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Wan MM, Cristall ND, Cooke LJ. Neurologists' Attitudes and Perceptions on Palliative Care: A Qualitative Study. Neurol Clin Pract 2024; 14:e200322. [PMID: 39166125 PMCID: PMC11332981 DOI: 10.1212/cpj.0000000000200322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/02/2024] [Indexed: 08/22/2024]
Abstract
Background and Objectives Despite significant advances in the treatment of neurologic disorders, many conditions require complex care planning and advanced care planning. Neurologists are in a unique position because they are integral in providing patient centered care, understanding neurologic disease and illness trajectory, and how disease can affect patients' sense of self and values. Currently, little is known about neurologists' perceptions and challenges in care planning and palliative care for their patients. Methods Neurologists from one Canadian academic institution participated in a 30-minute semistructured interview from November 2022 to April 2023. Interviews were conducted until saturation was reached and confirmed. Interviews occurred online through a secure platform or in-person and were recorded. Data were analyzed using a constant comparative method using constructivist grounded theory. Member checking was conducted post interview. Results Ten neurologists participated across a broad spectrum of neurology experience and subspecialties. We developed a detailed theory of understanding neurologists' attitudes and perceptions of palliative care. When neurologists delay or fail to initiate care planning discussions or palliative care, it results from a complex interplay between patient, physician, and resource accessibility factors. Certain contextual factors, such as a first visit or follow-up, inpatient vs outpatient setting, clinic culture, and the type of clinic practice, are factors that can influence these conversations. As a result, physicians may fail to use available resources, or they may involve other care providers or refer to subspecialty neurologic clinics. However, this delay can still lead to patient and provider harm. Opportunities to improve care exist with continuing education opportunities for trainees and staff, collaboration with palliative care specialists, and health systems support, such as increasing public awareness to address misconceptions about palliative care and resource availability. Discussion Our findings identify that failure or delay to initiate care planning and palliative care by neurologists results from a complex interplay between local culture, experience, context, practice type, and patient factors. Opportunities to improve care include increasing educational opportunities, building integrated and collaborative practices, and dedicated health systems support.
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Affiliation(s)
- Miranda M Wan
- Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada
| | - Nora D Cristall
- Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada
| | - Lara J Cooke
- Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada
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Hartley H, Dunning A, Dunn M, Grange A, Murray J, Simms-Ellis R, Unsworth K, Marran J, Lawton R. Managing nurse redeployment during the Covid-19 pandemic, lessons for future redeployment: A qualitative study. Int J Nurs Stud 2024; 157:104828. [PMID: 38865778 DOI: 10.1016/j.ijnurstu.2024.104828] [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: 11/10/2023] [Revised: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The mass redeployment of nurses was critical across countries necessitated by the acute health impact of Covid-19. Knowledge was limited regarding how to manage nurse redeployment or the impact that redeployment might have. Redeployment continues, particularly in response to the current staffing crisis and surges such as winter pressures. This study aims to address these gaps in evidence to inform guidance on how best to manage nurse redeployment in practice. OBJECTIVES First, to understand the processes and underpinning decisions made by managers when managing nurse redeployment prior to and during the Covid-19 pandemic. Second, to identify the lessons that can be learned to improve the management of on-going nurse redeployment. DESIGN Qualitative study utilising semi-structured interviews and focus groups with nurse managers (ISRCTN: 18172749). SETTING(S) Three acute National Health Service (NHS) Trusts in England with geographical and ethnic diversity, and different Covid-19 contexts. PARTICIPANTS Thirty-two nurse managers and four Human Resource advisors responsible for redeploying nurses or receiving and supporting redeployed nurses. METHODS Participants took part in face-to-face or virtual semi-structured interviews from February 2021 to November 2021 and virtual focus groups from July to December 2021. Qualitative data were analysed using reflexive thematic analysis. RESULTS Four themes were evident in the data, capturing four distinctive phases of the redeployment process. There was a fundamental mismatch between how different parts of the nursing and managerial workforce conceived of their decision-making responsibilities across different phases. This led to managers taking inconsistent and sometimes contradictory approaches when redeploying nurses, and a disconnect between nursing staff at all levels of the chain of command. Furthermore, in conjunction with limited guidance in operationalising redeployment and the distressing experiences vocalised by nurses, nurse managers found nurse redeployment logistically and emotionally challenging; and felt 'caught in the middle' of meeting both their managerial and mentoring responsibilities. This became increasingly challenging during subsequent phases of redeployment and remained challenging once the pandemic waned. CONCLUSIONS The approach to nurse redeployment in response to the Covid-19 pandemic prioritised nurse staffing numbers over personal well-being. Key principles of good practice relating to nurse redeployment during the Covid-19 pandemic can be applied to improve future redeployment of nurses and support positive outcomes. Having a planned approach for staff redeployment during normal service delivery comprising operational guidance for those tasked with implementing redeployment, that is scalable in a crisis setting, would be beneficial for the nursing workforce.
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Affiliation(s)
- Hannah Hartley
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK. https://twitter.com/HartleyHL
| | - Alice Dunning
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, University of Sheffield, Sheffield S1 4DA, UK
| | - Michael Dunn
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597.
| | - Angela Grange
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK
| | - Ruth Simms-Ellis
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK
| | - Kerrie Unsworth
- Leeds University Business School, University of Leeds, Leeds LS6 1AN, UK
| | - Jayne Marran
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK; School of Psychology, University of Leeds, Leeds LS2 9JT, UK
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Barboza J, Seedall R, Hooghe A, Kaplow J, Bradshaw S. Forming our grief rhythm: The relational window of tolerance for bereaved parents. FAMILY PROCESS 2024. [PMID: 39142334 DOI: 10.1111/famp.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024]
Abstract
The shared loss of a child can present challenges to couple relationships as both partners attempt to cope with their own grief and their partner's grief. In this longitudinal qualitative study, five bereaved parent couples participated in 13 total interviews, revealing coregulatory interactions surrounding their shared loss. Using thematic coding and grounded theory analysis, their reflections were organized into three interrelated process themes: regulating self, regulating other, and forming our grief rhythm. This article explores the complexity of the last theme "forming our grief rhythm" in-depth, and a new theoretical orientation, the relational window of tolerance, is introduced to examine how couples coregulate both fragile and stable states within their shared grief. The reflections of bereaved parents indicated that prolonged "dual fragile states" and prolonged "imbalanced states" may hinder relationship quality. In order to regain relationship stability, couples learned to trade off supporting one another and/or to resonate with one another in their shared pain. Implications for future research and clinical practice are discussed, focusing especially on how to integrate individual and relational needs into grief therapy frameworks.
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Affiliation(s)
| | | | - An Hooghe
- Center for Relationship and Family Therapy, UZ Leuven, Leuven, Belgium
| | - Julie Kaplow
- Meadows Mental Health Policy Institute, Dallas, Texas, USA
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Lake JD, Barnsley J, Lofters A, Austin Z. A Goffmanian analysis of impact of unclear professional identity and role negotiation of pharmacists in primary care: A multiple case study. Res Social Adm Pharm 2024; 20:768-777. [PMID: 38704302 DOI: 10.1016/j.sapharm.2024.04.016] [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: 03/17/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams. OBJECTIVES This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams. METHODS This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case. RESULTS Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and "not a physician". These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists' professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist. CONCLUSION Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings.
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Affiliation(s)
- Jennifer D Lake
- Leslie Dan Faculty of Pharmacy, University of Toronto, 639 - 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - Janet Barnsley
- Institute of Health Policy Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Aisha Lofters
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, 707 - 144 College Street, Toronto, ON, M5S 3M2, Canada
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Teehan E, Phord-Toy A, Venkatapuram P, Kan KM. Creating a community advisory board for pediatric bladder health. Front Pediatr 2024; 12:1396003. [PMID: 39081924 PMCID: PMC11287218 DOI: 10.3389/fped.2024.1396003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/14/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Pediatric lower urinary tract symptoms (LUTS) are highly prevalent in neurologically healthy school-aged children. However, no evidence-based programs exist to prevent or treat LUTS in the community setting. To address this, we established the first community advisory board (CAB) that aims to identify individual and societal structures impacting pediatric bladder health in Northern California's Bay Area and co-design culturally relevant bladder health interventions. Methods Probability and non-probability sampling methods were used to recruit community stakeholders to the CAB. Our final CAB comprised of two parents, two community health workers, one educator, one pediatric urology registered nurse, and one pediatrician. The CAB met quarterly during the 1-year study period. Results Bi-directional feedback identified community-level barriers to bladder health, particularly in the school environment, and the need for tailored resources to teach children and families about healthy bladder behaviors. Discussion The CAB co-designed school-based bladder health interventions, including bladder health posters, and provided feedback on three school-based research study proposals. The CAB will continue to guide and inform future community-engaged research efforts.
