media-television and Facebook-on adolescents' mental health in relation to terrorist attack on APSP. Moreover, the effect of changes occurred in parents' behaviour and school settings after the stated terrorist attack were also considered. To gather data, six Focus Group Discussions (FGDs) were conducted with adolescents (N = 45) who were enrolled in educational institutes far from the epicentre of the attack and came to know about the attack through media. Acquired qualitative data was subjected to thematic analysis revealing that indirect exposure to terrorism through media negatively impact the mental health of adolescents. Likewise, the abrupt changes in school settings and parental behaviour cause disruption in their immediate environment that further impacts their well-being.

Culturally Adapting an Occupational Therapy Intervention for Black American Autistic Communities

IMPORTANCE

Ayres Sensory Integration® is an evidence-based intervention for autistic children, but there is no culturally responsive adaptation to support Black American autistic children and their families.

OBJECTIVE

To culturally adapt an occupational therapy intervention for Black American families.

DESIGN

Qualitative study involving focus groups and interviews, using researcher triangulation and member-checking surveys for the trustworthiness of findings.

SETTING

Zoom focus groups and interviews.

PARTICIPANTS

Convenience sampling resulted in 12 participants, including Black American parents and caregivers, cultural experts, and occupational therapy practitioners who provide services to Black American autistic children.

OUTCOMES AND MEASURES

Interviews and focus group discussions.

RESULTS

Four parents and caregivers, two cultural experts, and six practitioners participated. Five themes emerged regarding barriers and eight for supports in accessing and utilizing occupational therapy services, including cultural humility knowledge and practices by practitioners and strategies for engaging and incorporating families' culture.

CONCLUSIONS AND RELEVANCE

This study demonstrates the process of culturally adapting an occupational therapy intervention according to relevant literature and the insight and expertise of parents and caregivers, cultural experts, and occupational therapy practitioners. Plain-Language Summary: This project identified challenges and supports for Black American families of autistic children regarding access to and engagement in occupational therapy services. We adapted an occupational therapy intervention to address these challenges and to include recommended supports to guide occupational therapy practitioners to be more culturally responsive and collaborative with Black American families of autistic children throughout the therapeutic process. Positionality Statement: The inclusive term Black American is used to engage people from all cultural and ethnic backgrounds who are a part of the Black and African-American community throughout the United States (Rivera-Figueroa et al., 2022). Also, identity-first terminology and the term autistic are used according to autistic adults' preferences for embracing one's identity (Taboas et al., 2023). The research team consisted of female occupational therapists (Rachel Dumont, Roseann Schaaf, Lady Rios-Vega, and Taylor Sivori, who self-identified as White, White, Latina, and White, respectively); female and male occupational therapy students (Allison Barrett, Emily Knell, and Joshua Njoroge, who self-identified as Asian, White, and Black and White, respectively); and a male focus group facilitator (Levone Cannady, who self-identified as Black). The principal investigator (PI) for this study, Rachel Dumont, and co-PI, Roseann Schaaf, have 16 yr and more than 30 yr of research experience, respectively. The co-PI has extensive experience with occupational therapy using Ayres Sensory Integration and was the director of the Jefferson Autism Center of Excellence. The focus group facilitator had over 8 yr of experience in leading groups and workshops.

Exploring data security risks associated with trauma medical data within hospitals in China: a qualitative study

OBJECTIVES

To explore data security risks associated with trauma medical data within hospitals in China, identify and explore the potential underlying factors contributing to these risks and collect suggestions from different stakeholders.

DESIGN

This is a qualitative study involving two types of hospital personnel. Data analysis was performed using thematic analysis.

SETTING

The study was conducted in 21 tertiary hospitals from 12 provinces in China, distributed across the eastern, central and western regions of the country. The interviews were conducted between April and August 2022.

PARTICIPANTS

A total of 27 respondents (7 department heads and 20 doctors) were interviewed through stratified purposive sampling.

RESULTS

Data security risks associated with trauma medical data might arise from trauma physicians' inadequate management of trauma data, the absence of trauma data administrators and data management systems and the lack of security measures for trauma databases. Feasible suggestions included training trauma physicians, establishing a trauma data administrator and a trauma data management system and improving basic data security protection measures.

CONCLUSIONS

Determining the risks of trauma medical data security and providing tailored suggestions contribute to the development of healthcare data governance in China. This research establishes a foundation for addressing the current risks related to trauma medical data security and could contribute to efforts to improve the overall capacity of trauma data management in China.

Implicit bias in referrals to relational psychological therapies: review and recommendations for mental health services

Introduction

Timely and appropriate psychological treatment is an essential element required to address the growing burden of mental health issues, which has significant implications for individuals, society, and healthcare systems. However, research indicates that implicit biases among mental health professionals may influence referral decisions, potentially leading to disparities in access to relational psychological therapies. This study investigates bias in referral practices within mental health services, identifying key themes in referral procedures and proposing recommendations to mitigate bias and promote equitable access.

Methods

A systematic review of literature published between 2002 and 2022 was conducted, focusing on biases, referral practices, and relational psychological therapies. The search strategy involved full-text screening of studies meeting inclusion criteria, specifically those examining professional and organizational implicit bias in mental health referrals. Thematic synthesis was employed to analyze and categorize bias within these domains, providing a structured framework for understanding its impact on referral decision making processes.

