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Ashcroft R, Donnelly C, Sheffield P, Lam S, Kemp C, Adamson K, Brown JB. A qualitative examination of the experiences and perspectives of interprofessional primary health care teams in the distribution of the COVID-19 vaccination in Ontario, Canada. PLoS One 2024; 19:e0304616. [PMID: 38857248 PMCID: PMC11164373 DOI: 10.1371/journal.pone.0304616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Primary health care (PHC) teams contributed to all phases of the COVID-19 vaccination distribution. However, there has been criticism for not fully utilizing the expertise and infrastructure of PHC teams for vaccination distribution. Our study sought to understand the role PHC teams had in the distribution of the COVID-19 vaccine in Ontario, Canada. The key objective informing this study was to explore the experiences and perspectives of interprofessional PHC teams in the distribution of COVID-19 vaccination across Ontario. METHODS A qualitative approach was used for this study, which involved 39 participants from the six health regions of the province. Eight focus groups were conducted with a range of interprofessional healthcare providers, administrators, and staff working in PHC teams across Ontario. The sample reflected a diverse range of clinical, administrative, and leadership roles in PHC. Focus groups were audio-recorded and transcribed, while transcriptions were then analyzed using thematic analysis. RESULTS We identified the following four themes in the data: i) PHC teams know their patients; ii) mobilizing team capacity for vaccination, iii) intersectoral collaborations, and iv) operational challenges. CONCLUSIONS PHC teams were an instrumental component in supporting COVID-19 vaccinations in Ontario. The involvement of PHC in future vaccination efforts is key but requires additional resourcing and inclusion of PHC in decision-making. This will ensure provider well-being and maintain collaborations established during COVID-19 vaccination.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Donnelly
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Connor Kemp
- Frontenac, Lennox, and Addington Ontario Health Team, Kingston, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Pearson M, Long L, Baker C, Doran D, Pringle A. "It's really important work…and celebrating that, I think, is really important" - co-produced qualitative research into future of mental health nurse education. Int J Ment Health Nurs 2024. [PMID: 38812126 DOI: 10.1111/inm.13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
The education of mental health nurses has long remained a contentious topic in the UK and internationally. This research seeks to gather the perspectives of those directly affected by mental health nurse education. To investigate what knowledge, skills and values current mental health nursing students, graduate mental health nurses and people with lived experience of accessing mental health services believe should be paramount within pre-registration education. Data was gathered through focus groups involving a mix of pre- and post-qualified mental health nurses and people with lived experience of accessing mental health services. Data was collected through audio recordings, which were transcribed and subjected to thematic analysis. The analysis generated four themes of: (i) Values and ethics-based education, (ii) Self-awareness, (iii) Understanding and therapeutically being with others and (iv) Specialism versus Genericism. The findings speak to the special nature of mental health nursing and the need for students to develop specialist mental health knowledge and skills, alongside self-knowledge. The findings provide a unique insight into the aspects of pre-registration nursing felt to be most valuable by the three participant groups in this study. The findings reiterate the importance nurse education celebrating the specialism of mental health nursing and adds to the growing weight of literature for increased specialism with future education standard reviews.
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Affiliation(s)
| | | | | | - Dan Doran
- University of Nottingham, Nottingham, UK
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Kaiser A, Sessford J, Chan K, Martin S, McCullum S, Athanasopoulos P, Rice C, Leo J, Forrester S, MacRitchie I, Zariffa J, Musselman KE. Tracking activity-based therapy for people living with spinal cord injury or disease: insights gained through focus group interviews with key stakeholders. Disabil Rehabil 2024; 46:1354-1365. [PMID: 37096637 DOI: 10.1080/09638288.2023.2196443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/24/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. MATERIALS AND METHODS Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. RESULTS Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. CONCLUSIONS Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada.
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Affiliation(s)
- Anita Kaiser
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Canadian Spinal Research Organization, Toronto, Canada
| | - James Sessford
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Samantha Martin
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shane McCullum
- Stan Cassidy Centre for Rehabilitation, Horizon Health Network, Fredericton, Canada
| | | | - Chris Rice
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer Leo
- The Steadward Centre For Personal & Physical Achievement, University of Alberta, Edmonton, Canada
| | - Scott Forrester
- The Steadward Centre For Personal & Physical Achievement, University of Alberta, Edmonton, Canada
| | - Iona MacRitchie
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - José Zariffa
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Ashcroft R, Donnelly C, Lam S, Sheffield P, Hamilton B, Kemp C, Adamson K, Brown JB. A qualitative examination of primary care team's participation in the distribution of the COVID-19 vaccination. BMC PRIMARY CARE 2024; 25:85. [PMID: 38486138 PMCID: PMC10938813 DOI: 10.1186/s12875-024-02327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Primary health care (PHC) has historically led and implemented successful immunization programs, driven by strong relationships with patients and communities. During the COVID-19 pandemic, Canada began its vaccination strategy with mass immunizations that later included local efforts with PHC providers. This study seeks to understand how PHC contributed to the different phases of the COVID-19 vaccination rollouts in Ontario, Canada's most populous province. METHODS We conducted a descriptive qualitative study with focus groups consisting of PHC providers, administrators, and staff in Ontario. Eight focus groups were held with 39 participants representing geographic diversity across the six Ontario Health regions. Participants reflected a diverse range of clinical, administrative, and leadership roles. Each focus group was audio-recorded and transcribed with transcriptions analyzed using thematic analysis. RESULTS With respect to understanding PHC teams' participation in the different phases of the COVID-19 vaccination rollouts, we identified five themes: (i) supporting long-term care, (ii) providing leadership in mass vaccinations, (iii) integrating vaccinations in PHC practice sites, (iv) reaching those in need through outreach activities; and (v) PHC's contributions being under-recognized. CONCLUSIONS PHC was instrumental in supporting COVID-19 vaccinations in Ontario, Canada across all phases of the rollout. The flexibility and adaptability of PHC allowed teams to participate in both large-scale and small-scale vaccination efforts.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | | | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Bryn Hamilton
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Connor Kemp
- Frontenac, Lennox, and Addington Ontario Health Team, Kingston, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Swink LA, Mealer ML, Miller MJ, Anderson CB, Cook PF, Stevens-Lapsley JE, Christiansen CL. Telehealth Walking Self-Management for Individuals With Amputation: A Qualitative Study of Therapist Perspectives on Adoption. Phys Ther 2024; 104:pzad155. [PMID: 37944092 PMCID: PMC10902556 DOI: 10.1093/ptj/pzad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to understand therapist-identified factors influencing clinical adoption of a telehealth walking self-management intervention for individuals with lower limb amputation. METHODS Semi-structured focus groups were completed with actively practicing physical and occupational therapists treating populations that are medically complex. A qualitative explorative design was employed with conventional content analysis and iterative independent parallel coding using 2 analysts. Themes and subthemes were generated with a consensus building process identifying patterns and collapsing codes to represent participant perspectives. RESULTS Thematic saturation was met after 5 focus groups (24 therapists). Therapists were on average 34 years old and predominantly female (n = 19; 79%) physical therapists (n = 17; 71%). Three primary facilitator and barrier themes were identified for intervention adoption: system, therapist, and person. System considerations included telehealth support and interprofessional care coordination. Therapist facilitators included self-management programming that overlapped with standard of care and personalization methods. However, limited behavioral theory training was a therapist level barrier. Finally, person factors such as patient activation could influence both positively and negatively. Person facilitators included social support and barriers included the complex health condition. CONCLUSION System, therapist, and person facilitators and barriers must be considered to maximize the adoption of similar telehealth walking self-management interventions and prior to larger scale implementation of the current intervention for individuals with lower limb amputation. IMPACT A telehealth walking self-management intervention has potential impact for individuals with lower limb amputation and must be considered in terms of optimizing system, therapist, and person level facilitators and barriers to implementation.
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Affiliation(s)
- Laura A Swink
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Meredith L Mealer
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Matthew J Miller
- School of Medicine, University of California, San Francisco, California, USA
| | - Chelsey B Anderson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Cory L Christiansen
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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Karlsson AW, Lundsgaard HH, Janssens A. Mothers' Views on the Storage and Usage of Their Children's Biological Material Under the Danish Biobanking Model: A Narrative Approach Using Epistemic Injustice. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1308-1313. [PMID: 37187237 DOI: 10.1016/j.jval.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To investigate the knowledge and attitudes of mothers living in Denmark on the storage and usage of their children's biological material. The Danish Neonatal Screening Biobank contains blood from the Phenylketonuria-screening test. Legal, ethical, and moral concerns have been raised in several countries of how consent is obtained best in pediatric biobank governance. Research on knowledge and attitudes of Danish parents on the usage of their children's biological material is scarce. METHODS A coproduced study between a mother and 2 researchers. We analyzed 5 online focus group interviews using Ricoeur's hermeneutical narrative analysis. RESULTS Mothers have very little knowledge on the storage and usage of their children's biological material. They consider the Phenylketonuria-screening test to be part of a birth package, which leaves very little option of choice. They accept donating the material as a token of appreciation in an act of altruism toward the wider society but are only comfortable supporting Danish research. CONCLUSIONS An exploration of the communal narrative build in the interviews reveal an overall feeling of duty to help benefit society, an overwhelming trust toward the health system, and epistemic unjust storage information practices.