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Affiliation(s)
| | | | | | - Kathleen M. Kan
- School of Medicine, Stanford University, Stanford, CA, United States
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d’Errico M, Giannarelli D, d’Angela D, Pinto C, Polistena B, Spandonaro F. Advancing early access policies for innovative cancer drugs: a scoping review and explorative analysis in the Italian setting. J Pharm Policy Pract 2024; 17:2377697. [PMID: 39015752 PMCID: PMC11251434 DOI: 10.1080/20523211.2024.2377697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Considering the clinical impact of innovative cancer therapies, policy makers strive to balance timely access and thorough value-assessment. While some European countries promoted early access schemes, Italy does not yet display a consolidated strategy for innovative drugs or for medicines targeting pathologies with a high unmet need. Methods To better understand the risks and opportunities of early access strategies that could be applied in the Italian setting, we performed a scoping review, searching the PubMed and Web of Science databases and interviewing two field experts. The review results were complemented with an exemplificative quantitative analysis for a subset of innovative oncology drugs, to assess the clinical and economic impact of the price and reimbursement negotiation. Results Our study suggests that early access schemes developed in Germany and France, combining a free-pricing period, pay-back mechanism, and arbitration, could serve as a basis for developing a feasible strategy in Italy. The quantitative analysis indicated that timely access to innovative drugs could have potentially prevented many cancer progressions, associated with a significant healthcare expenditure. Conclusion Albeit not allowing to express a conclusive assessment, this study proposes a potential early access strategy for Italy and highlights the need for opening a debate on the opportunities and risks of such schemes.
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Affiliation(s)
| | | | | | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Wood A, Hill A, Cottrell N, Copley J. Clinician experience of being interprofessional: an interpretive phenomenological analysis. J Interprof Care 2024:1-15. [PMID: 38989964 DOI: 10.1080/13561820.2024.2371342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/18/2024] [Indexed: 07/12/2024]
Abstract
Clinicians are increasingly required to work and learn interprofessionally, yet few studies explore the nature of being interprofessional. The purpose of this study was to explore the lived experience of clinicians who identify as interprofessional or have an interprofessional identity. Interpretive phenomenological analysis (IPA) was applied as a qualitative research approach and analytical method. Fifteen key informants from a range of professions, settings, and roles were recruited via purposive sampling. Data was collected via semi-structured interviews, observation of participants' day-to-day practice, and review of organizational documents, and analyzed using IPA. Six interdependent Group Experiential Themes were developed: (i) The power of person-centered holistic care, (ii) Learning and growth through curiosity, reflection, and willingness to be vulnerable, (iii) Welcomes, values, and empowers all others, (iv) Trust and mutual respect through belonging and connection, (v) The contribution of background and previous experiences, and (vi) The influence of workplace context. Each Group Experiential Theme had between two and nine sub-themes. Results support the value of understanding and making explicit the concepts that comprise clinician interprofessional identity. The findings can be used to support clinicians, educators, leaders, and policy makers to develop and sustain interprofessional identity, and subsequently cultivate a culture of interprofessional collaborative practice. Future research is needed to further explore the themes, investigate their inter-relationships, and present the concepts that comprise clinician interprofessional identity in a way that is accessible to healthcare professionals and facilitates their integration into practice.
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Affiliation(s)
- Angela Wood
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Anne Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- School of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jodie Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Vella J. In pursuit of credibility: Evaluating the divergence between member-checking and hermeneutic phenomenology. Res Social Adm Pharm 2024; 20:665-669. [PMID: 38575497 DOI: 10.1016/j.sapharm.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
Credibility refers to the trustworthiness, genuineness, and plausibility of the research findings and has always been a contentious issue in qualitative research, particularly for those conducting studies on the hermeneutic phenomenology paradigm. The relationship between credibility and high qualitative research is noted by many qualitative scholars. Member checking, also known as participant or respondent validation, is a technique for exploring the credibility of results where data or results are returned to participants to check for accuracy and resonance with their experiences. Although member-checking has long been accepted as the gold standard in quantitative research, research shows that it is not the pinnacle for expressing rigor in Heideggerian hermeneutic phenomenology because it contradicts many of the underpinning philosophies. Within this article the author explores how member checking has been used in published research and presents a brief overview of the various discourses on member checking in qualitative research. The author discusses the importance of evaluating whether the method fits with the theoretical position of a study and the importance to consider how member checking was undertaken and for what purpose. It is essential that researchers are transparent about what they hope to achieve with the method and how their claims about credibility and validity fit with their epistemological stance.
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Samuelson S, Pennbrant S, Svensson A, Svenningsson I. Standing together at the helm - how employees experience employee-driven innovation in primary care. BMC Health Serv Res 2024; 24:655. [PMID: 38778370 PMCID: PMC11110197 DOI: 10.1186/s12913-024-11090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Primary care needs to find strategies to deal with today's societal challenges and continue to deliver efficient and high-quality care. Employee-driven innovation is increasingly gaining ground as an accessible pathway to developing successful and sustainable organisations. This type of innovation is characterised by employees being engaged in the innovation process, based on a bottom-up approach. This qualitative study explores employees' experiences of employee-driven innovation at a primary care centre in Sweden. Data are collected by focus group interviews and analysed by inductive qualitative content analysis. The result is presented with the overarching theme "Standing together at the helm" followed by three categories: "Motivating factors for practising employee-driven innovation", "Challenges in practising employee-driven innovation" and "Benefits of employee-driven innovation", including nine subcategories. The study found that employee-driven innovation fosters organisational innovation, empowers employees, and enhances adaptability at personal and organisational levels. This enables individual and collective learning, and facilitates the shaping, development, and adaptation of working methods to meet internal and external requirements. However, new employees encountered difficulty grasping the concept of employee-driven innovation and recognising its long-term advantages. Additionally, the demanding and task-focused environment within primary care posed challenges in sustaining efforts in innovation work. The employees also experienced a lack of external support to drive and implement some innovative ideas.
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Affiliation(s)
- Sarah Samuelson
- Region Västra Götaland, Research, Education, Development & Innovation (REDI), Primary Health Care, Sweden.
- University West, School of Business, Economics and IT, Trollhättan, 461 86, Sweden.
- General Practice, Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Sandra Pennbrant
- University West, Department of Health Sciences, Trollhättan, 461 86, Sweden
| | - Ann Svensson
- University West, School of Business, Economics and IT, Trollhättan, 461 86, Sweden
| | - Irene Svenningsson
- Region Västra Götaland, Research, Education, Development & Innovation (REDI), Primary Health Care, Sweden
- General Practice, Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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King E, Gustafson O, Williams A, Vollam S, Williams MA. Musculoskeletal impairments after critical illness: A protocol for a qualitative study of the experiences of patients, family and health care professionals. Nurs Crit Care 2024; 29:622-627. [PMID: 37642162 DOI: 10.1111/nicc.12972] [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: 07/25/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Survivors of critical care are at risk of long-term disability from musculoskeletal (MSK) impairments. These can have a biopsychosocial impact on the patient and their families with a reduction in health-related quality of life, increased health care utilization, caregiving roles and associated psychological distress. AIMS To understand the experiences of patients living with MSK impairments following critical illness, and family and health care professionals supporting them, to inform the development of a future intervention to improve MSK health following critical illness. STUDY DESIGN A four-site qualitative case study approach will be taken, with each of the four hospital sites and associated community services representing a case site. We will conduct semi-structured interviews with 10-15 patients/family members and 10-15 health care professionals about their experiences of MSK impairment following critical illness. Interviews will be audio recorded, transcribed verbatim and analysed using reflexive thematic analysis within a descriptive phenomenological approach. Alongside interview data, analysis of publicly available policy documentation, patient-facing materials and information from service leads at the four sites will be conducted. Discourse analysis will be used for this case study documentation. RESULTS This protocol describes a qualitative study exploring the experiences of patients living with MSK impairments following critical illness, and the family and health care professionals supporting them. RELEVANCE TO CLINICAL PRACTICE Data analysis will illuminate their experiences and enable data richness to contribute to the qualitative body of evidence of intensive care unit (ICU) survivors. These findings will inform the development of a complex intervention for MSK rehabilitation after critical illness.
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Affiliation(s)
- Elizabeth King
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Allied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Owen Gustafson
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Allied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Annabel Williams
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Allied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Institute of Allied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Mark A Williams
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Allied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Thomson H, Prospero LD, Xiao S, Legere L, Harth T, Rashleigh L, Parzanese M, Graves L, Wilcocks K, Alam F. Experiencing COVID-19 Through the Patient Lens to Promote Empathy: Pilot Testing a Virtual Reality Learning Opportunity. J Patient Exp 2024; 11:23743735241241462. [PMID: 38665326 PMCID: PMC11044778 DOI: 10.1177/23743735241241462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Understanding the patient's experience with COVID-19 was essential to providing high-quality, person-centered care during the pandemic. Having empathy or being able to understand and respond to the patient's experience may lead to improved outcomes for both patients and clinicians. There is mixed evidence about how best to teach empathy, particularly related to promoting empathy during COVID-19. Literature suggests that virtual reality may be effective in empathy-related education. In collaboration with four patient partners with lived experience, a 360° VR video was developed reflecting their stories and interactions with the healthcare system. The aim of this study was to pilot test the video with interprofessional healthcare providers (HPs) to explore acceptability and utility, while also seeking input on opportunities for improvement. Eleven HPs reviewed the video and participated in one of three focus groups. Focus group data were analyzed using thematic analysis. Data suggest that video content is acceptable and useful in promoting a better understanding of the patient's experience. Building on these encouraging findings, additional iterations of videos to promote empathy will be developed and tested.