Results

The search yielded 2,964 relevant papers, of which 77 underwent full-text screening. Ultimately, eight studies met the inclusion criteria and were incorporated into the review. The analysis revealed that bias development mechanisms in referral decisions occurred across five key domains: resource allocation, organizational procedures, clinical roles, decision-making, and referral preferences. These domains highlight organizational and practitioner-level factors contributing to disparities in access to psychological therapies.

Discussion

Findings suggest that implicit biases within referral processes can limit equitable access to psychological therapies, particularly relational therapies that emphasize therapeutic alliance and patient-centered care. This study provides recommendations to address these biases, including standardized referral guidelines, enhanced professional training on implicit bias, and improved oversight mechanisms within mental health services.

Principles to award learning achievements for lifelong learning in health using micro-credentials: an international Delphi study

BACKGROUND

This research investigates micro-credentialing as an approach to recognise learning achievements in health. Establishing international standards can ensure consistency, promote equity, and enhance quality of recognition systems. Achieving stakeholder consensus on the key topic areas is an important precursor to lead to relevant topics from which to build appropriate standards. This research supports the efforts by UN agency representatives and experts in qualification systems, medical education, the health and care sector, regulation, and accreditation, to build foundations from which to launch normative work on the application of micro-credentials to award learning achievements for health and care workers.

METHODS

A modified Delphi study following methodological steps was conducted. From April to May 2021, a literature review investigated existing standards in continuing professional development and the use of micro-credentialing in health. Results from the review informed the initial draft of statements that were then refined through three iterative Delphi rounds between May to September 2021. The process culminated in a final workshop in March 2023.

RESULTS

A total of 53 participants completed the Delphi, with results analysed by researchers using qualitative analysis. Consensus was achieved on the core principles to recognise learning achievements. The expert panel agreed on the need for standards that are competency-based, and require evidence of learning indicating what a learner can do. There was also consensus that the characteristics of a valid digital award or micro-credential should be portable, standardised, secure, interoperable, stackable and verifiable.

CONCLUSIONS

The growing body of literature on micro-credentialing highlights its potential as a method to recognise learning achievements. The interest in alternative pathways to award health practitioners, through short competency-based micro-learning opportunities, has spurred discussions on the practical application of micro-credentials. This research outlines the categories and principles for a proposed framework to implement micro-credentialing to recognise learning achievements within the health and care sector.

Feasibility of using patient navigation to improve identification of hereditary cancer syndromes in newly diagnosed patients with colorectal cancer

PURPOSE

Germline genetic testing to identify hereditary cancer syndromes in patients newly diagnosed with colorectal cancer (CRC) carries substantial benefits. We examined the feasibility of using patient navigation, an evidence-based approach to reduce structural barriers to recommended care, to improve test completion by increasing pretest counseling attendance.

METHODS

We conducted key informant interviews with representatives from organizations providing cancer care to CRC patients. Interviews included questions derived from the Consolidated Framework for Implementation Research, which delineates barriers and facilitators to implementing evidence-based practices. We used an inductive-deductive coding approach to identify themes related to program feasibility.

RESULTS

We interviewed 19 participants across 13 organizations. Key feasibility barriers included funding to implement and sustain a navigation program, staffing and supervising the navigator role, health information technology needs, gaining administrators' buy-in, and evolving genetic service delivery models. Participants suggested multiple strategies to address implementation barriers, but most would prefer other approaches to improve genetic test completion over implementing a genomics-focused patient navigation program.

CONCLUSION

Stakeholders across a range of health care organizations saw limited value in improving the identification of hereditary CRC syndromes by implementing a program designed to increase pretest genetic counseling attendance. The need to scale up genetic testing has shifted interest toward delivery models better integrated in established care pathways, requiring fewer resources and providing broader reach.

"'We don't want them to have to live out their lives in the hospital": mixed-methods study exploring palliative care needs amongst refugees'

Background

The increasing life expectancy and resultant chronic medical comorbidities have resulted in more people requiring palliative care. Unfortunately, palliative care is restricted to marginalized populations, including refugees. In Canada, refugees are only eligible for federal health insurance, which provides basic medical and social coverage until they can obtain provincial health insurance.

Objectives

This study explored limitations in providing palliative care to refugees who had either federal or provincial health insurance in two care settings in Ontario, Canada.

Design

An explanatory sequential mixed-methods approach guided the review of local administrative data and interview data to understand palliative care delivery for refugees.

Methods

Local administrative data from a community health centre and an acute care hospital providing a palliative care approach were collected to review healthcare utilization for refugees with palliative care needs. Interviews from two focus groups with fourteen healthcare providers shared their care experiences in coordinating palliative care for refugees with either federal or provincial health insurance.

Results

Refugee patients with palliative care needs appeared to be accessing acute care services frequently to meet their needs over a 5-year period. Due to a lack of citizenship or permanent residency status, many refugees have access to only federal health insurance. Compared to those with routine provincial coverage, federally insured patients were admitted more frequently. Furthermore, healthcare provider experiences revealed that refugees with only federal insurance coverage had significant barriers to accessing community palliative care support, leading to increased reliance on acute care for quality palliative care.

Conclusion

This study highlights significant gaps in palliative care access for refugees, especially those with federal health insurance. Equitable access is essential in ensuring that patient-centred, quality palliative care is available to all.