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Affiliation(s)
- Anne Wettergren Karlsson
- Department of Public Health, University of Southern Denmark, Odense, Denmark; Centre for Research with Patients and Relatives, Odense University Hospital, Odense, Denmark.
| | | | - Astrid Janssens
- Department of Public Health, University of Southern Denmark, Odense, Denmark; Utrecht University Medical Center, Utrecht University, The Netherlands; Centre for Research with Patients and Relatives, Odense University Hospital, Odense, Denmark; University of Exeter Medical School, Exeter, England, UK
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Nightingale R, Kirk S, Swallow V, McHugh GA. Supporting the parent-to-child transfer of self-management responsibility for chronic kidney disease: A qualitative study. Health Expect 2023; 26:683-692. [PMID: 36562551 PMCID: PMC10010075 DOI: 10.1111/hex.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As children with long-term conditions (LTCs) mature, they are usually expected to assume responsibility from their parents for self-management of their condition. Little is known about what supports families with this handover of responsibility, including the role of healthcare professionals (HCPs). This study aimed to explore what supports young people with chronic kidney disease (CKD) to assume self-management responsibility and parents to relinquish control. METHODS A qualitative study, using a grounded theory approach was conducted. Individual and dyadic interviews and focus groups were carried out with 16 young people aged 13-17 years old with CKD, 13 parents, and 20 HCPs. Participants were recruited from two UK children's renal units. FINDINGS Building and maintaining trust, fostering positivity, learning from mistakes, forming partnerships and individualized support, facilitated the transfer of self-management responsibility. However, HCPs' focus on developing partnerships with young people meant some parents felt excluded, highlighting uncertainty around whether support should be child- or family-centred. Although tailored support was identified as critical, aspects of local service provision appeared to impact on HCPs' capacity to implement individualized approaches. CONCLUSION This study has identified what supports the handover of responsibility, and, importantly, HCPs' current, and potential role in helping young people to assume responsibility for managing their LTC. Further research is needed to explore how HCPs' involvement balances child- and family-centred care, and how HCPs can adopt personalized, strengths-based approaches to help ensure the support that families receive is tailored to their individual needs. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Language and Cognition Department, UCL Division of Psychology and Language Science, University College London, London, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Schuster RC, Brewis A, Wutich A, Safi C, Vanrespaille TE, Bowen G, SturtzSreetharan C, McDaniel A, Ochandarena P. Individual interviews versus focus groups for evaluations of international development programs: Systematic testing of method performance to elicit sensitive information in a justice study in Haiti. EVALUATION AND PROGRAM PLANNING 2023; 97:102208. [PMID: 36603349 DOI: 10.1016/j.evalprogplan.2022.102208] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 08/03/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
Focus group discussions (FGDs) and individual interviews (IIs) with community members are common methods used in evaluations of all kinds of projects, including those in international development. As resources are often limited, evaluators must carefully choose methods that yield the best information for their particular program. A concern with FGDs and IIs is how well they elicit information on potentially sensitive topics; very little is known about differences in disclosure by methodology in the domain of justice. Using FGDs (n = 16) and IIs (n = 46) from a USAID project in Haiti, we systematically coded responses based on a shared elicitation guide around access to and engagement with the formal and informal justice systems and performed thematic and statistical comparisons across the two methods. We introduce the continuous thought as the novel standard unit for statistical comparison. Participants in IIs were statistically more likely to provide themes relevant to genderbased violence. Importantly, sensitive themes extracted in IIs (e.g., related to sexual violence, economic dimensions, and restorative justice) did not emerge in FGDs. Given these results and other limitations to the FGD, prioritizing interviews over focus group modalities may be appropriate to guide targeted, effective programming on justice or other socially sensitive topics.
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Affiliation(s)
- Roseanne C Schuster
- School of Human Evolution & Social Change, Arizona State University, Tempe, AZ, USA.
| | - Alexandra Brewis
- School of Human Evolution & Social Change, Arizona State University, Tempe, AZ, USA.
| | - Amber Wutich
- School of Human Evolution & Social Change, Arizona State University, Tempe, AZ, USA.
| | - Christelle Safi
- Chemonics/Justice Sector Strengthening Project; Port-au-Prince, Haiti.
| | | | - Gina Bowen
- School of Human Evolution & Social Change, Arizona State University, Tempe, AZ, USA.
| | | | - Anne McDaniel
- School of Human Evolution & Social Change, Arizona State University, Tempe, AZ, USA.
| | - Peggy Ochandarena
- Director of Development Research, Chemonics International, Washington, DC, USA.
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Ashcroft R, Donnelly C, Lam S, Kourgiantakis T, Adamson K, Verilli D, Dolovich L, Sheffield P, Kirvan A, Dancey M, Gill S, Mehta K, Sur D, Brown JB. Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic. BMJ Open 2023; 13:e067208. [PMID: 36731930 PMCID: PMC9895917 DOI: 10.1136/bmjopen-2022-067208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe Ontario primary care teams' experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection. SETTING Primary care teams located in Ontario, Canada. PARTICIPANTS Our study conducted 11 focus groups with 10 primary care teams, with a total of 48 participants reflecting a diverse range of interprofessional healthcare providers and administrators working in primary care. RESULTS Three themes were identified using thematic analysis: (1) prepandemic team functioning facilitated adaptation, (2) new processes of team interactions and collaboration, and (3) team as a foundation of support. CONCLUSIONS Results revealed the importance of collaboration for provider well-being, and the challenges of providing collaborative team-based primary care in the pandemic context. Caution against converting primary care collaboration to predominantly virtual modalities postpandemic is recommended. Further research on team functioning during the COVID-19 pandemic in other healthcare organisations will offer additional insight regarding how primary care teams can work collaboratively in a postpandemic environment.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Donnelly
- Rehabilitation Therapy, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - David Verilli
- Village Family Health Team, Toronto, Ontario, Canada
| | - Lisa Dolovich
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Maya Dancey
- Telfer School of Management University of Ottawa, Ottawa, Ontario, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Williams BR, Burgio KL, Hebert-Beirne J, James A, Kenton K, LaCoursiere DY, Rickey L, Brady SS, Kane Low L, Newman DK. A multisite focus group study of US adult women's beliefs and assumptions about bladder health and function. Neurourol Urodyn 2022; 41:1590-1600. [PMID: 35819129 PMCID: PMC9595129 DOI: 10.1002/nau.25006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
AIMS This analysis explored and characterized the ideas adult women have about how the bladder works, the assumptions guiding their bladder-related behaviors, and the beliefs they hold about how their behaviors affect bladder health. METHODS This was a directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities, and Experiences, a focus group study conducted at seven United States research centers (July 2017 to April 2018). Participants were 316 adult women organized by four age categories (age range: 18-93 years). Analysis and interpretation focused on the "bladder assumptions and beliefs" code using a transdisciplinary lens and inductive approach. RESULTS During their focus group discourse, participants exhibited a speculative mode of thinking about bladder health and function characterized by uncertainty about how the bladder works. They described the bladder as a mechanism for cleansing the body of impurities, viewing it as part of a larger interconnected bodily system to enable the body to stay healthy. They saw it as susceptible to anatomical changes, such as those related to pregnancy and aging. The women also postulated perceived relationships between bladder function and several health behaviors, including eating healthy foods, staying hydrated, engaging in physical activity and exercise, and adopting specific toileting and hygiene practices. CONCLUSIONS The findings underscore the importance of guidance from healthcare professionals and systematic community based educational programs for promoting women's understanding about bladder health and empowering them to exert agency to engage in healthy bladder behaviors.
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Affiliation(s)
- Beverly Rosa Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Jeni Hebert-Beirne
- School of Public Health, Division of Community Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Aimee James
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kimberly Kenton
- Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daphne Yvette LaCoursiere
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, San Diego, California, USA
| | - Leslie Rickey
- Departments of Urology and Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sonya S Brady
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Assessing equity and quality indicators for older people – Adaptation and validation of the Assessing Care of Vulnerable Elders (ACOVE) checklist for the Portuguese care context. BMC Geriatr 2022; 22:561. [PMID: 35790949 PMCID: PMC9256534 DOI: 10.1186/s12877-022-03104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Development has promoted longer and healthier lives, but the rise in the proportion of older adults poses new challenges to health systems. Susceptibilities of older persons resulting from lower knowledge about services availability, health illiteracy, lower income, higher mental decline, or physical limitations need to be identified and monitored to assure the equity and quality of health care. The aim of this study was to develop equity indicators for the Assessing Care of Vulnerable Elders (ACOVE)-3 checklist and perform the first cross-cultural adaptation and validation of this checklist into Portuguese. Methods A scoping literature review of determinants or indicators of health (in)equity in the care of older people was performed. A total of 5 language experts and 18 health professionals were involved in the development and validation of the equity and quality indicators through expert opinion and focus groups. Data collected from focus groups was analyzed through directed or conventional content analysis. The usefulness of the indicators was assessed by analyzing the clinical records of 30 patients. Results The literature review revealed that there was a worldwide gap concerning equity indicators for older people primary health care. A structured and complete checklist composed of equity and quality indicators was obtained, validated and assessed. A significant number of non-screened quality or equity related potential occurrences that could have been avoided if the proposed indicators were implemented were detected. The percentage of non-registered indicators was 76.6% for quality and 96.7% for equity. Conclusions Applying the proposed checklist will contribute to improve the monitoring of the clinical situation of vulnerable older people and the planning of medical and social actions directed at this group. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03104-5.
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12
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Nightingale R, McHugh GA, Swallow V, Kirk S. Shifting responsibilities: A qualitative study of how young people assume responsibility from their parents for self-management of their chronic kidney disease. Health Expect 2022; 25:1919-1929. [PMID: 35770677 PMCID: PMC9327865 DOI: 10.1111/hex.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The responsibility for managing a long-term condition (LTC) such as chronic kidney disease (CKD) typically transfers from parent to child, as children become older. However, children can find it challenging to become independent at managing their LTC, and evidence for how healthcare professionals (HCPs) support transfer of responsibility is limited. This study aimed to explore how young people with CKD assume responsibility for managing their condition and the HCP's role during this process. METHODS Sampling, qualitative data collection and analysis were guided by a constructivist grounded theory approach. Individual and dyadic interviews, and focus groups, were conducted with 16 young people aged 13-17 years with CKD, 13 parents and 20 HCPs. FINDINGS A grounded theory, shifting responsibilities, was developed that provides new insights into how young people's, parents' and HCPs' constructions of the transfer of responsibility differed. These diverse constructions contributed to multiple uncertainties around the role of HCPs, when the process started and was completed and whether the endpoint of the process was young people's self-management or young person-parent shared management. CONCLUSION Families would benefit from HCP support over a longer timeframe that integrates assuming self-management responsibility with gaining independence in other areas of their lives and focuses on young people 'doing' self-management. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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13
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Bradford A, Young K, Whitechurch A, Burbury K, Pearson EJM. Disabled, invisible and dismissed-The lived experience of fatigue in people with myeloproliferative neoplasms. Cancer Rep (Hoboken) 2022; 6:e1655. [PMID: 35705529 PMCID: PMC9875604 DOI: 10.1002/cnr2.1655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/03/2022] [Accepted: 05/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) are rare haematological cancers. Several studies report the most common MPN symptom leading to reduced quality of life is fatigue. Yet, how fatigue affects the lives of people with MPN is not well described. AIMS The purpose of this qualitative study is to better understand the lived experience of fatigue associated with MPN. METHODS AND RESULTS People with MPN who had experienced fatigue were invited to complete an online survey and if eligible, then to participate in semi-structured interviews and focus groups, exploring their experiences of fatigue. Thematic analysis of interview transcripts by two researchers produced themes describing the lived experience of fatigue. Twenty-three people with MPN participated in seven interviews and four focus groups. Qualitative data revealed how fatigue significantly affected participants' experiences of functional, social, family and emotional wellbeing. Participants reported that fatigue was infrequently acknowledged or addressed by health professionals, and a lack of information or support to manage their fatigue. Four themes including 12 sub-themes describe the experience of fatigue in MPN: (1) the distress of the MPN diagnosis, (2) sensations of fatigue, (3) daily life and emotional burden with fatigue and (4) how people managed their fatigue with limited guidance. CONCLUSION Fatigue in MPN is common, debilitating and distressing. It affects all aspects of health, wellbeing and life. Health professionals could affect patients' lives substantially by acknowledging and understanding fatigue in MPN, including contributing factors and potential opportunities for management. More systematic data describing the causes and management of MPN fatigue is needed.