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Affiliation(s)
- Heather Thomson
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa Di Prospero
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Xiao
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Laurie Legere
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tamara Harth
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Laura Rashleigh
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maria Parzanese
- Practice-Based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Kyle Wilcocks
- Department of Anesthesiology & Pain Medicine, Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Fahad Alam
- Department of Anesthesiology & Pain Medicine, Temerty Faculty of Medicine, Toronto, ON, Canada
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Chiappinotto S, Igoumenidis M, Galazzi A, Kokic A, Palese A. Between mandatory and aspirational ethics in nursing codes: a case study of the Italian nursing code of conduct. BMC Nurs 2024; 23:30. [PMID: 38200503 PMCID: PMC10777559 DOI: 10.1186/s12912-024-01697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Over the years, national and international nurses' organisations have drawn up Codes of Conduct and Codes of Ethics. A new differentiation has emerged over time between mandatory and aspirational approaches underlying how nurses can be supported by documents with rules to be respected (mandatory ethics) or by incentives (aspirational ethics). However, to date, no research has applied these approaches to analyse available Codes and to identify which approach are predominantly used. METHODS In this case study, the Italian Nursing Code of Conduct (NCC), published in 2019, composed of 53 articles distributed in eight chapters, was first translated, and then analysed using a developed matrix to identify the articles that refer to mandatory or aspirational ethics. A nominal group technique was used to minimise subjectivity in the evaluation process. RESULTS A total of 49 articles addressing the actions of the individual nurse were considered out of 53 composing the NNC. Articles were broken down into 97 units (from one to four for each article): 89 units (91.8%) were attributed to a unique category, while eight (8.2%) to two categories according to their meaning. A total of 38 units (39.2%) were categorised under the mandatory ethics and 58 (59.8%) under the aspirational ethics; however, one (1.0%) reflected both mandatory and aspirational ethics. CONCLUSIONS According to the findings, the Italian Professional Body (FNOPI) has issued a modern code for nursing professionals in which an aspirational perspective is dominant offering a good example for other nursing organisations in the process of updating their codes when aimed at embodying an aspirational ethics.
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Affiliation(s)
| | | | | | - Andjela Kokic
- Department of Medicine, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
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Verburgh M, Verdonk P, Muntinga M, van Valkengoed I, Hulshof C, Nieuwenhuijsen K. "But at a certain point, the lights literally went out": A qualitative study exploring midlife women's experiences of health, wellbeing, and functioning in relation to paid work. Work 2024; 77:799-809. [PMID: 37781836 DOI: 10.3233/wor-220567] [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] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND In the Netherlands, the fact that midlife women constitute a considerable segment of the working population is relatively new. Generally paid work contributes to midlife women's wellbeing, but they also report health challenges, such as work-related fatigue and the menopause. OBJECTIVE The objective of this study is to understand how midlife women themselves perceive their health, wellbeing, and functioning in relation to paid work. METHODS In this exploratory qualitative study, 28 women participated in five ethnically homogeneous focus group discussions (FGDs). De FGDs were recorded, transcribed verbatim, and thematically analyzed using MAXQDA. RESULTS We identified exhaustion as central to our analysis. During midlife, exhaustion seems to occur once a certain limit has been reached, both physically and mentally, with women feeling to have reached the end of their rope. Besides obvious physiological challenges, we identified two major themes in which we discuss challenges both in paid work and private life: (1) work environment and working conditions, and (2) burdens in private life. Participants took various measures to manage and try to reduce exhaustion, including finding a new job or negotiating different job tasks, and reducing work hours. CONCLUSION This study indicates that the extent to which women experience exhaustion is associated with challenges in both paid work and private life. The underlying processes do not seem to reflect individual problems, but reflect a complex set of factors at the structural level. Nevertheless, women take several individual measures to reduce their exhaustion, including reducing their participation in paid work.
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Affiliation(s)
- Marjolein Verburgh
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Petra Verdonk
- Department of Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, Amsterdam, The Netherlands
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, Amsterdam, The Netherlands
| | - Irene van Valkengoed
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carel Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Nieuwenhuijsen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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de Loyola González-Salgado I, Rivera-Navarro J, Gutiérrez-Sastre M, Conde P, Franco M. Conducting member checking within a qualitative case study on health-related behaviours in a large European city: Appraising interpretations and co-constructing findings. Health (London) 2024; 28:3-21. [PMID: 35822544 DOI: 10.1177/13634593221109682] [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] [Indexed: 11/16/2022]
Abstract
Although member checking is a well-established strategy for appraising credibility, there is a lack of research reporting procedures and outcomes when using this strategy. In recent years, scholars have implemented new member checking strategies along with several epistemological stances. In this work, researchers conducted member checking in three neighbourhoods with different socioeconomic status in Madrid, Spain. Attendance at member checking meetings was lower than expected. Member checking meetings were conducted in public halls within each neighbourhood and lasted approximately 2 hours. During the first hour, researchers introduced the aim of the meetings and shared summarized research findings with attendees using a slideshow. During the second hour, attendees had the opportunity to comment on any aspect of the research. Researchers used grounded theory coding strategies and a constructivist approach informed the analysis of the transcribed member checking meetings. One core category emerged, and it was named 'Co-constructing findings and side effects of the interaction between researchers and participants in member checking'. Member checking attendees contributed to co-constructing findings by means of underscore and disagreement. It is possible that these meetings might have caused side effects such as unintended comparisons between neighbourhoods and negative health-related behaviours. Attendees wondered how the findings could improve their neighbourhoods. The meetings allowed interaction between participants and researchers and resulted in appraising and co-constructing qualitative research findings. More research is needed to advance knowledge about member checking.
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Affiliation(s)
| | | | | | | | - Manuel Franco
- University of Alcalá, Spain
- City University of New York, USA
- Johns Hopkins Bloomberg School of Public Health, USA
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Fonda F, Galazzi A, Chiappinotto S, Justi L, Frydensberg MS, Boesen RL, Macur M, Reig EA, Espaulella ER, Palese A. Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study. Healthcare (Basel) 2023; 12:16. [PMID: 38200922 PMCID: PMC10778608 DOI: 10.3390/healthcare12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.
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Affiliation(s)
- Federico Fonda
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Alessandro Galazzi
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Stefania Chiappinotto
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Linda Justi
- Health Innovation Centre of Southern Denmark, Forskerparken 10, 5230 Odense, Denmark; (L.J.); (M.S.F.); (R.L.B.)
| | | | - Randi Lehmann Boesen
- Health Innovation Centre of Southern Denmark, Forskerparken 10, 5230 Odense, Denmark; (L.J.); (M.S.F.); (R.L.B.)
| | - Mirna Macur
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270 Jesenice, Slovenia;
| | - Erik Andrés Reig
- TIC Salut Social, Carrer de Roc Boronat 81, 08005 Barcelona, Catalonia, Spain; (E.A.R.); (E.R.E.)
| | | | - Alvisa Palese
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
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Thomsen EL, Hanghøj S, Esbensen BA, Hansson H, Boisen KA. Parents' views on and need for an intervention during their chronically ill child's transfer to adult care. J Child Health Care 2023; 27:680-692. [PMID: 35481769 DOI: 10.1177/13674935221082421] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents of chronically ill adolescents play a significant role during their child's transition and transfer to adult care. Parents seek help and support, but appropriate initiatives are still lacking. Thus, there is an urgent call for knowledge regarding parents' needs and views on such support. The aim of this study was to examine, in relation to parents of chronically ill adolescents: 1) views and experiences regarding their child's transfer from paediatric to adult care, and 2) which initiatives parents preferred in relation to the transfer. The study was based on the interpretive description method, and data were collected through face-to-face or telephone interviews with parents of chronically ill adolescents aged 16-19 (n = 11). We found three overall findings: 'Feeling acknowledged vs. feeling excluded', 'Perceived differences between paediatric and adult care' and 'Feeling safe vs. entering the unknown', together with three preferred initiatives: 1) Joint consultations, 2) Educational events and 3) Online support/website. In general, we found that some parents were extremely worried about the transfer, while others were not. Our results suggest that transfer initiatives targeting parents should focus on knowledge, expectations, relationships and goals in accordance with the social-ecological model of adolescent and young adult readiness to transition (SMART).