Behind the label: a qualitative study of the self-perceptions of individuals with advanced lung cancer receiving immunotherapy or targeted therapy

OBJECTIVES

Individuals with lung cancer are living longer due to recent treatment advances such as immunotherapy and targeted therapy. The preferred label(s) of this new population are unknown. This is important as personal/advocacy benefits have been reported by using "survivor" or "thriver" by some groups; however, these same labels have been rejected by others. The goal of the present study was to explore the meaning of different labels and reasons given for preferred label(s) among people diagnosed with advanced lung cancer receiving these treatments.

METHODS

The study is part of a larger project conducted in partnership with Lung Cancer Canada to identify the supportive care needs of individuals with advanced lung cancer receiving immunotherapy or targeted therapy. Participants (n = 24) were recruited across Canada. In-depth qualitative interviews were coded using reflexive thematic analysis.

RESULTS

Labels are important and serve four functions: meaning-making, acceptance, maintaining a positive outlook, and shaping how people in participants' circle understand and react to them. Participants felt their experience did not fit traditional labels. While "survivor" was associated with maintaining a positive outlook by some, it was strongly rejected by others as it implied a cure. Some felt "patient" conveyed realism, but others found it deprived them of empowerment. "Person living with cancer" was perceived as reflecting the ongoing nature of the disease while not overly centring cancer within a person's identity.

CONCLUSION

Participants identified with various labels and emphasized how the label reflected their identity and psychological experiences of the disease. Thus, it is important that clinicians elicit and use individuals' preferred terms, and default to person-first language if unknown.

Unveiling the hidden burden: Exploring the psychosocial impact of cutaneous leishmaniasis lesions and scars in southern Ethiopia

BACKGROUND

Cutaneous leishmaniasis (CL) poses a major public health concern in Ethiopia, with lesions and scars commonly affecting exposed body parts, resulting in physical, social, and psychological consequences. This study aims to assess the psychosocial impacts of CL, shedding light on the experiences and perceptions of affected individuals, thus contributing to the knowledge on Cutaneous leishmaniasis in Ethiopia and informing public health interventions to address its psychosocial effects.

METHODS

Using a descriptive phenomenological design, the study explored the lived experiences of individuals with Cutaneous leishmaniasis lesions and scars. Participants were purposively selected, and data was collected through open-ended in-depth interviews. The analysis combined inductive and deductive approaches through an iterative process, developing a coding framework with seven themes (lesion & CL scar each) and subthemes, resulting in giving important insights in the psychosocial impacts of CL. NVivo 12v supported the analysis process.

RESULT

The study unveiled negative views and misconceptions surrounding CL and its impact. Application of traditional herbal medicine for CL lesions often leads to pus formation and a foul odour, triggering negative attitudes from others, resulting in embarrassment, pain, and anxiety, leading to discomfort and isolation. The negative psychosocial attitudes associated with CL scars deeply impacted affected individuals, influencing their behaviour. This included isolation and absenteeism from school. CL scars served as unique identifiers, shaping the affected individuals' identity and self-perception. The unreceptive environment affected the participant's self-esteem and coping mechanisms. The negative impact of CL scars extended to role performance, marriage prospects, and overall happiness, particularly for females facing additional societal pressure and stigma.

CONCLUSION

The study highlights the need for improved education and awareness about CL to reduce misconceptions and negative attitudes towards affected individuals. Additionally, more effective treatment options and integrated preventive ways should be explored to minimize the physical and psychological impact of CL on affected individuals.

The integration of hospital pharmacists into primary care settings in Shenzhen, China: a qualitative study

BACKGROUND

Integrating hospital pharmacists into primary care settings can enhance the quality of patient care. However, the challenges vary across countries. China has piloted such collaborations between hospital pharmacists and primary care practitioners in recent years, but research on this subject is limited. This study aims to examine the integration of hospital pharmacists into primary care settings in Shenzhen, China, and identify the perceived barriers and facilitators.

METHODS

From May 1 to November 30, 2022, a qualitative study gathered key informant interviews and on-site observations at three community health centers (CHCs) in Shenzhen. Two researchers collected the data, and all interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic approach.

RESULTS

Seventeen key informants were recruited (eight hospital pharmacists, six GPs, and three health administrators), most of whom were women (n = 11). Hospital pharmacists mainly conduct medication reviews and consultations in clinics or pharmacies of CHCs and engage in home visits with GPs in a few cases. Barriers to their integration include pharmacists' inadequate competency, a lack of patient recognition, GPs' resistance, and insufficient technological support. Patient needs, incentive systems, administrative leadership, social media use, and colocation were identified as facilitators of integration.

CONCLUSION

While unique opportunities may exist for primary care settings to improve patient care by integrating hospital pharmacists, it is essential to address the barriers stemming from individuals and the health system. Efforts should focus on the targeted training of pharmacists' practical skills, strategic campaigns to raise awareness among the public and healthcare providers, and policy-led efforts to foster technological progress.

Perceptions of care homes as practice learning environments for pre-registration nursing students: A systematic-narrative hybrid literature review

BACKGROUND

The ageing population is increasing demand for skilled nurses in long-term care settings, such as care homes. However, attracting qualified nurses remains challenging. Pre-qualification experience could enhance skills, recruitment and retention, but requires greater understanding and support of care homes as learning environments.