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Affiliation(s)
- Ashleigh Bradford
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Clinical Pathology | The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Ken Young
- MPN Alliance AustraliaSandringhamVictoriaAustralia
| | - Ashley Whitechurch
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Kate Burbury
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Clinical Pathology | The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Elizabeth Jane M. Pearson
- Department of Health Services and Implementation Research | Department of Nursing | Department of Clinical HematologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Clinical Pathology | The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
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14
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Pocock T, Smith M, Wiles J. Recommendations for Virtual Qualitative Health Research During a Pandemic. QUALITATIVE HEALTH RESEARCH 2021; 31:2403-2413. [PMID: 34384307 DOI: 10.1177/10497323211036891] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Qualitative health research has been uniquely affected by the COVID-19 pandemic. Various public health directives will likely remain in place until this pandemic is fully controlled, creating long-lasting impacts on the design and conduct of qualitative health research. Virtual qualitative research provides an alternative to traditional interviews or focus groups and can help researchers adhere to public health directives. In this commentary, we respond to methodological needs created by the COVID-19 pandemic. Specifically, we explore unique elements of, and recommendations for, the design and conduct of obtrusive virtual qualitative research (online interviews, online focus groups, and email interviews) and demonstrate crucial ethical, recruitment, analytical, and interpretive considerations. Researchers are currently faced with an ethical imperative to advance virtual qualitative research methods and ensure that rigorous qualitative health research continues during this pandemic and beyond. Our discussions provide a starting point for researchers to explore the potential of virtual qualitative research.
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Affiliation(s)
- Tessa Pocock
- The University of Auckland, Auckland, New Zealand
| | - Melody Smith
- The University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- The University of Auckland, Auckland, New Zealand
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15
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Mehrabi S, Muñoz JE, Basharat A, Boger J, Cao S, Barnett-Cowan M, Middleton LE. Immersive virtual reality exergames to promote well-being of community-dwelling older adults: a mixed-methods pilot study protocol (Preprint). JMIR Res Protoc 2021; 11:e32955. [PMID: 35700014 PMCID: PMC9237784 DOI: 10.2196/32955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/21/2022] [Accepted: 04/21/2022] [Indexed: 01/26/2023] Open
Abstract
Background Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults. Objective The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics). Methods The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults. Results The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ≥80%. Challenges associated with VR technology and the complexity of remote assessments are expected. Conclusions This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults’ well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults. International Registered Report Identifier (IRRID) DERR1-10.2196/32955
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Affiliation(s)
- Samira Mehrabi
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - John E Muñoz
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Aysha Basharat
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - Shi Cao
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
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Ashcroft R, Menear M, Greenblatt A, Silveira J, Dahrouge S, Sunderji N, Emode M, Booton J, Muchenje M, Cooper R, Haughton A, McKenzie K. Patient perspectives on quality of care for depression and anxiety in primary health care teams: A qualitative study. Health Expect 2021; 24:1168-1177. [PMID: 33949060 PMCID: PMC8369101 DOI: 10.1111/hex.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team-based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care. OBJECTIVE The main study objective was to understand patients' perspectives on the quality of care that they received for anxiety and depression in primary care teams. METHODS This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data. RESULTS Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs. CONCLUSION Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process.
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Affiliation(s)
- Rachelle Ashcroft
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
| | - Matthew Menear
- Faculty of MedicineDepartment of Family Medicine and Emergency MedicineUniversité LavalQuebecQuebecCanada
| | - Andrea Greenblatt
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
| | - Jose Silveira
- Faculty of MedicineDepartment of PsychiatryUniversity of TorontoTorontoONCanada
| | - Simone Dahrouge
- Faculty of MedicineDepartment of Family MedicineUniversity of OttawaOttawaONCanada
| | - Nadiya Sunderji
- Faculty of MedicineDepartment of PsychiatryInstitute for Health Policy, Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Monica Emode
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Jocelyn Booton
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
| | - Marvelous Muchenje
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
| | - Rachel Cooper
- Center for BioethicsHarvard Medical SchoolBostonMAUSA
| | | | - Kwame McKenzie
- Faculty of Medicine, Department of Psychiatry, University of Toronto IWellesley InstituteTorontoONCanada
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17
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Ashcroft R, Donnelly C, Dancey M, Gill S, Lam S, Kourgiantakis T, Adamson K, Verrilli D, Dolovich L, Kirvan A, Mehta K, Sur D, Brown JB. Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study. BMC FAMILY PRACTICE 2021; 22:143. [PMID: 34210284 PMCID: PMC8248293 DOI: 10.1186/s12875-021-01496-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022]
Abstract
Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01496-8.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | | | - Maya Dancey
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | | | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, ON, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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18
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Duboz P, Macia E, Diallo AH, Cohen E, Bergouignan A, Seck SM. The good life in rural and urban Senegal: A qualitative and quantitative study. PLoS One 2021; 16:e0252134. [PMID: 34043694 PMCID: PMC8158971 DOI: 10.1371/journal.pone.0252134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/10/2021] [Indexed: 01/07/2023] Open
Abstract
Very few studies have analyzed the influence of the environment, rural or urban, on the notion of good life and subjective well-being in sub-Saharan Africa and none, to our knowledge, has combined qualitative and quantitative methodologies for this purpose. The objectives of this interdisciplinary study were: a) to understand the emic representations of the good life in rural and urban Senegal and; b) to compare the levels and determinants of satisfaction with life between these two populations. This study was carried out in Dakar and in a very isolated rural area in the North East of Senegal: the sylvo-pastoral zone of Ferlo. A total of six focus groups were conducted for the qualitative phase, while the quantitative phase was conducted on representative samples of the populations living in Dakar (N = 1000) and Téssékéré (N = 500). Our results indicate that, against all expectations, life satisfaction is better in the Senegalese Ferlo than in the capital, Dakar. This difference may be the joint result of less meaningful social comparisons and a relationship with nature as a source of stress restoration in rural areas. However, the lifeworld of the rural Fulani of the Ferlo is being undermined by global climatic disturbances, which imposes rapid adaptations of pastoralism; otherwise this activity, that is not only subsistence but also identity-based, may disappear.
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Affiliation(s)
- Priscilla Duboz
- IRL 3189 Environnement, Santé, Sociétés, Faculté de médecine, CNRS / Université de Bamako / CNRST Burkina-Faso, Université Cheikh Anta Diop, Dakar, Senegal
- * E-mail:
| | - Enguerran Macia
- IRL 3189 Environnement, Santé, Sociétés, Faculté de médecine, CNRS / Université de Bamako / CNRST Burkina-Faso, Université Cheikh Anta Diop, Dakar, Senegal
| | - Amadou H. Diallo
- IRL 3189 Environnement, Santé, Sociétés, Faculté de médecine, CNRS / Université de Bamako / CNRST Burkina-Faso, Université Cheikh Anta Diop, Dakar, Senegal
| | - Emmanuel Cohen
- UMR 7206 Eco-Anthropologie, CNRS / MNHN / Université de Paris, Site du Musée de l’Hommes, Paris, France
| | - Audrey Bergouignan
- UMR 7178 Institut Pluridisciplinaire Hubert Curien, CNRS / Université de Strasbourg, Strasbourg, France
- Division of Endocrinology, Metabolism and Diabetes, Anschutz Health & Wellness Center, University of Colorado, Aurora, Colorado, United States of America
| | - Sidy M. Seck
- IRL 3189 Environnement, Santé, Sociétés, Faculté de médecine, CNRS / Université de Bamako / CNRST Burkina-Faso, Université Cheikh Anta Diop, Dakar, Senegal
- Internal Medicine and Nephrology Department, University Gaston Berger, Saint-Louis, Senegal
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19
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Heggdal K, Mendelsohn JB, Stepanian N, Oftedal BF, Larsen MH. Health-care professionals' assessment of a person-centred intervention to empower self-management and health across chronic illness: Qualitative findings from a process evaluation study. Health Expect 2021; 24:1367-1377. [PMID: 33934447 PMCID: PMC8369120 DOI: 10.1111/hex.13271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/17/2021] [Accepted: 04/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background Person‐centred care (PCC) empowers patients to manage their chronic illness and promote their health in accordance with their own beliefs, values and preferences. Drawing on health‐care professional's (HCP’s) experiences implementing an empowerment‐focused, person‐centred intervention called the Bodyknowledging Program (BKP), we undertook a process evaluation that aimed to assess the impact on patient health and well‐being. Methods We used individual in‐depth interviews and semi‐structured focus groups comprising n = 8 interprofessional HCP who facilitated intervention sessions with n = 58 patients situated in Norwegian specialist care sites. Content analysis was used to analyse the data and summarize major themes. Results Health‐care professional interviews revealed four main ways in which the intervention operated in support of health‐related patient outcomes: (i) addressing the whole person; (ii) hope and affirmation; (iii) expanding recovery; and (iv) social support and revitalized relationships. The intervention provided new tools for patients to understand the social, emotional and physical impact of their illness. Health‐care professional reported new insights to facilitate patient engagement and to promote patients’ health. Conclusions The Bodyknowledging Program facilitated patient engagement through the promotion of patient‐centred care while developing the patients’ ability to exploit their own resources for effectively managing their health within illness. The process evaluation supported the underlying theoretical basis of the intervention and was suggestive of its potential transferability elsewhere.
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20
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Williams M, Thomson L, Butcher E, Morriss R, Khunti K, Packham C. NHS Health Check Programme: a qualitative study of prison experience. J Public Health (Oxf) 2020; 44:174-183. [PMID: 33215193 DOI: 10.1093/pubmed/fdaa189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/28/2020] [Accepted: 09/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND NHS Health Checks began in England in 2009 and were subsequently introduced into English prisons. Uptake has been patchy and there is limited understanding about factors that may limit or enhance uptake in prison settings. Uptake of this programme is a key policy in reducing the risk of cardiovascular disease and death in these settings. METHOD Semi-structured focus groups were conducted with groups of prisoners (attendees and non-attendees to the health check), prison healthcare staff, custodial staff and ex-prisoners (n = 50). Participants were asked about their awareness and experiences of the NHS Health Check Programme in prison. RESULTS All groups highlighted barriers for not attending a health check appointment, such as poor accessibility to the healthcare department, stigma and fear. The majority of participants expressed a lack of awareness and discussed common misconceptions regarding the health check programme. Methods of increasing the uptake of health checks through group-based approaches and accessibility to healthcare were suggested. CONCLUSIONS This study reports on prisoner, staff and ex-prisoner perspectives on the implementation of NHS Health Checks within a restrictive prison environment. These findings have potentially substantial implications for successful delivery of care within offender healthcare services.