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Affiliation(s)
- Ena L Thomsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Signe Hanghøj
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bente A Esbensen
- Center of Rheumatology and Spine Disorders, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helena Hansson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kirsten A Boisen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
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Cheung L, Chiang J, Kaiser A, Patterson KK, Musselman KE. Exploring the Experiences and Perceptions of Adults With Spinal Cord Injury or Disease Aged 50 Years or Older on Participation in Sports. Top Spinal Cord Inj Rehabil 2023; 29:37-50. [PMID: 38076497 PMCID: PMC10704220 DOI: 10.46292/sci23-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Sports are physical activities that provide physical, psychological, and social benefits for individuals with spinal cord injury/disease (SCI/D). However, most sports research has been completed on individuals with SCI/D who are aged >50 years, even though the majority of people with SCI/D are aged >50 years. Despite substantial evidence supporting sports for older adults not living with a disability, there is currently no research examining the impact of sports for adults with SCI/D aged ≥50 years. Objectives To explore the perceptions and experiences of individuals with SCI/D aged 50 years or older who participate in sports in the community. Methods Fifteen adults with SCI/D aged ≥50 years who participated in community-based sports were interviewed. Interviews were audio-recorded and transcribed verbatim. Conventional content analysis was applied to the data. Results The overarching theme identified was that sports are fun and adaptable physical activities that have the potential to optimize physical, psychological, and social health in all people with SCI/D, regardless of age. Within this overarching theme, six categories surfaced: (1) importance of participating in sports later in life, (2) prioritizing health over performance, (3) uncertainties about participating in sports later in life, (4) reflections on participating in sports later in life, (5) beliefs on alternative sports involvement, and (6) advice for other aging adults with SCI/D considering sports. Conclusion Sports are perceived to provide physical, psychological, and social benefits for individuals with SCI/D aged 50 years or older. Findings will inform the development of future adaptive sports programs for older individuals with SCI/D.
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Affiliation(s)
- Lovisa Cheung
- 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
| | - Jessica Chiang
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anita Kaiser
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kara K. Patterson
- 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
| | - 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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Sahay S, Dwyer M. I Am Not a 'Hero': U.S. Nurses' Identity Overlaps and Conflict During COVID-19. HEALTH COMMUNICATION 2023; 38:2537-2548. [PMID: 35729746 DOI: 10.1080/10410236.2022.2088021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The current COVID-19 pandemic exemplifies a crisis that is redefining the meaning of communication for many. Metaphors like the "hero" trope are being used to represent our frontline employees, such as nurses who work directly with COVID-19 patients. However, we know very little about how these tropes influence the identities of these nurses and how it impacts their work. This article draws on social identity theory and key works related to role and identity conflict to look at nurses' perceptions of the hero trope being used to define them during this crisis. The study involved 23 semi-structured interviews with nurses from the United States who were working with COVID-19 patients. Nurses described how, due to COVID-19-especially in light of the hero trope - multiple identities became salient during the pandemic. Many of the identity overlaps were minimized during this time as the trope modified the meaning of how some norms around these different sub-identities were understood. This also highlights the role of communication in shaping and modifying group identity norms during crises, thus suggesting an integration of SIT with the constructivist or even some level of poststructural perspective. As a consequence of the pandemic and the minimized overlaps between the identities, nurses felt more self-doubt or failure, which impacted their overall psychological well-being as well as their efficacy at work. Nurses used communication strategies such as providing reminders, separating myth from reality, and directly approaching their managers, to cope with the identity conflicts.
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Affiliation(s)
- Surabhi Sahay
- Corporate Communication, Pennsylvania State University-Abington
| | - Maria Dwyer
- School of Communication and Information (Ret.), Rutgers University
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19
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Trinkley KE, Dafoe A, Malone DC, Allen LA, Huebschmann A, Khazanie P, Lunowa C, Matlock DC, Suresh K, Rosenberg MA, Swat SA, Sosa A, Morris MA. Clinician challenges to evidence-based prescribing for heart failure and reduced ejection fraction: A qualitative evaluation. J Eval Clin Pract 2023; 29:1363-1371. [PMID: 37335624 PMCID: PMC11075805 DOI: 10.1111/jep.13885] [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: 03/16/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Reasons for suboptimal prescribing for heart failure with reduced ejection fraction (HFrEF) have been identified, but it is unclear if they remain relevant with recent advances in healthcare delivery and technologies. This study aimed to identify and understand current clinician-perceived challenges to prescribing guideline-directed HFrEF medications. METHODS We conducted content analysis methodology, including interviews and member-checking focus groups with primary care and cardiology clinicians. Interview guides were informed by the Cabana Framework. RESULTS We conducted interviews with 33 clinicians (13 cardiology specialists, 22 physicians) and member checking with 10 of these. We identified four levels of challenges from the clinician perspective. Clinician level challenges included misconceptions about guideline recommendations, clinician assumptions (e.g., drug cost or affordability), and clinical inertia. Patient-clinician level challenges included misalignment of priorities and insufficient communication. Clinician-clinician level challenges were primarily between generalists and specialists, including lack of role clarity, competing priorities of providing focused versus holistic care, and contrasting confidence regarding safety of newer drugs. Policy and system/organisation level challenges included insufficient access to timely/reliable patient data, and unintended care gaps for medications without financially incentivized metrics. CONCLUSION This study presents current challenges faced by cardiology and primary care which can be used to strategically design interventions to improve guideline-directed care for HFrEF. The findings support the persistence of many challenges and also sheds light on new challenges. New challenges identified include conflicting perspectives between generalists and specialists, hesitancy to prescribe newer medications due to safety concerns, and unintended consequences related to value-based reimbursement metrics for select medications.
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Affiliation(s)
- Katy E. Trinkley
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- University of Colorado Health, Denver, Colorado, USA
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel C. Malone
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
| | - Larry A. Allen
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Prateeti Khazanie
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cali Lunowa
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel C. Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Geriatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Colorado, USA
| | - Krithika Suresh
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Michael A. Rosenberg
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stanley A. Swat
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Aracely Sosa
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan A. Morris
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Boltey E, Iwashyna T, Cohn A, Costa D. Identifying the unique behaviors embedded in the process of interprofessional collaboration in the ICU. J Interprof Care 2023; 37:857-865. [PMID: 37086195 DOI: 10.1080/13561820.2023.2202218] [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: 06/30/2022] [Revised: 02/16/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
Interprofessional collaboration (IPC) is an important aspect of high-quality care in intensive care units (ICUs). The practice of IPC, however, is complex and the components that constitute IPC are not well defined. We sought to identify distinct behaviors embedded in clinician workflow that indicate engagement in the IPC process. We conducted a clinical ethnography in two ICUs in southeastern Michigan. From March 2017 to March 2019, we collected 31 hours of observations and completed 12 separate clinician shadowings and 12 interviews with ICU nurses, physicians, and respiratory therapists. We applied an iterative analytical approach to identify two types of IPC behaviors which we a priori labeled as "enablers" (i.e. the ways clinicians transition into or facilitate collaboration) and "collaborative activities" (i.e. behaviors clinicians use to directly collaborate with other professionals). 18 IPC behaviors were identified - ten "enablers" and eight "collaborative activities." Specifically, the enablers include: active listening, approach, coordinating work, intraprofessional consultation, invitation, nonverbal accessibility, reflexive questioning, sending pages/call, validation, and verbal accessibility. The collaborative activities are: correction, fill in the gap, information exchange, negotiation, providing help, socializing, teaching/training, and troubleshooting. By identifying IPC behaviors embedded in clinician workflow, our results may support more focused assessments of IPC in practice and guide clinicians toward behaviors they can use to engage in the IPC process.
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Affiliation(s)
- Emily Boltey
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Theodore Iwashyna
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
| | - Amy Cohn
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Deena Costa
- School of Nursing, Yale University, New Haven, CT
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT
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Drewitt-Smith L, Marczak M. Men's Experiences of Self-Conscious Emotions Following Childhood Sexual Abuse. JOURNAL OF CHILD SEXUAL ABUSE 2023; 32:674-693. [PMID: 37555335 DOI: 10.1080/10538712.2023.2244950] [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: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023]
Abstract
Rates of detection and disclosure of childhood sexual abuse (CSA) are believed to be lower in males due to gender socialization fears. The experience of CSA is thought to increase negative self-conscious emotions (shame, guilt, embarrassment, anger, and fear). Such self-conscious emotions have been associated with a range of mental and public health issues. As there has been no research to date that has explored the experience of shame and guilt within the wider context of self-conscious emotional states for males, this research aimed to explore men's experiences of self-conscious emotions following CSA. Nine semi-structured interviews with males were completed. Interpretative Phenomenological Analysis identified three themes: "Invisible In This World" captures participants' isolating circumstances surrounding their CSA, and how this impacted their perception of not being protected or able to speak out; "The Emotional Fallout" describes the overwhelming emotions experienced as a result of the CSA and how such emotions have impacted participants lives, and "Learning To Live With The Wound That May Never Heal" addresses how participants have spent their lives living with the abuse and how it's a process to learn how to adapt and live with the abuse. Findings suggest there is a clear need to recognize the role and power of self-conscious emotions in male CSA, especially for healthcare professionals and services supporting males with CSA. Without addressing such self-conscious emotions, males who have experienced CSA are at risk of enduring the emotional fallout throughout their lives.
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Affiliation(s)
- Leah Drewitt-Smith
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - Magda Marczak
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Vargas C, Whelan J, Feery L, Greenslade D, Farrington M, Brimblecombe J, Thuruthikattu F, Allender S. Developing Co-Creation Research in Food Retail Environments: A Descriptive Case Study of a Healthy Supermarket Initiative in Regional Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6077. [PMID: 37372664 PMCID: PMC10298708 DOI: 10.3390/ijerph20126077] [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: 03/23/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.