AIM

To identify and synthesise research evidence related to care homes as learning environments, and to investigate factors influencing learning within such settings.

DESIGN

Systematic-narrative hybrid review.

DATA SOURCES

CINAHL, PubMed, Medline, Scopus, Web of Science, Nursing and Allied Health and Google Scholar were searched for research articles published between January 2014 and October 2023 which sought to explore the learning opportunities of nursing students in care homes. Studies published in English were considered.

REVIEW METHODS

Retrieved articles were assessed for suitability, quality and inclusion through title and abstract examination facilitated by the use of an appropriate critical appraisal tool (PICO). Articles were read, and re-read, evidence extracted, tabulated, and then synthesised using a thematic approach. Reporting is consistent with PRISMA guidelines for reporting systematic reviews.

RESULTS

4203 articles were screened, 31 studies matched the inclusion criteria. Three key themes were developed through thematic synthesis: (i) Positive but challenging experiences (ii) Barriers to learning include lack of registered nurses, time pressure and high workload, and lack of financial investment (iii) Facilitators of learning in care homes include positive supervisory relationship, effective orientation and reception, and partnership and collaboration between educational institutions and care home settings.

CONCLUSION

This review reveals the potential of care homes as settings that offer valuable learning opportunities for nursing students, as well as a sector that support the future needs of an ageing population. Advocating for policies that specifically address the support of nurse education and nurses in this environment is warranted.

How Do Persons With Disabilities and/or Complex Health Conditions Perceive Oral Health? A Qualitative Study

OBJECTIVES

This qualitative study aimed to explore the experience and perception of the mouth, oral health, functioning and the social environment amongst adults with disabilities and complex health conditions.

METHODS

Purposive sampling using the maximum variation strategy was performed to select participants with a wide range of experiences in terms of demographics, disability and health conditions. Consent was sought, and semi-structured interviews were conducted, recorded and transcribed verbatim. Within the interpretivist tradition, a phenomenological approach was used to describe the lived, contextualised experience of people in relation to their mouths, as described by participants. Thematic analysis was undertaken.

RESULTS

Eighteen participants with disabilities and complex health conditions were interviewed. Twelve individuals had an intellectual disability. Three main themes were identified: perception of the mouth and oral health; symptomatic perceptions and responses to oral health problems; and inter-relationships between the mouth, oral health and the socio-medical environment. The mouth had a central place in the lives of the participants, but its importance was only recognised when oral health problems interfered with daily life, function, social relationships, family life or autonomy. Certain social determinants of health were identified: social exclusion, financial insecurity, lack of autonomy, nutrition and negotiation of services. Oral problems were perceived as an additional burden to those with disabilities or complex health conditions.

CONCLUSION

This study provided insight into the daily lives of adults with disabilities and complex health conditions. It helps to fill the gaps in the existing literature regarding the perceptions of the mouth and oral health, connecting oral function, general health and social environment for this population.

TRIAL REGISTRATION

This study was registered into ClinicalTrials.gov (NCT04815434).

Ankle Scientific Knowledge and Physiotherapy Practice: A Thematic Analysis of Clinical Behaviors of French-Speaking Physiotherapists

CONTEXT

Chronic ankle instability (CAI) is prevalent among individuals who sustain a lateral ankle sprain (LAS) injury. The persistence of the characteristic long-standing clinical symptoms of CAI may be attributable to the lack of adoption by physiotherapists of evidence-informed clinical guidelines.

OBJECTIVE

To investigate the extent to which French-speaking physiotherapists implement the International Ankle Consortium rehabilitation-oriented assessment (ROAST) framework when providing clinical care for individuals with an acute LAS injury.

DESIGN

Cross-sectional study.

SETTING

Online survey informed by a Delphi process of foot-ankle experts.

PATIENTS OR OTHER PARTICIPANTS

A total of 426 French-speaking physiotherapists completed the online survey.

MAIN OUTCOME MEASURE(S)

The survey was disseminated to French-speaking physiotherapists in France; Switzerland; Quebec, Canada; Luxembourg; and Belgium. It comprised closed and open-ended questions organized in 5 sections: (1) participant demographics, (2) participant self-assessment of expertise, (3) clinical diagnostic assessment of the ankle (bones and ligaments), (4) clinical evaluation after an acute LAS injury (ROAST framework), and (5) CAI. The qualitative data from the open-ended questions were analyzed using best-practice thematic-analysis guidelines.

RESULTS

Only 6.3% (n = 27) of the respondents could name all Ottawa Ankle Rules criteria. Only 25.6% (n = 109) of the respondents cited or described criterion standard tests from the literature to assess the integrity of the lateral ankle ligaments. Less than 25% (n = 71) of the respondents reported using clinical evaluation outcome metrics (ROAST) recommended by the International Ankle Consortium to inform their clinical care for individuals with an acute LAS injury. In general, the respondents had a greater knowledge of the functional than the mechanical insufficiencies associated with CAI.

CONCLUSION

A minority of French-speaking physiotherapist survey respondents use the International Ankle Consortium ROAST to inform their clinical care for individuals with an acute LAS injury. This highlights the responsibility of the scientific community to better disseminate evidence-informed research to clinicians.