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Affiliation(s)
- Marie Williams
- Nottinghamshire Healthcare NHS Trust, Nottingham NG6 3AA, UK
| | - Louise Thomson
- Centre for Organizational Health and Development, University of Nottingham, Nottingham NG8 1BB, UK
| | | | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Chris Packham
- Nottinghamshire Healthcare NHS Trust, Nottingham NG6 3AA, UK
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21
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Pocobello R, El Sehity T, Negrogno L, Minervini C, Guida M, Venerito C. Comparison of a co-produced mental health service to traditional services: A co-produced mixed-methods cross-sectional study. Int J Ment Health Nurs 2020; 29:460-475. [PMID: 31820569 PMCID: PMC7328716 DOI: 10.1111/inm.12681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
Abstract
This study investigates the differences between a co-produced experimental mental health centre and traditional day centres. For this purpose, we used a collaborative and mixed-method approach in two complementary studies: (i) a quantitative cross-sectional study designed to compare users' hospitalization rates and their use of psychiatric medications and (ii) a qualitative study designed to explore and document the experienced differences between co-produced and traditional services. In the quantitative cross-sectional study, surveys were administered to 37 users of one co-produced mental health service and to 40 users of traditional mental health services. A negative binomial regression analysis was performed to examine the relationships between predictors and users' hospitalization rates. After adjusting for the potential confounders, users of the co-produced centre reported a 63.2% reduced rate of hospitalizations compared with users of traditional mental health services (P = 0.002). Furthermore, 39% of users of the co-produced centre reported a reduction or even withdrawal from psychiatric medications against 22% of the comparison group (P = 0.036). In the qualitative study, six main differences emerged from a thematic analysis of a large user-led focus group. In the participants' experiences, the co-produced service focused on (i) parity and respectful relationships, (ii) people's strengths, (iii) freedom, (iv) psychological continuity, (v) social inclusion, and (vi) recovery orientation. Our research provides empirical evidence concerning the 'preventive aspect' of co-produced mental health services. Additionally, new insights into how different stakeholders, particularly users of co-produced mental health services, experience the differences between co-produced and traditional mental health services are provided.
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Affiliation(s)
- Raffaella Pocobello
- Istituto di Scienze e Tecnologie della Cognizione Consiglio Nazionale delle Ricerche, Rome, Italy
| | - Tarek El Sehity
- Istituto di Scienze e Tecnologie della Cognizione Consiglio Nazionale delle Ricerche, Rome, Italy.,Faculty of Psychology, Sigmund Freud University, Vienna, Austria
| | | | - Carlo Minervini
- ASL Brindisi - CSM, Brindisi, Italy.,Associazione 180Amici, Latiano Brindis, Italy
| | - Maddalena Guida
- ASL Brindisi - CSM, Brindisi, Italy.,Associazione 180Amici, Latiano Brindis, Italy
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Bin Sheeha B, Williams A, Johnson DS, Granat M, Jones R. Patients' experiences and satisfaction at one year following primary total knee arthroplasty: A focus-group discussion. Musculoskeletal Care 2020; 18:434-449. [PMID: 32462750 DOI: 10.1002/msc.1478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To date, no study has explored patients' experiences, outcome expectations and satisfaction 1-year post-total knee arthroplasty (TKA) using focus-group discussion (FGD). The exploration of patients' expectations, functional recovery and limitations may support future modifications and thus improve outcomes post-TKA. METHODS An FGD was conducted with patients at 1-year post-TKA. Moderators led the discussion using a semistructured discussion guide. The discussion was digitally recorded, transcribed verbatim and analysed to formulate themes. RESULTS The study identified four main themes: recovery experience post-TKA, experience before TKA, activity of daily living (ADL) changes post-TKA and post-TKA outcome expectations. The recovery experience theme explores the overall experience post-TKA in terms of symptoms and progression issues; their experience with the orthopaedic surgeon and physiotherapy; and the differences between first and second knee replacements. The experience before TKA theme discusses many issues raised by patients that they believed strongly affected TKA outcomes and their satisfaction, such as the referral process, ADL limitations before TKA and their beliefs about post-TKA outcomes. The ADL changes post-TKA theme discusses the diversity of functional improvements, limitations and new functional ability. The outcome expectation theme explores what the patients expected to gain from surgery and the factors that modified those expectations, and whether their expectations were met. CONCLUSIONS Patient attitude, sufficient preoperative education, outcome expectation modification, communication with the surgeon and patients taking an active role in rehabilitation can all affect post-TKA outcomes and satisfaction. Hence, the recommendation is to address all of these issues before TKA to enhance outcomes and patient satisfaction.
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Affiliation(s)
- Bodor Bin Sheeha
- College of Health & Rehabilitation Science, Princess Nourah Bint Abdul Rahman University, Riyadh, KSA.,School of Health and Society, University of Salford Manchester, Salford, UK
| | - Anita Williams
- School of Health and Society, University of Salford Manchester, Salford, UK
| | - David Sands Johnson
- Trauma and orthopedics department, Stockport NHS Foundation Trust, University of Salford Manchester, Salford, UK
| | - Malcolm Granat
- School of Health and Society, University of Salford Manchester, Salford, UK
| | - Richard Jones
- School of Health and Society, University of Salford Manchester, Salford, UK
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Williams HM, Jones LL, Coomarasamy A, Topping AE. Men living through multiple miscarriages: protocol for a qualitative exploration of experiences and support requirements. BMJ Open 2020; 10:e035967. [PMID: 32414830 PMCID: PMC7232625 DOI: 10.1136/bmjopen-2019-035967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Up to 1 in 4 pregnancies and 1 in 20 subsequent pregnancies end in miscarriage. Despite such prevalence the psychosocial effects are often unrecognised and unsupported. In the absence of any biomedical sequelae among men such marginalisation may be intensified. Men living through multiple miscarriages may also find any grief or anxiety intensified by loss of hope for future parenthood, but robust qualitative studies of these experiences are limited. We aim to rectify the deficiency. METHODS AND ANALYSIS Our qualitative study will adopt the sounds of silence framework designed by Serrant-Green to hear the voices of populations possibly marginalised. We will listen and learn from 30 to 50 men with a history of two or more miscarriages. The research participants will be recruited from a recurrent miscarriage clinic at a large tertiary hospital in England, and from advertisements to be disseminated by the project sponsor and miscarriage charities.Individual telephone interviews supported by a semistructured discussion guide will be audio-recorded, transcribed and anonymised. The transcriptions and any field notes will be interpreted by the framework method of Ritchie and Lewis embedded within the sounds of silence framework. Tentative findings will be presented to research participants in face-to-face focus group discussion, to enable member synthesis to enhance authenticity. The focus group discussion will be audio-recorded, transcribed, anonymised and similarly interpreted to contribute to our final synthesis. ETHICS AND DISSEMINATION The protocol of this project received a favourable opinion from the West Midlands South Birmingham Research Ethics Committee (16/WM/0423). Results will be submitted for publication in peer-reviewed journals and at conferences, and disseminated via newsletters and social media of our clinical collaborators and miscarriage charities. Outputs are anticipated to inform future policy and practice in the management of multiple miscarriages. TRIAL REGISTRATION NUMBER ISRCTN 21828561.
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Affiliation(s)
- Helen Marie Williams
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Annie E Topping
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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24
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Theis RP, Wells BA, Staras SAS. "I can be the Judge of What's Serious": A Qualitative Pilot Study of Parents' Responses to Messaging About Side Effects of the HPV Vaccine. Matern Child Health J 2020; 24:456-461. [PMID: 31893386 PMCID: PMC7082199 DOI: 10.1007/s10995-019-02856-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Parents' concerns about vaccine safety and side effects likely contribute to low rates of human papillomavirus (HPV) vaccination among adolescents. To facilitate parent-provider discussions about the HPV vaccine, we developed and tested the content of a clinical decision support application for implementation in pediatric clinical settings. This study sought to elicit perspectives of parents and providers on the best way to communicate information on vaccine side effects. METHODS To understand the acceptability of the application's content, we conducted focus groups with parents (n = 11) and providers (n = 9) at three primary care clinics. Focus groups transcriptions were analyzed using iterations of deductive and inductive coding, with independent coding by two trained reviewers to improve inter-rater reliability. RESULTS Surprisingly, when parents reviewed screen shots of HPV vaccine safety and side effect messages, parents took exception to the expression "no evidence of serious side effects". Parents wanted side effects listed explicitly so they could decide for themselves which side effects were "serious". Parents also felt that the HPV vaccine did have serious side effects, and the wording undermined their trust in the vaccine messaging overall. Providers accepted the phrasing of side effects and did not express concerns that parents would object to the messaging. CONCLUSIONS Further research is needed to confirm parents' concerns with the phrasing "no serious side effects" for the HPV vaccine and to assess the impact on HPV vaccination deferral or delay.
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Affiliation(s)
- Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida, P.O. Box 100177, Gainesville, FL, 32610, USA
- Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Brittny A Wells
- Department of Health Professions, College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, University of Florida, P.O. Box 100177, Gainesville, FL, 32610, USA.
- Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
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25
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Stolk-Vos AC, Kasigar H, Nijmeijer KJ, Missotten TO, Busschbach JJ, van de Klundert JJ, Kranenburg LW. Outcomes in patients with chronic uveitis: which factors matter to patients? A qualitative study. BMC Ophthalmol 2020; 20:125. [PMID: 32228570 PMCID: PMC7106635 DOI: 10.1186/s12886-020-01388-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose Outcome measurements currently used in chronic uveitis care fail to cover the full patient perspective. The aim of this study is to develop a conceptual model of the factors that adult patients with chronic uveitis consider to be important when evaluating the impact of their disease and treatment. Methods A qualitative study design was used. Twenty chronic uveitis patients were recruited to participate in two focus groups. Data were transcribed verbatim and analysed using thematic analysis in ATLAS.ti. Results Coding of the transcripts resulted in a total of 19 codes divided over five themes: 1) disease symptoms and treatment; 2) diagnosis and treatment process; 3) impact on daily functioning; 4) emotional impact; and 5) treatment success factors. Conclusion The conceptual model resulting from this study can contribute to the development of future uveitis specific measures in adults.