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Affiliation(s)
- Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (J.W.)
| | - Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (J.W.)
| | - Louise Feery
- Ballarat Community Health, Ballarat, VIC 3350, Australia; (L.F.); (D.G.); (M.F.)
| | - Deborah Greenslade
- Ballarat Community Health, Ballarat, VIC 3350, Australia; (L.F.); (D.G.); (M.F.)
| | - Melissa Farrington
- Ballarat Community Health, Ballarat, VIC 3350, Australia; (L.F.); (D.G.); (M.F.)
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia;
| | | | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (J.W.)
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Vargas C, Brimblecombe J, Allender S, Whelan J. Co-creation of health-enabling initiatives in food retail: academic perspectives. BMC Public Health 2023; 23:953. [PMID: 37231441 DOI: 10.1186/s12889-023-15771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Co-creation of healthy food retail comprises the systematic collaboration between retailers, academics and other stakeholders to improve the healthiness of food retail environments. Research into the co-creation of healthy food retail is in its early stages. Knowledge of the roles and motivations of stakeholders in intervention design, implementation and evaluation can inform successful co-creation initiatives. This study presents academic experiences of stakeholder roles and motivations in the co-creation of healthy food retail environments. METHODS Purposive sampling of academics with research experience in the co-creation of healthy food retail initiatives. Semi-structured interviews conducted between October and December 2021 gathered participants' experiences of multi-stakeholder collaborative research. Thematic analysis identified enablers, barriers, motivations, lessons and considerations for future co-creation of healthy food retail. RESULTS Nine interviewees provided diverse views and applications of co-creation research in food retail environments. Ten themes were grouped into three overarching areas: (i) identification of stakeholders required for changes to healthier food retail; (ii) motivations and interactions, which included the intrinsic desire to build healthier communities along with recognition of their work; and (iii) barriers and enablers included adequate resourcing, effective and trusting working relationships and open communications. CONCLUSION This study provides insights that could help future co-creation in healthy food retail environments. Trusting and respectful relationships and reciprocal acknowledgement between stakeholders are key practices in the co-creation process. These constructs should be considered in developing and testing a model that helps to systematically co-create healthy food retail initiatives that ensure all parties meet their needs while also delivering research outcomes.
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Affiliation(s)
- Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
- , Locked Bag 20000, Geelong, VIC, 3220, Australia.
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University Clayton, Clayton, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
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Chen L, Vivekananda K, Guan L, Reupert A. Parenting and family experiences of Chinese fathers with mental illness. J Psychiatr Ment Health Nurs 2023; 30:267-277. [PMID: 35993891 DOI: 10.1111/jpm.12867] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Having a mental illness may undermine men's self-image as a father while having children may facilitate their recovery. Many fathers who experience mental health issues experience stigma and are reluctant to seek support in their parental role. Most studies in this field focus on fathers from Western countries. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Similar to Western fathers, Chinese fathers reported both negative parenting (parenting disengagement, harsh parenting and inconsistent discipline) and positive father-child interactions when ill. Unlike their Western counterparts, Chinese fathers relied on extended family support in their parenting role, though this support was problematic at times. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research helps mental health nurses understand the experiences of Chinese fathers with mental illness. Findings suggest that specific cultural adaptions to family-focused interventions are needed for the Chinese context including considering extended family members (e.g. grandparents). ABSTRACT INTRODUCTION: Parenting roles are important for those with a mental illness. While research on mothers is well established there is scant focus on fathers with mental illness, especially in non-Anglophone countries. AIM To better understand the parenting and family experiences of fathers, who have a mental illness, from the People's Republic of China. METHOD Qualitative semi-structured interviews were conducted with nine Chinese fathers with mental illness, using Interpretative Phenomenological Analysis. RESULTS Seven superordinate themes were identified: (i) mental illness undermines idealized images of fatherhood; (ii) parenting in the context of mental illness; (iii) concerns about the negative impact of their illness on children; (iv) children as a burden and a source of hope; (v) stigma; (vi) relying on family support; and (vii) unmet professional and peer support needs. DISCUSSION Chinese fathers held a gendered image of fatherhood, and experienced self-stigma for not living up to their ideal sense of fatherhood, which resulted in a reluctance to seek support. This study adds to the existing literature by focusing on Chinese fathers. Although many of their experiences are similar to fathers from Western countries, some differences were found, notably around a reliance on extended family support. IMPLICATIONS FOR PRACTICE Nurses and other mental health professionals need to adopt a family-focused, culturally informed approach to supporting Chinese fathers with mental illness and their families.
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Affiliation(s)
- Lingling Chen
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Kitty Vivekananda
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Lili Guan
- National Clinical Research Centre for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
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Dyer TA, Chapple B. 'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements. Br Dent J 2023; 234:527-533. [PMID: 37059783 DOI: 10.1038/s41415-023-5688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 04/16/2023]
Abstract
Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.
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Affiliation(s)
- Thomas A Dyer
- Senior Clinical Teacher, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK.
| | - Briana Chapple
- Academic Development Adviser, Academic Development Team, The Elevate Hub, University of Sheffield, 210 Portobello, Sheffield, S1 4AE, UK
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Co-creation Approach in Practice: Naming a Cafe Located within a Rural Health Service Provides Added Value to a Health Strategy. ADVANCES IN PUBLIC HEALTH 2023. [DOI: 10.1155/2023/9989552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Objective. The Victorian Government in Australia has developed Healthy Choices guidelines to ensure that healthy foods and drinks are offered and promoted in places such as hospitals. This brief report aims to present complex theoretical attributes related to cocreation through an accessible example of a competition to create a new name for the previously understated hospital “kiosk.” Methods. A mixed-methods approach using an online survey and semistructured interviews were used to obtain detailed insights from hospital staff members to engage in a naming competition for a hospital-based cafe. Results. The level of engagement in this activity was higher than anticipated by the management staff. Conclusions. Active involvement of staff members through a cocreation process can enable the development of innovative healthy eating strategies and increase staff engagement to further changes in the cafe. Implications for public health cocreation in public health promises effective stakeholder engagement and requires significant scientific advancement. This brief report illustrates theoretical constructs of cocreation through a naming competition activity that occurred as part of a larger project to improve Wimmera Base Hospital’s food environment.
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Brunt MW, Weary DM. Perceptions of laboratory animal veterinarians regarding institutional transparency. Anim Welf 2023; 32:e32. [PMID: 38487423 PMCID: PMC10936364 DOI: 10.1017/awf.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
Institutions using animals for research typically have a veterinarian who is responsible for the veterinary care programme and compliance with regulatory obligations. These veterinarians operate at the interface between the institution's animal research programme and senior management. Veterinarians have strong public trust and are well positioned to share information about animals used for scientific purposes, but their perspectives on sharing information with the public are not well documented and their perceptions of transparency may influence how institutional policies are developed and applied. The objective of our study was to analyse the perceptions of institutional transparency among laboratory animal veterinarians working at different universities. Semi-structured, open-ended interviews were used to describe perceptions of 16 attending veterinarians relating to animal research transparency. Three themes were drawn from the interviews: (i) reflections on transparency; (ii) reflections on culture; and (iii) reflections on self. Veterinarians reflected on their personal priorities regarding transparency and when combined with barriers to change within the institutions, sometimes resulted in reported inaction. For example, sometimes veterinarians chose not to pursue available opportunities for change at seemingly willing universities, while others had their initiatives for change blocked by more senior administrators. The sharing of information regarding the animals used for scientific purposes varied in how it was conceptualised by attending veterinarians: (i) true transparency; communication of information for the sake of openness; (ii) strategic transparency; attempt to educate people about animal research because then they will support it; (iii) agenda-driven transparency; selective release of positive stories to direct public opinion; and (iv) fearful non-transparency; not communicating any information for fear of negative opposition to animal research. Transparency was not perceived as an institutional priority by many of the veterinarians and a cohesive action plan to increase transparency that involves multiple universities was identified as a promising avenue to overcome existing barriers.