Silent struggles: a qualitative study exploring mental health challenges of undergraduate healthcare students

BACKGROUND

Mental health is a critical aspect of overall well-being, influencing how individuals think, feel, and perform. Mental health among healthcare students has become a major concern, drawing attention due to its profound impact on their welfare, academic performance, and ability to effectively interact with patients. This paper aimed to explore the experiences of undergraduate healthcare students facing mental health challenges at Qatar University. With a focus on understanding the factors contributing to mental health issues and exploring their coping mechanisms, the research also sought to identify students' recommendations for institutional support to improve their mental well-being.

METHODS

A qualitative approach using semi-structured face-to-face interviews was employed to collect data. A purposive sampling method was used to recruit students from five healthcare disciplines- Medicine, Dentistry, Pharmacy, Health Sciences and Nursing- who had self-reported mild to moderate depressive symptoms based on the Patient Health Questionnaire (PHQ-9) and Depression Anxiety and Stress Scale (DASS21). A total of 15 interviews were conducted, recorded, and transcribed verbatim, with thematic analysis used to identify key themes.

RESULTS

Several themes emerged from the interviews, including academic pressure, social isolation, anxiety, coping mechanisms, fear of failure, and stigma surrounding mental health support. Academic pressure was consistently reported as a major stressor, contributing to anxiety and emotional strain. Social isolation further exacerbated mental health challenges, while many students highlighted a lack of well-established coping strategies. Stigma related to seeking mental health support was a significant barrier, preventing students from accessing available services.

CONCLUSION

The study highlights the mental health challenges faced by healthcare students, emphasizing the need for effective institutional mental health support. Addressing academic pressures, enhancing self-coping mechanisms and social support systems, and reducing the stigma around mental health care are essential steps toward improving student well-being.

CLINICAL TRIAL NUMBER

Not applicable.

Addressing Rotator Cuff-Related Shoulder Pain: Findings from a Greek Regional Observational Study Utilizing a Clinical Case Scenario

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal issue, encompassing various shoulder conditions. While exercise typically forms the foundation of conservative treatment, there exists ongoing discourse regarding the effectiveness and role of passive treatments. International guidelines recommend initial conservative management, with surgery considered only after failed conservative treatment. However, recent studies reveal discrepancies between recommended practices and actual clinical management. The aim of the study was to assess current practices in managing RCRSP among Greek physiotherapists, with a focus on understanding the alignment of these practices with international guidelines for conservative treatment. Methods: A cross-sectional survey was conducted among Greek physiotherapists to assess current practices in managing RCRSP. The survey, adapted from previous studies, collected demographic data and assessed clinical reasoning through a vignette-based approach. Responses were analyzed for alignment with guideline-recommended care. Results: Out of over 9000 contacted physiotherapists, 163 responded. A majority expressed a specific interest in shoulder pain (85%). Patient education (100%) and exercise (100%) were widely endorsed, with limited support for imaging (44%), injection (40%), and surgery (26%). Younger respondents were less inclined towards surgical referral (p = 0.001). Additionally, adjunctive interventions like mobilization (66%) and massage therapy (58%) were commonly employed alongside exercise and education. Treatment duration typically ranged from 6 to 8 weeks, with exercises reviewed weekly. Conclusions: The study highlights a consistent preference for conservative management among Greek physiotherapists, aligning with international guidelines. However, there are variations in practice, particularly regarding adjunctive interventions and exercise prescription parameters. Notably, there is a disparity between recommended and actual use of certain modalities.

The Impact of Rural Alimentation on the Motivation and Retention of Indigenous Community Health Workers in India: A Qualitative Study

Background

Rural health care delivery remains a global challenge and India is no exception, particularly in regions with Indigenous populations such as the state of Jharkhand. The Community Health Centres in Jharkhand, India, are staffed by Indigenous workers who play a crucial role in bridging the health care gap. However, their motivation and retention in these challenging areas are often influenced by a complex mix of sociocultural and environmental factors. One such significant but understudied influencing factor is alimentation, or nutrition, in rural settings. Previous studies have identified several motivators, including community ties, cultural alignment, job satisfaction, and financial incentives. However, the role of alimentation in their motivation and retention in rural areas has not been sufficiently explored.

Objective

This study aims to explore how the strong bond with locally produced food products impacts the retention of Indigenous community health workers (CHWs) in Jharkhand, India, and shed light on a crucial aspect of rural health care workforce sustainability.

Methods

This study adopted a phenomenological research design to explore the lived experiences and perspectives of Indigenous CHWs in Jharkhand. A purposive sampling method was used to select CHWs who had worked in rural areas for at least five years. Data were collected through semistructured interviews, focusing on the participants' experiences of rural alimentation and how it influences their motivation and retention for rural health care. The interviews were audio recorded, transcribed, and analyzed using thematic analysis to identify common themes and patterns in their experiences related to nutrition and retention.

Results

The study revealed that rural alimentation plays a significant role in both the motivation and retention of CHWs in Jharkhand. CHWs who experienced consistent access to local food reported higher job satisfaction, better physical well-being, and a stronger commitment to their roles. It has also been perceived that consuming nutrient-dense food products decreases the risk of chronic illness among rural populations. Additionally, community support systems related to alimentation were found to be crucial in maintaining motivation, with many CHWs emphasizing the importance of local food availability and cultural ties. The findings suggest that improving access to organic nutrition can positively influence the retention of CHWs in rural areas.