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Affiliation(s)
- Aline C Stolk-Vos
- Rotterdam Ophthalmic Institute, Schiedamse Vest 160, Rotterdam, 3011 BH, The Netherlands. .,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | | | | | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joris J van de Klundert
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Prince Mohammad Bin Salman School of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
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26
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Oedingen C, Bartling T, Dierks ML, Mühlbacher AC, Schrem H, Krauth C. Public preferences for the allocation of donor organs for transplantation: Focus group discussions. Health Expect 2020; 23:670-680. [PMID: 32189453 PMCID: PMC7321724 DOI: 10.1111/hex.13047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Deceased donor organs are scarce resources because of a large supply-and-demand mismatch. This scarcity leads to an ethical dilemma, forcing priority-setting of how these organs should be allocated and whom to leave behind. OBJECTIVE To explore public preferences for the allocation of donor organs in regard to ethical aspects of distributive justice. METHODS Focus groups were facilitated between November and December 2018 at Hannover Medical School. Participants were recruited locally. Transcripts were assessed with content analysis using the deductive framework method. All identified and discussed criteria were grouped according to the principles of distributive justice and reported following the COREQ statement. RESULTS Six focus groups with 31 participants were conducted. Overall, no group made a final decision of how to allocate donor organ; however, we observed that not only a single criterion/principle but rather a combination of criteria/principles is relevant. Therefore, the public wants to allocate organs to save as many lives as possible by both maximizing success for and also giving priority to urgent patients considering the best compatibility. Age, waiting time, reciprocity and healthy lifestyles should be used as additional criteria, while sex, financial status and family responsibility should not, based on aspects of equality. CONCLUSIONS All participants recognized the dilemma that prioritizing one patient might cause another one to die. They discussed mainly the unclear trade-offs between effectiveness/benefit and medical urgency and did not establish an agreement about their importance. The results suggest a need of preference studies to elucidate public preferences in organ allocation.
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Affiliation(s)
- Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Axel C Mühlbacher
- Institute of Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.,Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Harald Schrem
- Department of General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria.,Transplant Center Graz, Medical University Graz, Graz, Austria
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
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Degeling C, Rock M. Qualitative Research for One Health: From Methodological Principles to Impactful Applications. Front Vet Sci 2020; 7:70. [PMID: 32133378 PMCID: PMC7039926 DOI: 10.3389/fvets.2020.00070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022] Open
Abstract
The One Health concept has inspired a rich vein of applied research and scholarly reflection over the past decade, yet with little influence from qualitative methodologists. With this overview, we describe the underpinning assumptions, purposes, and potential pitfalls of data collection techniques and methods of data analysis in key qualitative research methodologies. Our aim is to enhance One Health collaborations involving qualitative researchers, veterinary epidemiologists, and veterinary economists. There exist several distinct traditions of qualitative research, from which we draw selectively for illustrative purposes. Notwithstanding important distinctions, we emphasize commonalities and the potential for collaborative impact. The most important commonality is a shared focus on contextualizing human behavior and experience–culturally, economically, historically, and socially. We demonstrate that in-depth attention to context can assist veterinary economists and epidemiologists in drawing lessons from the implementation of policies and programs. In other words, qualitative researchers can assist One Health teams in distilling insights from “success stories,” but also from adverse events and unintended consequences. As a result, qualitative researchers can contribute to One Health research and policy discussions by formulating more accurate and contextually-relevant parameters for future quantitative studies. When performed well, qualitative methodologies can help veterinary economists and epidemiologists to develop impactful research questions, to create more accurate and contextually-relevant parameters for quantitative studies, and to develop policy recommendations and interventions that are attuned to the political and socio-cultural context of their implementation. In sketching out the properties and features of influential methodologies, we underscore the value of working with seasoned qualitative researchers to incorporate questions about “what,” “how,” and “why” in mixed-methods research designs.
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Affiliation(s)
- Chris Degeling
- Faculty of Social Science, Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Melanie Rock
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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28
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Shulman R, Zenlea I, Shah BR, Clarson C, Harrington J, Landry A, Punthakee Z, Palmert MR, Mukerji G, Austin PC, Parsons J, Ivers N. Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group. BMC Health Serv Res 2019; 19:885. [PMID: 31766999 PMCID: PMC6878686 DOI: 10.1186/s12913-019-4690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. METHODS This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. DISCUSSION There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
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Affiliation(s)
- Rayzel Shulman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada. .,SickKids Research Institute, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada.
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Missisauga, Canada
| | - Baiju R Shah
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cheril Clarson
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Jennifer Harrington
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alanna Landry
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Markham Stouffville Hospital, Markham, Canada
| | | | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Janet Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Noah Ivers
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.,Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
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Harries T, Rettie R, Gabe J. Shedding new light on the (in)compatibility of chronic disease management with everyday life - social practice theory, mobile technologies and the interwoven time-spaces of teenage life. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1396-1409. [PMID: 31124176 DOI: 10.1111/1467-9566.12952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article uses a socio-material approach, social practice theory, to provide new insights into the self-management of chronic illness. It demonstrates how this theory can bridge arguments about the respective roles of social and individual influences, and how it can foreground an oft-overlooked aspect of the issue - the demands of self-care technologies and consequences for participation in social life. Drawing on interviews and focus groups with 25 young type-1 diabetes outpatients in London, UK, the study points to the conflicts that occur when disease management technologies compete for time and space with the social practices of everyday life, and when self-care tasks threaten to interrupt the flow of social life and make people feel 'left behind'. The paper concludes that young people are disabled by the contingent position of self-care activities in daily life, which oblige them to compromise either their physical health or their immersion in the social world. This disabling effect would be mitigated if social practices were reorganised to make them more amenable to the time-space requirements of disease management. A social practice theory lens can help throw light onto this issue and make a valuable contribution to the study of the self-management of chronic illness.
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Affiliation(s)
- Tim Harries
- Kingston Business School, Kingston University London, Kingston-upon-Thames, UK
| | - Ruth Rettie
- Kingston Business School, Kingston University London, Kingston-upon-Thames, UK
| | - Jonathan Gabe
- School of Law and Social Science, Royal Holloway University of London, London, UK
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30
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Subramani S. Practising reflexivity: Ethics, methodology and theory construction. METHODOLOGICAL INNOVATIONS 2019. [DOI: 10.1177/2059799119863276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reflexivity as a concept and practice is widely recognized and acknowledged in qualitative social science research. In this article, through an account of the ‘reflexive moments’ I encountered during my doctoral research, which employed critical theory perspective and constructivist grounded theory methodology, I elaborate how ethics, methodology and theory construction are intertwined. Further, I dwell on the significance of reflexivity, particularly in qualitative research analysing bioethics concepts. Through an account of the universal ethical principles that ‘I’, as a researcher, encounter, and a micro-analysis of the observed relationships that influence the theoretical construction and arguments developed, I explore the quandaries an ethics researcher undertaking a reflexive approach faces. I elucidate that reflexivity unveils – for both researcher and reader – how the researcher(s) arrive(s) at certain positions during the knowledge construction process. I conclude by stating that reflexivity demystifies the moral and epistemological stances of both the study and researcher(s).
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Affiliation(s)
- Supriya Subramani
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
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31
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Brunton L, Boaden R, Knowles S, Ashton C, Parry-Jones AR. Pre-hospital stroke recognition in a UK centralised stroke system: a qualitative evaluation of current practice. Br Paramed J 2019; 4:31-39. [PMID: 33328826 PMCID: PMC7706776 DOI: 10.29045/14784726.2019.06.4.1.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: A significant number of patients conveyed via ambulance to hyper acute stroke units (HASU) with suspected stroke have other diagnoses. This may delay treatment for non-stroke patients and cause burden to stroke teams. The Greater Manchester (GM) Connected Health Cities (CHC) stroke project links historical North West Ambulance Service NHS Trust (NWAS) data with Salford Royal Hospital electronic data to study stroke pathway compliance and accuracy of paramedic diagnosis and aims to use these data to improve pre-hospital clinicians’ accurate recognition of stroke through development of service improvement innovations. We report on supplementary qualitative work required to understand stroke recognition from the pre-hospital clinician’s perspective. Methods: Focus groups and semi-structured interviews were conducted with pre-hospital clinicians of various grades, working in the GM area of NWAS. Focus groups and interviews were audio recorded and transcribed verbatim. We used thematic analysis informed by normalisation process theory (NPT) to analyse the data. This theory helps us to understand how innovations are developed, implemented and sustained into healthcare practice. Results: Sixteen pre-hospital clinicians took part in two focus groups, one dyad interview and five one-to-one interviews. Analysis identified that respondents were unaware of false positive stroke rates entering onto the stroke pathway. Pre-hospital clinicians receive limited feedback from jobs and this impedes their ability to learn from their experiences. Respondents reported difficulty in ruling out stroke in certain patient cohorts and difficulty in recognising differential diagnoses. They expressed a lack of confidence to rule out stroke in the pre-hospital setting. They also expressed greater concern for ‘missed strokes’. Conclusion: The qualitative findings support the development of innovations to improve accurate recognition of stroke in the pre-hospital setting. An enhanced FAST tool, better relations with HASU clinicians, feedback and education on the stroke pathway and differential diagnoses were all considered useful to improve accurate stroke recognition.