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Affiliation(s)
- Michael W Brunt
- Animal Welfare Program, Faculty of Food and Land Systems, The University of British Columbia, Vancouver, British Columbia Canada, V6T 1Z6
| | - Daniel M Weary
- Animal Welfare Program, Faculty of Food and Land Systems, The University of British Columbia, Vancouver, British Columbia Canada, V6T 1Z6
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Ter Wal N, van Ewijk L, Dijkhuis L, Visser-Meily JMA, Terwee CB, Gerrits E. Everyday Barriers in Communicative Participation According to People With Communication Problems. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1033-1050. [PMID: 36787154 DOI: 10.1044/2022_jslhr-22-00405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE The purpose of this study was to gain a comprehensive understanding of participation situations that are challenging for people with communication problems, to provide input for the further development of potential items for the Communicative Participation Item Bank (CPIB). METHOD A purposive sampling strategy was used to include a diverse group of people with communication problems. Diaries were used as a sensitizing exercise for inductive in-depth interviews. In these interviews, elements of communicative participation situations (concepts) were elicited that participants themselves experienced as difficult because of their communication problem. A thematic content analysis was used to identify overarching themes. In addition, new items were formulated based on the raw codes of the transcripts and linked to the International Classification of Functioning, Disability and Health Activity and Participation domains to examine the distribution of items across the breadth of the construct of communicative participation. RESULTS Eighteen interviews yielded 44 different concepts. They were clustered in six themes, which capture the person, location, topic, mode, moment, and pace of communication. In total, 103 new items measuring communicative participation were formulated. Most of these items relate to International Classification of Functioning, Disability and Health Activity and Participation domains "interpersonal interactions and relationships," "major life areas," and "community, social, and civic life." CONCLUSIONS This study resulted in an overview of self-reported barriers in daily communicative participation experienced by people with communication problems. These communicative participation situations can be captured within 44 concepts, which are covered by six themes. Future work should investigate if the newly written items can be added to the CPIB. The concepts and the themes can be used in designing and delivering a participation-focused intervention for this population.
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Affiliation(s)
- Nicole Ter Wal
- Research Centre Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Department of Languages, Literature and Communication, Institute for Language Sciences (ILS), Utrecht University, the Netherlands
| | - Lizet van Ewijk
- Research Centre Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
| | - Lotti Dijkhuis
- Research Centre Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and Utrecht University, and De Hoogstraat Rehabilitation, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Ellen Gerrits
- Research Centre Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, the Netherlands
- Department of Languages, Literature and Communication, Institute for Language Sciences (ILS), Utrecht University, the Netherlands
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Vaccarino F, Vaccarino Z, Armstrong D, Borkin E, Hewitt A, Oswin A, Quick C, Smith E, Glew A. Self-advocates with Down syndrome research the lived experiences of COVID-19 lockdowns in Aotearoa New Zealand. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:300-309. [PMID: 36458448 PMCID: PMC9877824 DOI: 10.1111/jar.13059] [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] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/25/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Individuals with Down syndrome are particularly vulnerable to COVID-19 because they are recognised as significantly immunocompromised. Yet their voices regarding their lived experiences of pandemic lockdowns have not been sought or heard. AIM This study aims to describe the lived experiences of people with Down syndrome during the pandemic lockdowns in Aotearoa New Zealand to add evidence in order to inform systemic advocacy. METHOD A mixed-methods approach positioned within an inclusive research paradigm was used, in which a group of self-advocates with Down syndrome co-designed a structured interview schedule and conducted 40 face-to-face interviews. Key themes were identified by using content analysis. RESULTS Despite the difficulties associated with lockdowns and participants not receiving their usual supports and having to make significant adjustments, they remained positive, adapted well, and demonstrated a high level of resilience and adaptability. CONCLUSIONS The findings add to the limited research on the lived experiences of people with Down syndrome during pandemic lockdowns. This research has given them a voice to contribute to policy, government initiatives, and service providers; particularly on issues around support during lockdown and staying connected with others.
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Affiliation(s)
- Franco Vaccarino
- School of Communication, Journalism and Marketing, Massey University, Manawatū campusPalmerston NorthAotearoaNew Zealand
| | - Zandra Vaccarino
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Duncan Armstrong
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Edward Borkin
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Alexandra Hewitt
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Andrew Oswin
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Caroline Quick
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Erin Smith
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
| | - Averill Glew
- New Zealand Down Syndrome AssociationAucklandAotearoaNew Zealand
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Liberman AL, Holl JL, Romo E, Maas M, Song S, Prabhakaran S. Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis. Acad Emerg Med 2023; 30:187-195. [PMID: 36565234 DOI: 10.1111/acem.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To date, many emergency department (ED)-based quality improvement studies and interventions for acute stroke patients have focused on expediting time-sensitive treatments, particularly reducing door-to-needle time. However, prior to treatment, a diagnosis of stroke must be reached. The ED-based stroke diagnostic process has been understudied despite its importance in assuring high-quality and safe care. METHODS We used a learning collaborative to conduct a failure modes, effects, and criticality analysis (FMECA) of the acute stroke diagnostic process at three health systems in Chicago, IL. Our FMECA was designed to prospectively identify, characterize, and rank order failures in the systems and processes of care that offer opportunities for redesign to improve stroke diagnostic accuracy. Multidisciplinary teams involved in stroke care at five different sites participated in moderated sessions to create an acute stroke diagnostic process map as well as identify failures and existing safeguards. For each failure, a risk priority number and criticality score were calculated. Failures were then ranked, with the highest scores representing the most critical failures to be targeted for redesign. RESULTS A total of 28 steps were identified in the acute stroke diagnostic process. Iterative steps in the process include information gathering, clinical examination, interpretation of diagnostic test results, and reassessment. We found that failure to use existing screening scales to identify patients with large-vessel occlusions early on in their ED course ranked highest. Failure to obtain an accurate history of the index event, failure to suspect acute stroke in triage, and failure to use established stroke screening tools at ED arrival to identify potential stroke patients were also highly ranked. CONCLUSIONS Our study results highlight the critical importance of upstream steps in the acute stroke diagnostic process, particularly the use of existing tools to identify stroke patients who may be eligible for time-sensitive treatments.
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Affiliation(s)
- Ava L Liberman
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Jane L Holl
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Elida Romo
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Matthew Maas
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Sarah Song
- Department of Neurology, Rush University, Chicago, Illinois, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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Weijers M, Boumans N, van der Zwet J, Feron F, Bastiaenen C. A feasibility Randomised Controlled Trial as a first step towards evaluating the effectiveness of a digital health dashboard in preventive child health care: a mixed methods approach. Pilot Feasibility Stud 2023; 9:25. [PMID: 36793130 PMCID: PMC9930344 DOI: 10.1186/s40814-022-01214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/29/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Within preventive Child Health Care (CHC), the 360°CHILD-profile has been developed. This digital tool visualises and theoretically orders holistic health data in line with the International Classification of Functioning, Disability and Health. It is anticipated that evaluating the effectiveness of the multifunctional 360°CHILD-profile within the preventive CHC-context is complex. Therefore, this study aimed at investigating the feasibility of RCT procedures and the applicability of potential outcome measures for assessing the accessibility and transfer of health information. METHODS During the first introduction of the 360°CHILD-profile in CHC practice, a feasibility RCT with an explanatory-sequential mixed methods design was executed. CHC professionals (n=38) recruited parents (n=30) who visited the CHC for their child (age 0-16). Parents were randomised to "care as usual" (n=15) or "care as usual with, in addition, the availability of a personalised 360°CHILD-profile during 6 months" (n=15). Quantitative data on RCT feasibility were collected on recruitment, retention, response, compliance rates and outcome data on accessibility and transfer of health information (n=26). Subsequently, thirteen semi-structured interviews (5 parents, 8 CHC professionals) and a member check focus group (6 CHC professionals) were performed to further explore and gain a deeper understanding of quantitative findings. RESULTS Integration of qualitative and quantitative data revealed that the recruitment of parents by CHC professionals was problematic and influenced by organisational factors. The used randomisation strategy, interventions and measurements were executable within the setting of this specific study. The outcome measures showed skewed outcome data in both groups and a low applicability to measure accessibility and transfer of health information. The study revealed points to reconsider regarding the randomisation and recruitment strategy and measures in the next steps. CONCLUSIONS This mixed methods feasibility study enabled us to gain a broad insight into the feasibility of executing an RCT within the CHC context. Trained research staff should recruit parents instead of CHC professionals. Measures, potentially for evaluating 360°CHILD-profile's effectiveness, need further exploration and thorough piloting before proceeding with the evaluation process. Overall findings revealed that executing an RCT within the context of evaluating 360°CHILD-profile's effectiveness in the CHC setting will be much more complex, time-consuming and costly than expected. Thereby, the CHC context requires a more complex randomisation strategy than executed during this feasibility study. Alternative designs including mixed methods research must be considered for the next phases of the downstream validation process. TRIAL REGISTRATION NTR6909; https://trialsearch.who.int/ .
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Affiliation(s)
- Miriam Weijers
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Nicolle Boumans
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Jonne van der Zwet
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Frans Feron
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Caroline Bastiaenen
- grid.5012.60000 0001 0481 6099Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Weselman T, Naseri C, Vaz S, Beilby J, Garswood L, O'Connell H, Hill AM. Older adults' experiences of a community wellness program (Connect 60+) that focused on physical activity and social connections: a qualitative exploratory study. Aust J Prim Health 2023; 29:64-73. [PMID: 36323491 DOI: 10.1071/py22153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/06/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Being physically active and socially connected is positively associated with healthy aging. Older adults living in the community may be at risk of social isolation and reduced physical activity, especially in recent times due to COVID-19. There are many programs that offer opportunities for evidence-based physical activity or social connection; however, there is a lack of programs that include both. The objective of this study was to explore the lived experience of older adults who participated in Connect 60+ - a program that promoted exercise and social activities - delivered from a community hub that could be attended either in person or online. METHODS A qualitative study that used descriptive phenomenology was conducted. A purposive sample of 13 older adults (age ≥65years) was recruited to take part in semistructured telephone interviews to discuss barriers and enablers to program engagement. Data were analysed using thematic analysis. RESULTS The overarching theme was that participating in Connect 60+ was an enjoyable and encouraging experience for participants. The program enabled them to increase their physical activity and build social connections within their community. The main themes that enabled engagement were: (1) an enabling program design, (2) developing new connections in the community, and (3) experiencing motivation to engage. A few barriers were identified, including difficulties connecting online and lack of male attendance. CONCLUSIONS Wellness programs delivered in community hubs may facilitate older adults to increase their engagement in both physical and social activity. The program appeared to impact positively on participants' motivation, with some participants reporting that they had sustained their behaviour changes since program completion. To address identified barriers, easy to use online technology is recommended, and strategies to promote male attendance.