Conclusions

Indigenous communities have unique food habits and preferences deeply rooted in agriculture and arboriculture. Their traditional eating practices are integral to their rich cultural heritage, with significant social, symbolic, and spiritual importance. This study highlights the critical role of rural alimentation in motivating and retaining CHWs in rural Community Health Centres in Jharkhand. Therefore, addressing organic versus conventional food in rural health care policies plays a vital role in improving the retention rates of CHWs. By recognizing the interconnectedness of nutrition and workforce sustainability, health care systems can better support Indigenous CHWs and continue delivering health care services.

Caregivers' experience of having a child with Down syndrome: a meta-synthesis

BACKGROUND

This study aimed to integrate the experiences of caregivers of children with Down syndrome during the care process and understand their feelings and needs.

METHODS

We used Page et al.'s (2021) Preferred Reporting Items for Systematic Reviews and Meta-synthesis Statement. Ten databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL, PsycInfo, China Biology Medicine, China National Knowledge Infrastructure, Wanfang Data, and China Science and Technology Journal Database) were searched for relevant studies published from the inception of the database to October 2023. Eight qualitative studies were analysed. The following seven themes were included: 'feeding pressure', 'hope for education', 'societal rejection and stigma', 'psychological pressure', 'caring burden', 'family burden', and 'family adaptation and self-growth'.

RESULTS

We found that feeding pressures, educational concerns, language difficulties, and discrimination and stigmatisation led to psychological, economic, and family stress in caregivers of children with Down syndrome. We document the need for strong coping mechanisms and support systems for these families from medical and psychological institutions and a need for public education and awareness.

CONCLUSIONS

We summarised the daily care experiences of caregivers of children with Down syndrome. Our findings provide a scientific basis for further research focused on reducing physical and mental pressure on caregivers and improving the quality of family life.

Enhancing individual task performance and productivity: an ethnographic observational study of supported employment among social services clients in Finland

BACKGROUND

The purpose of the study was to investigate the various aspects of employees' work environment, including their job characteristics; the level of support provided by supervisors, job coaches and coworkers; and their perceptions of job performance and productivity from the perspectives of both employees and supervisors in the context of sustainable employability in supported employment interventions. This study was part of the Finnish Work Ability Programme Evaluation Study (2020-2024).

METHODS

This study is theoretically informed by the concepts of specific work ability and sustainable employability, as well as how health affects productivity at the task level-approach. The research is based on qualitative data obtained through ethnographic fieldwork, nonparticipating observing with interaction at work, which includes observing employed individuals in their workplaces. Additionally, we recorded discussions, took photos at work, and conducted interviews with supervisors and job coaches.

RESULTS

The main findings were that persons with disability or decreased work ability were employed in precarious low-productivity work, with limited opportunities for more sustainable employment. Several means from public employment services to decrease the employer's personnel costs were used. The supervisors appeared to have a strong grasp of each employee's task-specific productivity level. Supervisors had to adapt their usual tasks to provide extra support for employees, often focusing more on work performance. The role of coworkers and the work community as whole was also important. The personal support of job coaches during the employment phase was crucial, but their role in the workplace was unclear, especially to employers.

CONCLUSIONS

To strengthen sustainable careers, the matching of jobs and individuals should be promoted through closer and productivity-oriented cooperation with employers and work communities in vocational rehabilitation and re-employment. The chosen qualitative research strategy, ethnographic fieldwork at work and multi-perspective data collection provided new interpretations of the possibilities for sustainable employability using the Supported Employment method. From the perspectives of both enabling prolonged working careers for employees and providing a clear understanding of task-performance-based productivity to employers, there is a need for more microlevel data on what happens in work and workplaces, particularly the social mechanisms through which results are achieved.

Exploring the barriers to cervical screening and perspectives on new self-sampling methods amongst under-served groups

BACKGROUND

Cervical screening rates have fallen in recent years in the UK, representing a health inequity for some under-served groups. Self-sampling alternatives to cervical screening may be useful where certain barriers prohibit access to routine cervical screening. However, there is limited evidence on whether self-sampling methods address known barriers to cervical screening and subsequently increase uptake amongst under-screened groups. Addressing this research gap, the study aims to understand experiences during and barriers to attending cervical screening for under-screened groups and; explore the views of individuals eligible for screening towards self-sampling (vaginal swabbing and urine sampling) as alternative screening methods and how this may address existing barriers to screening.

METHODS

We draw on three integrated theoretical frameworks (access to primary care services, intersectional and feminist perspectives) to examine participants' barriers to screening and views toward self-sampling methods. We undertook primary qualitative data collection (interviews and focus groups) with 46 participants, facilitated by collaborations with the VCSE sector which successfully enhanced reach to under-served communities.

RESULTS

Known barriers to cervical screening persist for under-screened participant groups, but we also find numerous examples of good practice where some participants' needs were met throughout the screening process. Both positive and negative experiences tend to centre around experiences with healthcare professionals, with negative experiences also centring around the use of the speculum. Self-sampling methods (vaginal swab and urine collection) were positively received by participants, and may address some existing barriers through the proponents of enhanced choice - between method and location (which also dovetailed with convenience) leading to greater empowerment. The removal of the speculum and lack of invasive examination by a healthcare professional was also positively received.