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Mosor E, Waldherr K, Kjeken I, Omara M, Ritschl V, Pinter-Theiss V, Smolen J, Hübel U, Stamm T. An intergenerational program based on psycho-motor activity promotes well-being and interaction between preschool children and older adults: results of a process and outcome evaluation study in Austria. BMC Public Health 2019; 19:254. [PMID: 30823911 PMCID: PMC6397484 DOI: 10.1186/s12889-019-6572-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/20/2019] [Indexed: 12/01/2022] Open
Abstract
Background Limited evidence exists for intergenerational interventions to promote health and well-being in older adults and preschool children. We therefore aimed to evaluate the implementation, feasibility and outcome of an intergenerational health promotion program based on psycho-motor activity. Methods A multicenter mixed-methods study with preschool children and older adults as equivalent target-groups, and professionals and parents as additional informants was conducted in Austria. The study included a needs assessment, a pilot phase with a formative process evaluation and a subsequent rollout phase to evaluate the outcome and the adapted processes of the intervention program. To analyze the qualitative data, a modified form of the framework method was applied. Quantitative data were collected with a time-sampling method and were analyzed using descriptive and inferential statistical procedures. Results One hundred ninety-six participants (93 older adults [54 to 96 years old, 83% female], 78 children [2 to 7 years old, 58% female], 13 professionals and 12 parents) from 16 institutions (eight kindergartens and eight geriatric facilities) were included in the study. The qualitative process evaluation revealed several aspects for improvement of the intervention program. Well-being as measured by observing spontaneous intergenerational contacts (p < 0.001) and facial expressions (effect size r = 0.34; p < 0.001) showed a significant increase between the rollout baseline and follow-up assessments. Conclusions Professionals in geriatric institutions and kindergartens could facilitate interactions between members of the different generations by offering an intergenerational intervention program based on psycho-motor activities in the future. Electronic supplementary material The online version of this article (10.1186/s12889-019-6572-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Karin Waldherr
- FernFH Distance-Learning University of Applied Sciences, Zulingergasse 4, 2700, Wiener Neustadt, Austria
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Pb 23 Vinderen, 0319, Oslo, Norway
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Veronika Pinter-Theiss
- AKMÖ - Aktionskreis Motopädagogik Österreich, Döblinger Hauptstr. 7a/2/43, 1190, Vienna, Austria
| | - Josef Smolen
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ursula Hübel
- Wiener Gesundheitsförderung - WiG, Gesunde Stadt - Gesunde Organisationen, Treustraße 35 - 43/6/1, 1200, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Fête M, Aho J, Benoit M, Cloos P, Ridde V. Barriers and recruitment strategies for precarious status migrants in Montreal, Canada. BMC Med Res Methodol 2019; 19:41. [PMID: 30808301 PMCID: PMC6390306 DOI: 10.1186/s12874-019-0683-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Precarious status migrants are a group of persons who are vulnerable, heterogeneous, and often suspicious of research teams. They are underrepresented in population-based research projects, and strategies to recruit them are described exclusively in terms of a single cultural group. We analyzed the recruitment strategies implemented during a research project aimed at understanding precarious status migrants' health status and healthcare access in Montreal, Canada. The research sample consisted of 854 persons recruited from a variety of ethnocultural communities between June 2016 and September 2017. This article analyzes the strategies implemented by the research team to respond to the challenges of that recruitment, and assess the effectiveness of those strategies. Based on the results, we share the lessons learned with a view to increasing precarious status migrants' representation in research. METHOD A mixed sequential design was used to combine qualitative data gathered from members of the research team at a reflexive workshop (n = 16) and in individual interviews (n = 15) with qualitative and quantitative data collected using the conceptual mapping method (n = 10). RESULTS The research team encountered challenges in implementing the strategies, related to the identification of the target population, the establishment of community partnerships, and suspicion on the part of the individuals approached. The combination of a venue-based sampling method, a communications strategy, and the snowball sampling method was key to the recruitment. Linking people with resources that could help them was useful in obtaining their effective and non-instrumental participation in the study. Creating a diverse and multicultural team helped build trust with participants. However, the strategy of matching the ethnocultural identity of the interviewer with that of the respondent was not systematically effective. CONCLUSION The interviewers' experience and their understanding of the issue are important factors to take into consideration in future research. More over, the development of a community resource guide tailored to the needs of participants should be major components of any research project targeting migrants. Finally, strategies should be implemented as the result of a continuous reflexive process among all members of the research team.
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Affiliation(s)
- Margaux Fête
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Josephine Aho
- School of Public Health, University of Montreal, Montreal, Canada
| | - Magalie Benoit
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Patrick Cloos
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
- School of Social Work, Faculty of Arts and Sciences, University of Montreal, Montreal, Canada
| | - Valéry Ridde
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
- French Institute for Research on Sustainable Development (IRD), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
- Fellow de l’Institut Français des Migrations, Paris, France
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Stuhlfauth S, Knutsen IR, Foss C. Coming from two different worlds-A qualitative, exploratory study of the collaboration between patient representatives and researchers. Health Expect 2019; 22:496-503. [PMID: 30779324 PMCID: PMC6543145 DOI: 10.1111/hex.12875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/11/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background Interest in user involvement in research has increased and user involvement is increasingly seen as a prerequisite. Still, challenges in the collaboration process have been documented from both researchers' and users' perspective. Objective By bringing together researchers and patient representatives, this study explores and describes both parties' experiences with user involvement in research as they appear through interactions in a focus group. Design We apply a qualitative design using positioning theory as a theoretical framework. Setting and participants Researchers and patient representatives were mixed within 2 focus groups. Positioning theory was used to guide the analysis. Findings The discussion evolved around knowledge, equity and partnership, all related to power through constant negotiations of positions. Researchers and users ascribed various positions while discussing these topics. Various positions are seen as the result of different rights and duties in the research process. Power differences in the form of different rights and duties stand out as barriers. Being positioned as a partner was an important aspect for users in our study. Researchers assumed passive positions within the focus group, whereas users assumed active positions by expressing their wishes and needs. Discussion and conclusion Our study indicates that positions relating to status and knowledge in the involvement process are important. The findings suggest that the positions that users and researchers assume and ascribe throughout the process are constantly changing; however, the researchers tend to have more power. More studies are needed to understand how equity is perceived in user involvement in health research.
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Affiliation(s)
- Susanne Stuhlfauth
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Kjeller, Norway
| | - Christina Foss
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
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Litchfield I, Bentham L, Hill A, McManus RJ, Lilford R, Greenfield S. The impact of status and social context on health service co-design: an example from a collaborative improvement initiative in UK primary care. BMC Med Res Methodol 2018; 18:136. [PMID: 30445914 PMCID: PMC6240286 DOI: 10.1186/s12874-018-0608-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasingly, collaborative participatory methods requiring open and honest interaction between a range of stakeholders are being used to improve health service delivery. To be successful these methodologies must incorporate perspectives from a range of patients and staff. Yet, if unaccounted for, the complex relationships amongst staff groups and between patients and providers can affect the veracity and applicability of co-designed solutions. METHODS Two focus groups convened to discuss suggestions for the improvement of blood testing and result communication in primary care. The groups were mixed of patients and staff in various combinations drawn from the four participating study practices. Here we present a secondary mixed-method analysis of the interaction between participants in both groups using sociogrammatic and thematic analysis. RESULTS Despite a similar mix of practice staff and patients the two groups produced contrasting discussions, seemingly influenced by status and social context. The sociograms provided a useful insight into the flow of conversation and highlighted the dominance of the senior staff member in the first focus group. Within the three key themes of social context, the alliances formed between participants and the fluidity of the roles assumed manifested differently between groups apparently dictated by the different profile of the participants of each. CONCLUSIONS For primary care service improvement attention must be paid to the background of participants when convening collaborative service improvement groups as status and imported hierarchies can have significant connotations for the data produced.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Louise Bentham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ann Hill
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Lilford
- Warwick Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Bossy D, Knutsen IR, Rogers A, Foss C. Moving between ideologies in self-management support-A qualitative study. Health Expect 2018; 22:83-92. [PMID: 30289189 PMCID: PMC6351411 DOI: 10.1111/hex.12833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background Reforms in current health policy explicitly endorse health promotion through group‐based self‐management support for people with long‐term conditions. Health promotion and traditional medicine are based on different logics. Accordingly, health professionals in health‐promoting settings demand the adoption of new practices and ways of thinking. Objectives The objective of our study was to investigate how health professionals perceive the health‐promoting group‐based self‐management support that is politically initiated for people with long‐term conditions. Design This study had a qualitative research design that included focus group interviews and was guided by a social constructivist paradigm in which group‐based self‐management was viewed as a social construction. Different logics at play were analysed through the theoretical lens of institutional logic. Discussions among participants show frames of references seen as logics. Setting and participants We recruited health professionals from group‐based health‐promoting measures for people with type 2 diabetes in Norway. Two focus groups comprising four and six participants each were invited to discuss the practices and value of health promotion through group‐based self‐management support. Results The analysis resulted in three themes of discussion among participants that contained reflections of logics in movement. Health professionals’ discussions moved between different logics based on the importance of expert‐based knowledge on compliance and on individual lifestyle choices. Discussion and conclusion The study indicates that health promotion through self‐management support is still a field “in the making” and that professionals strive to establish new logics and practices that are not considered difficult to manage or do not contain incompatible understandings.
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Affiliation(s)
- Dagmara Bossy
- Norwegian National Advisory Unit on Learning and Mastery in Health, Universitetssykehus HF, Aker Sykehus, Oslo, Norway.,Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Kjeller, Norway
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Hampshire, UK
| | - Christina Foss
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
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Luhr K, Holmefur M, Theander K, Eldh AC. Patient participation during and after a self-management programme in primary healthcare - The experience of patients with chronic obstructive pulmonary disease or chronic heart failure. PATIENT EDUCATION AND COUNSELING 2018; 101:1137-1142. [PMID: 29290329 DOI: 10.1016/j.pec.2017.12.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient participation is facilitated by patients' ability to take responsibility for and engage in health issues. Yet, there is limited research as to the promotion of these aspects of patient participation in long-term healthcare interactions. This paper describes patient participation as experienced by patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF); the aim was to describe if and how a self-management programme in primary healthcare influenced patient participation. METHODS Patients who had participated in a self-management programme were interviewed in nine focus groups (36 patients). Data was analysed using qualitative content analysis. RESULTS Patients described equality in personal interactions, opportunities to share and discuss, and a willingness to share and learn to facilitate patient participation in a self-management programme. Consequently, patient participation was promoted by a match between the individuals' personal traits and the context. CONCLUSION Features facilitating patient participation by means of sharing and assimilating knowledge and insights should be included in self-management programmes and in the care for patients with COPD and CHF. PRACTICE IMPLICATIONS A self-management programme can complement regular primary care regarding enhanced understanding of one's disease and support patient participation and the patient's own resources in self-management.
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Affiliation(s)
- Kristina Luhr
- University Health Care Research Center, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Marie Holmefur
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Kersti Theander
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
| | - Ann Catrine Eldh
- Division of Nursing, Department of Medical and Health Sciences, Linköping University, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Savage RD, Rosella LC, Crowcroft NS, Arneja J, de Villa E, Horn M, Khan K, Varia M. How Can We Keep Immigrant Travelers Healthy? Health Challenges Experienced by Canadian South Asian Travelers Visiting Friends and Relatives. QUALITATIVE HEALTH RESEARCH 2018; 28:610-623. [PMID: 29239271 DOI: 10.1177/1049732317746381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Immigrant travelers who visit friends and relatives (VFR travelers) experience substantially higher rates of travel-related infections than other travelers, in part due to low uptake of pretravel health advice. While barriers to accessing advice have been identified, better characterization is needed to inform targeted interventions. We sought to understand how South Asian VFR travelers perceived and responded to travel-related health risks by conducting group interviews with 32 adult travelers from an ethnoculturally diverse Canadian region. Travelers positioned themselves as knowledgeable of key health risks, despite not seeking pretravel health advice. Their responses to risks were pragmatic and rooted in experience, but often constrained by competing concerns, including rushed travel, familial obligations, cost, and a desire to preserve authentic experiences. Moving beyond risk awareness to reinforcing the value of medical advice and intervention, in a manner that is sensitive to these unique concerns, is needed when delivering tailored health promotion messages to VFR travelers.