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Affiliation(s)
- Tammy Weselman
- The University of Western Australian, School of Allied Health, Crawley, WA 6009, Australia
| | - Chiara Naseri
- The University of Western Australian, School of Allied Health, Crawley, WA 6009, Australia; and Western Australian Centre for Health and Ageing, University of Western Australia, Crawley, WA 6009, Australia
| | - Sharmila Vaz
- The University of Western Australian, School of Allied Health, Crawley, WA 6009, Australia
| | - Janet Beilby
- Curtin University, School of Allied Health, Bentley, WA 6102, Australia
| | - Luke Garswood
- Connect Victoria Park, Victoria Park, WA 6100, Australia
| | | | - Anne-Marie Hill
- The University of Western Australian, School of Allied Health, Crawley, WA 6009, Australia; and Western Australian Centre for Health and Ageing, University of Western Australia, Crawley, WA 6009, Australia
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Raj EX, Daniels DE, Thomson PE. Facebook groups for people who stutter: An extension of and supplement to in-person support groups. JOURNAL OF COMMUNICATION DISORDERS 2023; 101:106295. [PMID: 36603411 DOI: 10.1016/j.jcomdis.2022.106295] [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: 01/09/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Online support group experiences, using social networking websites like Facebook, have shown much promise in past research unrelated to stuttering. Therefore, this study aimed to determine the utility of a Facebook-based stuttering support group that was created as an extension of and supplement to an in-person stuttering support group as a means of providing psychosocial support for people who stutter (PWS). METHOD A qualitative approach that was inspired by ethnography was used to explore the experiences of seven participants (six participants who stutter and one participant who does not stutter) who digitally connect on a private Facebook-based stuttering support group that was created as an extension of and supplement to an already existing in-person stuttering support group. The main question posed to the participants related to describing their experiences being a member of the Facebook-based stuttering support group. RESULTS Data analysis revealed two major themes, which included the benefits and challenges of participating in a Facebook-based stuttering support group. Each major theme contained five subthemes. Specific results are discussed with reference to past research, as well as implications for practice and recommendations for future research. CONCLUSIONS There are numerous benefits and challenges associated with being a member of a Facebook-based stuttering support group. However, the overall utility of a Facebook-based stuttering support group, used in tandem with an in-person stuttering support experience, seems to provide members with a useful and impactful way to gain psychosocial support from other PWS.
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Affiliation(s)
- Erik X Raj
- Monmouth University, Department of Speech-Language Pathology, 400 Cedar Avenue, West Long Branch, NJ 07764, USA.
| | - Derek E Daniels
- Wayne State University, Department of Communication Sciences and Disorders, 5201 Cass Avenue, 103 Prentis Building, Detroit, MI 48202, USA
| | - Paula E Thomson
- Monmouth University, Department of Speech-Language Pathology, 400 Cedar Avenue, West Long Branch, NJ 07764, USA
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Rauh L, Manze MG, Watnick D. Collaborating With Student Parents as Participatory Researchers in a Qualitative Study. Health Promot Pract 2023; 24:133-143. [PMID: 34628964 DOI: 10.1177/15248399211046578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
When embarking on research within a community where little empirical research exists, the inclusion of a structured participant group-such as a steering committee or advisory board-can formalize the participant-research team partnership, increase community buy-in for action items, and reinforce the trustworthiness of research findings. These were among the aims of the multimethod design of the Student Parent Project, a qualitative study to determine the barriers and facilitators of academic achievement and well-being at six community colleges within a large, urban, public university system. The initial step of the study was to create a Student Advisory Board by recruiting one student parent from each of the participating campuses. The Student Advisory Board then met intermittently to review the research approach, data collection instruments, and preliminary findings at different stages. In this article, we describe the process of convening and collaborating with the advisory board and identify key areas in which their participation influenced the study design, findings, and recommendations. Based on lessons learned, we offer recommendations for the design and implementation of a participatory advisory board within qualitative studies.
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Affiliation(s)
- Lauren Rauh
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Meredith G Manze
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Dana Watnick
- Albert Einstein College of Medicine, Bronx, NY, USA
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Nadarajah A, Shankar PR, Jayaraman S, Sreeramareddy CT. House officers' specialist career choices and motivators for their choice- a sequential mixed-methods study from Malaysia. BMC MEDICAL EDUCATION 2022; 22:796. [PMID: 36384571 PMCID: PMC9668396 DOI: 10.1186/s12909-022-03845-2] [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: 03/06/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers'' specialist career choices and motivators for their choice. PARTICIPANTS AND METHODS We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice. RESULTS HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for 'on-contract' HO to pursue specialist training. Motivators for first-choice specialty were related to 'work schedule', 'patient care characteristics', 'specialty characteristics', 'personal factors', 'past work experience', 'training factors', and 'career prospects.' House officers' first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, "younger age", "health professional in the family", "work schedule and personal factors", "career prospects" and "specialty characteristics" were associated with the first choice. CONCLUSIONS Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.
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Affiliation(s)
- Anuradha Nadarajah
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
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Bijlmakers L. Systems Science and Evidence-Informed Deliberation to Mitigate Dilemmas in Situations of Dual Agency at the Hospital Level Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations". Int J Health Policy Manag 2022; 11:2337-2339. [PMID: 35247940 PMCID: PMC9808293 DOI: 10.34172/ijhpm.2022.6940] [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: 11/14/2021] [Accepted: 02/12/2022] [Indexed: 01/12/2023] Open
Abstract
The article by Waitzberg et al on dual agency in hospitals reports on three strategies to mitigate dilemmas arising from conflicting clinical and economic considerations. This could be further explored by using systems science methods that allow in-depth analyses of (health) system dynamics, networks, and agent-based modelling, and that take into account local context, incentives and how institutions work. Future studies may also draw on the literature of multi-criteria decision-making and evidence-informed deliberative processes (EDPs) that are increasingly being used to optimise legitimate health benefit package design. Toolkits to assist hospital professionals in improving their decision-making need to be practical, with ample attention for the process of decision-making, including transparency, use of evidence, and opportunities for health professionals (and possibly others stakeholders) to contest or formally appeal against certain decisions.
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Affiliation(s)
- Leon Bijlmakers
- Department for Health Evidence (HEV), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
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Sharma A, Stuckey H, Mendez-Miller M, Cuffee Y, Juris AJ, McCall-Hosenfeld JS. The influence of patriarchy on Nepali-speaking Bhutanese women’s diabetes self-management. PLoS One 2022; 17:e0268559. [PMID: 36103470 PMCID: PMC9473401 DOI: 10.1371/journal.pone.0268559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women’s status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women’s diabetes self-management employing a conceptual framework based on Walby’s structures of patriarchy. Methods An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework. Results Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women’s patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women’s access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy. Conclusion Patriarchal practices that start early on within women’s lives, such as child marriage, religious restrictions as well as women’s access to education and autonomy impacted NSB women’s access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.
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Affiliation(s)
- Aditi Sharma
- Department of Urology, School of Medicine, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Heather Stuckey
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
| | - Megan Mendez-Miller
- Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Yendelela Cuffee
- Program in Epidemiology, College of Health Sciences, University of Delaware, Newark, Delaware, United States of America
| | - Aubrey J. Juris
- Pennsylvania Department of Health Office of Health Equity, Harrisburg, Pennsylvania, United States of America
| | - Jennifer S. McCall-Hosenfeld
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
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Russette HC, Grubin F, Ingalls A, Martin L, Leonard A, Kushman E, Cisler A, Leffler E, Herman A, Haroz EE. Home visitor perspectives on implementing a precision approach to home visiting in communities serving Native American families. Infant Ment Health J 2022; 43:744-755. [PMID: 35921432 DOI: 10.1002/imhj.22012] [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: 11/24/2021] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
Family Spirit (FS) is a federally endorsed evidence-based home visiting programs serving as a key prevention strategy for expectant families and families with young children. Like other home-visiting programs, it shares client challenges in retention and engagement during implementation. We assessed (1) the feasibility and acceptability of implementing a precision approach to FS; and (2) differences in approaches to FS delivery. Home visitors, serving primarily Native American families, that delivered a standard (N = 6) or a precision approach (N = 6) to FS across four study sites each participated in up to four virtual focus group discussions (FGDs) (N = 16). Facilitators and barriers to implementation were identified across the curriculum approach, relational and contextual levels. Facilitators: Relevant and culturally sensitive lessons, lesson structure, client-home visitor relationship, client buy-in, home visitor autonomy, leadership support, flexible funding, and training. Barriers: Irrelevant lessons, substance use content, missing topics, families experiencing crises, client and home visitor availability, client feedback, nonsupportive leadership, inadequate funding, and organizational policies and practices. The precision approach offers (1) tailoring of lessons that supports relevance of content to clients; and (2) a target timeframe that supports flexibility in lesson delivery. This model structure may improve client participation and retention.