CONCLUSIONS

Whilst barriers to cervical screening remain for under-served groups, examples of good practice are prevalent. Such examples should be implemented more widely to ensure consistency in patient experience and to ensure needs are better met for under-served groups. The introduction of self-sampling alongside traditional methods may reduce barriers to screening, and may boost screening rates for under-screened groups but only if they are implemented with appropriate information and sufficient communication. Failure to implement self-sampling without these considerations may threaten to undermine the identified and important benefits of self-sampling methods.

Powerful together with diabetes, a group-based self-management intervention for patients with type 2 diabetes from lower educational groups: study protocol for a hybrid type 2 evaluation

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is a major burden on public health worldwide. To reduce adverse events and complications, effective T2DM self-management is required. Self-management and glycaemic control are generally poorer in lower educated people compared with higher educated people. This study aims to assess the (cost-)effectiveness and to conduct a process evaluation of a diabetes self-management programme, 'Powerful Together With Diabetes' (PTWD), which is specifically developed for patients from lower educational groups.

METHODS AND ANALYSIS

The PTWD programme is focused on attaining basic knowledge and skills for effective diabetes self-management. In a previous study (the Diabetes in Social Context (DISC) study), lower-educated participants enjoyed the PTWD programme as well as improved their T2DM-related behaviours. The design of the study is an effectiveness-implementation hybrid type 2 trial. We will conduct mixed methods effectiveness, process and economic evaluations. To investigate the (cost-)effectiveness, a two-arm quasi-experimental trial will be conducted with a parallel mixed method process evaluation. The primary outcome of the study is change in haemoglobin A1c levels from baseline to 12 months. Secondary outcomes include use of primary and secondary care, medication use, blood biomarkers, T2DM self-management health behaviours, anthropometrics, and quality of life. Data will be collected with questionnaires, physical activity trackers and registration data from general practitioner registries. To see if the results are maintained, we will also measure the outcomes 24 months after baseline. Study participants are patients from lower educational groups living with T2DM between 35 and 70 years old. Participants will be recruited through general practices, and the intervention will be held in community centres. Our aim is to include 114 participants in the intervention group and 570 participants in the control group.

ETHICS AND DISSEMINATION

This study has been approved by the Medical Ethics Committee of the Academic Medical Center in Amsterdam (#2021_222). Participants will sign an informed consent form prior to enrolment. Manuscripts with the results of the effectiveness, economic and process evaluations will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN12982302 ISRCTN registry (registered on 29 March 2022).

Aerobiology matters: Why people in the community access pollen information and how they use it

BACKGROUND

Globally, many pollen monitoring networks provide the community with daily pollen information, but there are limited data on health consumer uses and benefits. This research investigated why individuals in the community access pollen information, how they use it, and the perceived benefits.

METHODS

In- and post-pollen season surveys (2017-2018 and 2018-2019) enquired about symptoms, diagnoses, symptom management, access, benefits and usefulness of pollen information provided by the AusPollen Partnership. Open text responses were examined by thematic analysis. Theme frequency and quantitative data were compared across pollen seasons, within and after the season, and between respondents with and without access to AusPollen information.

RESULTS

Surveys were completed 4044 times by 3604 individuals who predominantly self-reported severe and frequent allergic rhinitis symptoms. Local AusPollen information was accessible to 84.6% of participants, and was reportedly used for preparation and planning (34.6%), guiding activities (32.9%), and medication decisions (28.2%). When asked how pollen information helped, similar themes were evident; but 16.1% also mentioned safety for themselves and others. However, secondary analysis of survey responses indicated that self-reported medication use did not differ between those with or without access to pollen information or between time points surveyed. Suggestions for improvement included extended duration (16.4%), wider geographic range (13.5%), and information on other taxa (17.2%).

CONCLUSION

There was a perceived need for localised, detailed and timely pollen information by people with pollen allergy. Whilst responses suggested this helped inform behaviours linked to allergen avoidance, further education strategies on allergic rhinitis control are needed to support patients who self-manage their condition.

Peer-Assisted Learning in Undergraduate Midwifery Clinical Education: A Qualitative Study on Experiences of Nursing Students From Three Namibian Training Institutions

Introduction

Peer-assisted learning is widely used in nursing education and is reported to have a positive impact on the students' learning process. However, students' experiences of peer-assisted learning from midwifery clinical education in resource-constrained, overcrowded, and small maternity sections are not documented.

Objective

This study was undertaken to explore undergraduate nursing students' experiences of peer-assisted learning in midwifery clinical education context in Namibia.

Methods

The study was approached from a social constructivism, with explorative, descriptive, and contextual qualitative as a methodological approach. The sample consisted of 32 nursing students from three training institutions, who were conveniently sampled. Data collection was via five focus group discussions, which used a focus group discussion guide, audio recorder, and field notes as research instruments. Data were analyzed using thematic analysis.

Results

Main themes that emerged from thematic analysis are students' conceptions of peer-assisted learning, benefits, challenges, and suggestions made to improve peer-assisted learning in midwifery clinical education. In thematic area of students' conceptions of peer-assisted learning, peer teaching tools, engagement, care, and support of peers were recorded as subthemes. The benefits of peer-assisted learning included teamwork, professional identity, a deep approach to learning, communication, coping mechanisms, and socialization. Challenges experienced by students while using peer-assisted learning are learning wrong practices from peers, personality influence, discrimination, labeling, and name calling. Suggestions made by students were formalization and training of students on peer-assisted learning.