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Affiliation(s)
| | - Laura C Rosella
- 1 University of Toronto, Toronto, Ontario, Canada
- 2 Public Health Ontario, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- 1 University of Toronto, Toronto, Ontario, Canada
- 2 Public Health Ontario, Toronto, Ontario, Canada
| | | | - Eileen de Villa
- 1 University of Toronto, Toronto, Ontario, Canada
- 3 Toronto Public Health, Toronto, Ontario, Canada
| | - Maureen Horn
- 4 Peel Public Health, Mississauga, Ontario, Canada
| | - Kamran Khan
- 1 University of Toronto, Toronto, Ontario, Canada
- 5 St. Michael's Hospital, Toronto, Ontario, Canada
| | - Monali Varia
- 4 Peel Public Health, Mississauga, Ontario, Canada
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Celani MG, Cantisani TA, Bignamini A, Macone S, Papetti R, Baiocco L. Is it worth it, or possible, to measure what matters to patients with epilepsy and their caregivers? Epilepsy Behav 2018; 78:273-279. [PMID: 29128470 DOI: 10.1016/j.yebeh.2017.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/19/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to collect perspectives, ideas, and values of people affected by epilepsy and their carer to include them in new research in this area. DESIGN This is a semiquantitative study analyzing needs, emotions, and medical issues emerging from focus groups with patients and carers divided in three severity levels of disease. PARTICIPANTS The participants were 25 patients and 36 carers attending outpatients' service of tertiary epilepsy center in Umbria, Italy. RESULTS Assistance was the need expressed by more than 40% of the participants followed by experience-sharing, knowledge, control, clarity, and security. The only significant effect in logistic regression analysis after adjusting for severity was the patients' expressed need for "experience-sharing" more than their carers (OR 7.29, 95%CI: 1.76-30.18). Hope was the emotion expressed by more than 50% of the participants, followed by anger, fear, and resignation. After adjusting for severity, carers were more likely to express anger, in comparison with patients (OR 17.23, 95%CI: 3.55-83.74; P<0.001). The patients were 6.88 times more likely (95%CI 1.84-25.75; P=0.004) to express "resignation" than their carers. The most frequent medical issues were related to: "medications", "frequency of crises", "work impact", "quality of life", "psychomedical integration of care", and "development of new drugs". After adjusting for severity in a logistic regression analysis, patients were more likely to express concerns for the frequency of crises than carers (OR 3.57, 95%CI: 1.16-11.04; P=0.027). CONCLUSIONS Patients' and carers' priorities, based on intense personal insight, represent a starting point to work for shared outcome measures in clinical trials and shared agenda in research, including research of strong evidence in complex intervention as service models for people with epilepsy.
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Affiliation(s)
- Maria Grazia Celani
- Department of Neurophysiopathology, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; Cochrane Neurosciences Field, Direzione Salute Welfare, Region of Umbria, Perugia, Italy.
| | - Teresa Anna Cantisani
- Cochrane Neurosciences Field, Direzione Salute Welfare, Region of Umbria, Perugia, Italy; Perugia Hospital, Neurophysiopathology Unit, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
| | - Angelo Bignamini
- School of Specialisation in Hospital Pharmacy, Dept. of Pharmaceutical Sciences, University of Milan, Italy
| | - Sara Macone
- Cochrane Neurosciences Field, Direzione Salute Welfare, Region of Umbria, Perugia, Italy; University of Kansas Medical Center, Department of Dietetics and Nutrition, USA
| | - Rossella Papetti
- Perugia Hospital, Neurophysiopathology Unit, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
| | - Luisa Baiocco
- Perugia Hospital, Neurophysiopathology Unit, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
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Tobler-Ammann BC, Surer E, Knols RH, Borghese NA, de Bruin ED. User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study. JMIR Serious Games 2017; 5:e18. [PMID: 28842390 PMCID: PMC5591406 DOI: 10.2196/games.8013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. OBJECTIVE The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. METHODS A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. RESULTS The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. CONCLUSIONS Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. TRIAL REGISTRATION Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ).
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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van Kessel P, de Boer D, Hendriks M, Plass AM. Measuring patient outcomes in chronic heart failure: psychometric properties of the Care-Related Quality of Life survey for Chronic Heart Failure (CaReQoL CHF). BMC Health Serv Res 2017; 17:536. [PMID: 28784137 PMCID: PMC5547511 DOI: 10.1186/s12913-017-2452-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background The Care-Related Quality of Life survey for Chronic Heart Failure (CaReQoL CHF) is a newly developed patient-reported outcome measure (PROM) that measures care-related quality of life in patients diagnosed with chronic heart failure. This study describes the psychometric properties of the questionnaire and its relationship with disease severity and global rating of quality of care. Method Insurance companies selected patients with a recorded diagnosis of chronic heart failure and for whom the hospital submitted a billing statement in the last year. Exploratory factor analysis, Cronbach’s alpha and item-rest correlation were used to construct the CaReQoL CHF. Construct validity was assessed by examining the mean values of the CaReQoL CHF scales for the categories of the widely-used New York Heart Association (NYHA) functional classification and by correlating the global rating of quality of care with the CaReQoL CHF scales. Results One thousand eighteen patients with chronic heart failure filled out the CaReQoL CHF (RR: 35.7%). The CaReQoL CHF consists of 20 items and three scales: social and emotional problems, physical limitations, and being in safe hands. The mean scores of the three scales differed significantly for the NYHA categories, particularly for the social-emotional problems and physical limitation scales. The ‘being in safe hands’ scale showed a moderate positive correlation with the global rating of quality of care. Conclusions The CaReQoL CHF is a concise and valid PROM that matches patients’ priorities in healthcare. It adds a new element to existing quality of life questionnaires for patients with chronic heart failure, that is ‘being in safe hands’ scale. This scale is relevant for patients because they experience anxiety and tension about their condition. Future research should determine whether the CaReQoL CHF can help healthcare providers in daily practice to focus treatment on outcomes of care that are relevant to individual patients.
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Affiliation(s)
- Paul van Kessel
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Dolf de Boer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Michelle Hendriks
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.
| | - Anne Marie Plass
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,University Medical Center Göttingen (UMG)/ Georg-August-University, Institute of Medical Psychology and Medical Sociology, Göttingen, Germany
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Esquivel-Sada D, Nguyen MT. Diagnosis of rare diseases under focus: impacts for Canadian patients. J Community Genet 2017; 9:37-50. [PMID: 28733824 PMCID: PMC5752651 DOI: 10.1007/s12687-017-0320-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/03/2017] [Indexed: 11/06/2022] Open
Abstract
This paper presents an in-depth qualitative analysis of the impact of diagnosis on the lives of rare disease (RD) patients. While diagnosis may be described as a watershed step for RD patients, no extensive account of non-medical outcomes following a RD diagnosis exists within the literature. This study aims to fill this knowledge gap through an analysis of the impact of diagnosis on the lives of RD patients according to their personal experiences. Qualitative research was conducted in three provinces across Canada, with a total of 23 participants, both adult and parents of children with RD, diagnosed and not yet diagnosed. A thematic approach guided the analysis of the transcripts. The results reveal that the impacts of a RD diagnosis for both adults and paediatric patients are multifold, ranging from social to personal and medical impacts (including cases where etiological treatments for the diseases are non-existent). Furthermore, the results shed light on distinct factors that affect the scope of impacts of a diagnosis.
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Affiliation(s)
- Daphne Esquivel-Sada
- Centre of Genomics and Policy, Faculty of Medicine, Department of Human Genetics, McGill University, 740 Dr. Penfield Ave., Montreal, QC, H3A 0G1, Canada.
| | - Minh Thu Nguyen
- Centre of Genomics and Policy, Faculty of Medicine, Department of Human Genetics, McGill University, 740 Dr. Penfield Ave., Montreal, QC, H3A 0G1, Canada
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Samuel SM, Flynn R, Zappitelli M, Dart A, Parekh R, Pinsk M, Mammen C, Wade A, Scott SD. Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers. CMAJ Open 2017; 5:E424-E430. [PMID: 28592406 PMCID: PMC5498309 DOI: 10.9778/cmajo.20160078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. METHODS Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. RESULTS Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. INTERPRETATION Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes.
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Affiliation(s)
- Susan M Samuel
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Rachel Flynn
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Michael Zappitelli
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Allison Dart
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Rulan Parekh
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Maury Pinsk
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Cherry Mammen
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Andrew Wade
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Shannon D Scott
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
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Lie HC, Mellblom AV, Brekke M, Finset A, Fosså SD, Kiserud CE, Ruud E, Loge JH. Experiences with late effects-related care and preferences for long-term follow-up care among adult survivors of childhood lymphoma. Support Care Cancer 2017; 25:2445-2454. [PMID: 28236146 DOI: 10.1007/s00520-017-3651-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Given childhood cancer survivors' risk of treatment-induced late effects, long-term follow-up care is recommended. We explored experiences with late effects-related care and preferences for long-term follow-up care among adult survivors of childhood malignant lymphoma in Norway. METHODS We conducted five focus group interviews with 34 survivors (19 females; 21 Hodgkin/13 non-Hodgkin lymphoma survivors; mean age 39 years; mean time from diagnosis 26 years). Data was analyzed using principles of thematic analysis. RESULTS Two main themes were identified: (1) the survivors' experiences with late effects-related care and (2) their preferences for long-term follow-up care. Most of the survivors were dissatisfied with their late effects-related care due to perceptions of poor coordination of healthcare needs in a fragmented system, combined with a perceived lack of knowledge of late effects among themselves and general practitioners (GPs). All survivors valued long-term follow-up care. Oncologists were the preferred care providers, but GPs were considered acceptable providers if they had sufficient knowledge of late effects and routine examinations, short waiting times, and improved GP-oncologist collaboration. CONCLUSIONS Our results suggest that a shared care model of long-term follow-up care involving specialists, GPs, and the survivors themselves is likely to fulfill several of the currently unmet needs among adult survivors of childhood cancers. Improved patient education about late effects and follow-up care would aid self-management. The survivors' concerns regarding lack of sufficient knowledge of late effects among GPs suggest a need for improving access to, and dissemination of, information of late effects.