Conclusions

Students' experiences of peer-assisted learning relate to how they understand it as a concept, their interaction with peers, and learning materials. In addition, students made suggestions to improve peer-assisted learning in midwifery clinical practice. These results may be useful in developing peer-assisted frameworks and guiding documents for use in its implementation in midwifery clinical education.

Investigating the Impact of Ashwagandha and Meditation on Stress Induced Obesogenic Eating Behaviours

Obesity has been identified as a rapidly rising pandemic within the developed world, potentially increasing the risks of type 2 diabetes and cardiovascular disease. Various studies have identified a positive association between stress, elevated cortisol levels and obesity. Mechanisms of the stress response lead to hyperpalatable food preference and increased appetite through the activation of the HPA axis, elevated cortisol and the resulting interactions with the dopaminergic system, neuropeptide Y, ghrelin, leptin and insulin. The methodology of this review involved a Systematic Search of the Literature with a Critical Appraisal of papers considering ashwagandha, mediation and mindfulness in relation to mechanisms of the stress response. It incorporated 12 searches yielding 330 hits. A total of 51 studies met the inclusion criteria and were critically appraised with ARRIVE, SIGN50 and Strobe checklists. Data from the 51 studies was extracted, coded into key themes and summarized in a narrative analysis. Thematic analysis identified 4 key themes related to ashwagandha and 2 key themes related to meditation. Results provide an overview of evidence assessing the efficacy of ashwagandha and meditation in relation to weight loss interventions by supporting the stress response and the pathways highlighted. Results of Clinical studies indicate that ashwagandha supports weight loss through reduced stress, cortisol and food cravings. Pre-clinical studies also suggest that ashwagandha possesses the capacity to regulate food intake by improving leptin and insulin sensitivity and reducing addictive behaviors through dopamine regulation. Clinical studies on meditation indicate it may enhance a weight loss protocol by reducing the stress response, cortisol release and blood glucose and improving eating behaviors.

Boosting hospital falls prevention using health assistant staff alongside usual care

OBJECTIVES

Patient education is crucial for preventing hospital falls, yet workforce constraints can hinder targeted delivery. Utilising supervised healthcare assistants can enhance standard care. This study sought to understand factors that impact the feasibility of supplementing usual care with patient falls education delivered by supervised allied health assistants.

METHODS

In a qualitative study nested within a randomised controlled trial, focus groups and interviews were conducted with twelve health assistants, seven allied health professionals and two managers from the participating hospital. This elicited insights on barriers and facilitators to implementing workforce redesign to deliver tailored patient falls education. An inductive approach was used to thematically analyse the data.

RESULTS

Three key themes emerged: (i) it was feasible for health assistants to deliver hospital patient education; (ii) patients engaged with hospital falls prevention education delivered by assistants; (iii) hospital workforce redesign can be successfully implemented provided there is system-wide buy-in.

CONCLUSIONS

Health assistants can be trained to successfully deliver hospital falls prevention education provided they have adequate supervision, training, and resources.

PRACTICE IMPLICATIONS

Sustained implementation requires dedicated staffing hours for service delivery and staff education.

'Involve those who are managing these outbreaks': stakeholders' perspectives on the barriers and facilitators to the implementation of clinical management guidelines for high-consequence infectious diseases in Uganda-a thematic network analysis

Introduction

Prior research highlighting the complexity of clinical management guidelines' (CMGs) implementation during high consequence infectious disease (HCID) outbreaks has suggested that limited access to treatments and equipment and substantial issues regarding availability, inclusivity, quality and applicability hinders the implementation of CMGs in low- and middle-income countries (LMICs). This in-depth case study of Uganda-coincidentally occurring during the 2022 Sudan virus disease outbreak-aimed to explore contextual and supplementary factors which hinder or facilitate CMG development and implementation.

Methods

Between August and December 2022, 43 interviews were conducted with medical personnel, consultant physicians, case managers and Uganda Ministry of Health officials. Interviews were analysed using a thematic network analysis approach to visualise thematic codes in qualitative data and highlight inherent relationships between codes.

Results

Six thematic topics emerged as the main barriers to the implementation of CMGs during HCID outbreaks in Uganda: (1) deficient content and slow updates of CMGs; (2) scarce resources and healthcare disparities; (3) slow dissemination and limited access to guidelines; (4) improvisation of patient care (5) lack of training for healthcare workers (HCWs); and (6) limited pandemic preparedness and response infrastructure. Codes most strongly linked to facilitators and suggestions included: (1) HCW training in CMG implementation; (2) adequate resourcing; (3) involvement of personnel with prior HCID response experience in CMG development and (4) improvements in access to CMGs.

Conclusions

By illustrating linkages to resource constraints, healthcare disparities, and limited surveillance and referral infrastructure, our study displays how insufficient training, patchy dissemination and slow updating exacerbate many of the underlying difficulties for CMG implementation in LMIC contexts. Findings offer valuable insights for LMICs to improve HCID outbreak responses and inform implementation of CMGs in future HCID outbreaks, where evidence is often initially limited. Recommendations to enhance CMG implementation are provided.