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Affiliation(s)
- Hanne C Lie
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway. .,Department of Paediatric Medicine, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. .,National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway.
| | - Anneli V Mellblom
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Medicine, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon H Loge
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway.,Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
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Hwang AS, Rosenberg L, Kontos P, Cameron JI, Mihailidis A, Nygård L. Sustaining care for a parent with dementia: an indefinite and intertwined process. Int J Qual Stud Health Well-being 2017; 12:1389578. [PMID: 29050539 PMCID: PMC5654011 DOI: 10.1080/17482631.2017.1389578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/12/2022] Open
Abstract
This study aimed to understand how adult children sustain caring for persons with dementia (PwDs) within their family and formal care contexts in Canada. Half-day focus groups were conducted with adult daughters and adult sons in Toronto, Canada. Using constructivist grounded theory, we examined both substantive concepts and group dynamics. Sustaining care was interpreted as an indefinite process with three intertwined themes: reproducing care demands and dependency, enacting and affirming values, and "flying blind" in how and how long to sustain caring (i.e., responding to immediate needs with limited foresight). Family values and relationships, mistrust toward the institutional and home care systems, and obscured care foresight influenced care decisions and challenged participants in balancing their parents' needs with their own. Positive and negative aspects of care were found to influence one another. The implications of these findings for research and policy are discussed.
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Affiliation(s)
- Amy S. Hwang
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Lena Rosenberg
- Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Pia Kontos
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Jill I. Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Mihailidis
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Louise Nygård
- Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
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Hjortdahl M, Halvorsen P, Risør MB. Rural GPs' attitudes toward participating in emergency medicine: a qualitative study. Scand J Prim Health Care 2016; 34:377-384. [PMID: 27827547 PMCID: PMC5217286 DOI: 10.1080/02813432.2016.1249047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Health authorities want to increase general practitioner (GP) participation in emergency medicine, but the role of the GP in this context controversial. We explored GPs' attitudes toward emergency medicine and call outs. DESIGN Thematic analysis of focus group interviews. SETTING Four rural casualty clinics in Norway. PARTICIPANTS GPs with experience ranging from one to 32 years. RESULTS The GPs felt that their role had changed from being the only provider of emergency care to being one of many. In particular, the emergency medical technician teams (EMT) have evolved and often manage well without a physician. Consequently, the GPs get less experience and feel more uncertain when encountering emergencies. Nevertheless, the GPs want to participate in call outs. They believed that their presence contributes to better patient care, and the community appreciates it. Taking part in call outs is seen as being vital to maintaining skills. The GPs had difficulties explaining how to decide whether to participate in call outs. Decisions were perceived as difficult due to insufficient information. The GPs assessed factors, such as distance from the patient and crowding at the casualty clinic, differently when discussing participation in call outs. CONCLUSION Although their role may have changed, GPs argue that they still play a part in emergency medicine. The GPs claim that by participating in call outs, they maintain their skills and improve patient care, but further research is needed to help policy makers and clinicians decide when the presence of a GP really counts. Norwegian health authorities want to increase participation by general practitioners (GPs) in emergency medicine, but the role of the GP in this context is controversial. KEY POINTS The role of the GP has changed, but GPs argue that they still play an important role in emergency medicine. GPs believe that their presence on call outs improve patient care, but they find it defensible that patients are tended to by emergency medical technicians (EMTs) only. GPs offered different assessments regarding whether to participate in call outs in seemingly similar cases.
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Affiliation(s)
- Magnus Hjortdahl
- General Practice Research Unit, UiT The Arctic University of Norway, Tromsø, Norway
- CONTACT Magnus Hjortdahl General Practice Research Unit, UiT The Arctic University of Norway, Tromsø, Norway
| | - Peder Halvorsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mette Bech Risør
- General Practice Research Unit, UiT The Arctic University of Norway, Tromsø, Norway
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Lehoux P, Jimenez-Pernett J, Miller FA, Williams-Jones B. Assessment of a multimedia-based prospective method to support public deliberations on health technology design: participant survey findings and qualitative insights. BMC Health Serv Res 2016; 16:616. [PMID: 27784317 PMCID: PMC5081965 DOI: 10.1186/s12913-016-1870-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 10/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Using a combination of videos and online short stories, we conducted four face-to-face deliberative workshops in Montreal (Quebec, Canada) with members of the public who later joined additional participants in an online forum to discuss the social and ethical implications of prospective technologies. This paper presents the participants’ appraisal of our intervention and provides novel qualitative insights into the use of videos and online tools in public deliberations. Methods We applied a mixed-method study design. A self-administered survey contained open- and close-ended items using a 5-level Likert-like scale. Absolute frequencies and proportions for the close-ended items were compiled. Qualitative data included field notes, the transcripts of the workshops and the participants’ contributions to the online forum. The qualitative data were used to flesh out the survey data describing the participants’ appraisal of: 1) the multimedia components of our intervention; 2) its deliberative face-to-face and online processes; and 3) its perceived effects. Results Thirty-eight participants contributed to the workshops and 57 to the online forum. A total of 46 participants filled-in the survey, for a response rate of 73 % (46/63). The videos helped 96 % of the participants to understand the fictional technologies and the online scenarios helped 98 % to reflect about the issues raised. Up to 81 % considered the arguments of the other participants to be well thought-out. Nearly all participants felt comfortable sharing their ideas in both the face-to-face (89 %) and online environments (93 %), but 88 % preferred the face-to-face workshop. As a result of the intervention, 85 % reflected more about the pros and cons of technology and 94 % learned more about the way technologies may transform society. Conclusions This study confirms the methodological feasibility of a deliberative intervention whose originality lies in its use of videos and online scenarios. To increase deliberative depth and foster a strong engagement by all participants, face-to-face and online components need to be well integrated. Our findings suggest that online tools should be designed by considering, one the one hand, the participants’ self-perceived ability to share written comments and, on the other hand, the ease with which other participants can respond to such contributions.
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Affiliation(s)
- P Lehoux
- Department of Health Management, Evaluation and Policy, University of Montreal, Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal Research Chair on Responsible Innovation in Health, Branch Centre-ville, P.O. Box 6128, Montreal, QC, H3C 3 J7, Canada.
| | - J Jimenez-Pernett
- Department of Health Management, Evaluation and Policy, University of Montreal, IRSPUM, Montreal, Canada
| | - F A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - B Williams-Jones
- Department of Social and Preventive Medicine, University of Montreal, IRSPUM, Montreal, Canada
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Williams JK, Ayres L. `I'm like you': establishing and protecting a common ground in focus groups with Huntington disease caregivers. J Res Nurs 2016. [DOI: 10.1177/1744987107083514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Focus group research reflects content contributed by participants and the influence of interactions among participants. Analysis of interactions provides insights into focus group dynamics and the contextual meaning of focus group topics. The aim of this report is to analyse interactions that establish or protect a common ground in focus groups of family members caring for adults with Huntington disease (HD). HD tends to stigmatise persons with the disease, as well as their families. Thus, many of the topics in these groups were sensitive. Establishing a common ground was of paramount importance to group members. Participants used interactional processes that combined validations and challenges across assertions of knowledge or expertise, and disclosure of personally painful or socially sanctioned thoughts or feelings. Participants couched their contributions in ways that established similarity with others and when disagreements arose, group members developed processes to sustain their common ground. These behaviours served to facilitate group solidarity and may have influenced the information provided by group members. Awareness of interactions to facilitate maintenance of a common ground allows leaders to recognise the importance of such interactions for the group's functioning, and provides insights for researchers into meanings of focus group findings.
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Affiliation(s)
- Janet K. Williams
- College of Nursing, The University of Iowa, IA, USA, janet-williams@ uiowa.edu
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Scalp cooling: a qualitative study to assess the perceptions and experiences of Australian patients with breast cancer. Support Care Cancer 2016; 24:3813-20. [PMID: 27061409 DOI: 10.1007/s00520-016-3206-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Chemotherapy-induced hair loss is a common and distressing side effect. Scalp cooling is increasingly being used to reduce this hair loss. The purpose of this study was to explore patients' perceptions and experience of scalp cooling. METHODS Seventeen Australian women with a diagnosis of breast cancer participated in a focus group (n = 4) or a semi-structured interview (n = 3). Both scalp-cooled and non-scalp-cooled participant views were sought. Participant perceptions and experiences of scalp cooling were discussed as part of patients' overall chemotherapy experience and a thematic analysis conducted. RESULTS Five themes emerged from the data: (1) scalp cooling in the context of treatment decision-making discussions, (2) hair loss expectations vs. experiences, (3) treatment-related expectations vs. experiences, (4) the promise of faster regrowth and (5) satisfaction with scalp cooling and future scalp cooling decision-making considerations. Information during treatment decision-making was the primary factor that influenced whether patient expectations were met. Faster regrowth was a motivator to continue treatment. Efficacy and tolerability of scalp cooling influenced future hypothetical treatment decision-making for both scalp-cooled and non-scalp-cooled participants. CONCLUSIONS This study provides the first in-depth exploration of patient attitudes to scalp cooling. The results highlight a need for accurate information regarding efficacy and tolerability as well as hair care information to assist patients with their treatment decision-making.
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Tausch AP, Menold N. Methodological Aspects of Focus Groups in Health Research: Results of Qualitative Interviews With Focus Group Moderators. Glob Qual Nurs Res 2016; 3:2333393616630466. [PMID: 28462326 PMCID: PMC5342644 DOI: 10.1177/2333393616630466] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/15/2015] [Accepted: 12/28/2015] [Indexed: 11/17/2022] Open
Abstract
Although focus groups are commonly used in health research to explore the perspectives of patients or health care professionals, few studies consider methodological aspects in this specific context. For this reason, we interviewed nine researchers who had conducted focus groups in the context of a project devoted to the development of an electronic personal health record. We performed qualitative content analysis on the interview data relating to recruitment, communication between the focus group participants, and appraisal of the focus group method. The interview data revealed aspects of the focus group method that are particularly relevant for health research and that should be considered in that context. They include, for example, the preferability of face-to-face recruitment, the necessity to allow participants in patient groups sufficient time to introduce themselves, and the use of methods such as participant-generated cards and prioritization.
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Affiliation(s)
- Anja P Tausch
- GESIS-Leibniz Institute for the Social Sciences, Mannheim, Germany
| | - Natalja Menold
- GESIS-Leibniz Institute for the Social Sciences, Mannheim, Germany
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