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Affiliation(s)
- Helen C Russette
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Martin
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Amanda Leonard
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Elizabeth Kushman
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, Michigan, USA
| | | | | | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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The confinement and empowerment of Muslim leadership within the ‘iron cage of cultural complexity’: The case of an Islamic setting within Australia. JOURNAL OF MANAGEMENT & ORGANIZATION 2022. [DOI: 10.1017/jmo.2019.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe purpose of this empirical research is to address leadership within a complex multicultural context; namely Islamic organizations within a contemporary Western society (Australia). The researchers utilized qualitative analysis of triangulated, predominantly qualitative data. The analysis drew on core elements of grounded theory. It was found that both macro- and micro-dimensions of culture had an impact on Australian Muslim understandings of leadership and subsequently had an impact on leading. The analysis also uncovered intra- and inter-cultural complexity within Muslim organizations. The concept of an ‘iron cage’ of micro-cultures emerged to integrate these findings. An abstract storyline is posed wherein a new leadership identity will facilitate empowerment and uncertainty resolution about the stress of cultural complexity, resulting in more effective leadership.
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Reber L, Kreschmer JM, James TG, Junior JD, DeShong GL, Parker S, Meade MA. Ableism and Contours of the Attitudinal Environment as Identified by Adults with Long-Term Physical Disabilities: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127469. [PMID: 35742718 PMCID: PMC9224372 DOI: 10.3390/ijerph19127469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022]
Abstract
Adults with physical disabilities experience a continuum of enabling and disabling attitudes in the environment. This study identified where adults with physical disabilities experience the attitudinal environment, the continuum of those attitudes, and how they impact emotional and psychological health and well-being. Focus groups and interviews were conducted in 2019 and 2020 with adults with physical disabilities in southeastern Michigan in the United States. Participants discussed environmental factors that impact healthy aging. From an initial thematic coding of narratives, the attitudinal environment was identified. Transcripts were recoded and analyzed focusing on societal attitudes. Qualitative analyses revealed that participants did not experience societal attitudes as simply positive or negative, and that the contexts in which these attitudes were expressed were not limited to interpersonal interactions. Rather, these attitudes were also experienced in the built environment and through social institutions and organizations and their programs, systems, and structures that provide or deny needed accommodations, resources, and support. The spectrum of overlapping attitudes that participants articulated ranged from understanding and supportive, to not understanding, to being viewed and treated as less than human. Societal structures reflect and influence societal attitudes and have material consequences on the lives of adults with physical disabilities.
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Affiliation(s)
- Lisa Reber
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA; (J.M.K.); (M.A.M.)
- Correspondence:
| | - Jodi M. Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA; (J.M.K.); (M.A.M.)
| | - Tyler G. James
- Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104, USA;
| | - Jaime D. Junior
- Civil Rights, Inclusion and Opportunity Department, Detroit, MI 48226, USA;
| | | | - Shan Parker
- Department of Public Health and Health Sciences, University of Michigan, Flint, MI 48502, USA;
| | - Michelle A. Meade
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA; (J.M.K.); (M.A.M.)
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Mental Toughness Development via Military-Style Training in the NCAA: A Three-Phase, Mixed-Method Study of the Perspectives of Strength and Conditioning Coaches. Sports (Basel) 2022; 10:sports10060092. [PMID: 35736832 PMCID: PMC9230102 DOI: 10.3390/sports10060092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Sport cultures transmit values for anticipated conduct. Recent events have resulted in injuries/deaths of National Collegiate Athletic Association (NCAA) student-athletes, usually during off-season football training. Through media reports, strength and conditioning coaches (SCC) have been allegedly involved by incorporating military-style training (MST). Mental toughness (MT) has been associated with hypermasculine subcultures in sports. For the first time, perceptions of collegiate SCCs were chosen to contribute to the development of cultural best practices in sports, via a multiphase mixed-method design (Phase 1, n = 465; Phase 2, n = 72; Phase 3, n = 99). Quantitative and qualitative data were collected aiming to confirm and explore the use of MST in the NCAA, its connection to SCCs, its association with MT development, and the role of the media. MST is uncommon in the NCAA. MST takes place mostly during the off-season in the form of physical, in-scope protocols while football is the most common sport. MST promotes MT. The recent media backlash is considered unfounded. Cultures promoted by SCCs do not indicate conformity of student-athletes to unethical/unhealthy expectations. Future sport psychology research and practice should continue to prioritize culture, cultural identities, and physical and mental well-being.
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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Natafgi N, Ladeji O, Blackwell S, Hong YD, Graham G, Cort M, Mullins CD. Similar values, different expectations: How do patients and providers view 'health' and perceive the healthcare experience? Health Expect 2022; 25:1517-1528. [PMID: 35411659 PMCID: PMC9327836 DOI: 10.1111/hex.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/11/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION No one can argue on the importance of health in one's life. However, the value of health in the context of other priorities for individuals is not always as clear. Further, patients' experience with the healthcare system is rarely contrasted with the service providers' expectations. The aim of this paper is to examine and compare patients' and providers' own definitions of health and their perceptions of the healthcare delivery experience from the lens of residents and providers in West Baltimore, Maryland. METHODS This was a qualitative study with semi-structured focus groups (15 sessions) and individual in-depth interviews (21 interviews) with 94 participants. Two independent coders thematically analysed the transcripts. RESULTS Patients identified five areas where health systems can help them stay healthy or become healthier: affordability and costs of care; accessibility; clinician/patient communication; addressing social determinants; and stigma and trust. Providers acknowledged that the healthcare experience is not always perfect. While the medical team focuses on conversations that enhance medical care, patients are expecting providers to touch on subjects beyond medical care. CONCLUSIONS Patients and providers need to consider that although they have a common value towards health, there is still a gap in what users expect and what providers can offer. To further align those expectations, there is a need for increasing involvement of patient in care administration and improving dialogue between the parties about these differences. PATIENT OR PUBLIC CONTRIBUTION A Stakeholder Advisory Board (SAB)-comprised of a patient, two community leaders, a physician and two healthcare administrators-was instrumental in codeveloping the study material (e.g., interview guides), engaging patients in the research process, identifying participants and codeveloping dissemination material. Two SAB members-Gail Graham, a patient consultant/professor, and Marcia Cort, a physician-are coauthors.
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Affiliation(s)
- Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Olayinka Ladeji
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA
| | - Shanikque Blackwell
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yoon Duk Hong
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA
| | - Gail Graham
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA.,Mt. Lebanon Baptist Church HIV/AIDS Outreach Services, Baltimore, Maryland, USA
| | - Marcia Cort
- University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA
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Barriers and Facilitators to Prevention and Care of COVID-19 Infection in Cincinnati Latinx Families: a Community-Based Convergent Mixed Methods Study. J Racial Ethn Health Disparities 2022; 10:1067-1085. [PMID: 35411496 PMCID: PMC8999990 DOI: 10.1007/s40615-022-01294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
Background Latinx populations have experienced disproportionately high case rates of COVID-19 across the USA. Latinx communities in non-traditional migration areas may experience greater baseline day-to-day challenges such as a lack of resources for immigrants and insufficient language services. These challenges may be exacerbated by the COVID-19 pandemic. Objective This article describes the results of an initial community health needs assessment to better understand the prevention and care of COVID-19 infection in the Cincinnati Latinx community. Methods We used convergent mixed methods to examine barriers and facilitators to COVID-19 prevention and care for those with infection. Results Latinx adults ≥ 18 years old completed 255 quantitative surveys and 17 qualitative interviews. Overarching mixed methods domains included knowledge, prevention, work, challenges, and treatment. Quantitative results largely reinforced qualitative results (confirmation). Certain quantitative and qualitative results, however, diverged and expanded insights related to caring for COVID-19 infection among Latinx adults (expansion). There were infrequent contradictions between quantitative and qualitative findings (discordance). Primary barriers for the Latinx community during the COVID-19 pandemic included insecurities in food, jobs, housing, and immigration. Key facilitators included having trusted messengers of health-related information. Conclusion Public health interventions should be centered on community partnerships and the use of trusted messengers. Wraparound services (including resources for immigrants) are essential public health services. Close partnership with employers is essential as lack of sick leave and mask supplies were more frequent barriers than knowledge. These findings emerged from experiences during the COVID-19 pandemic but likely generalize to future public health crises. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01294-7.
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Peterson M, Rink E, Schure M, Mikkelsen K, Longtree H, FireMoon P, Johnson O. Early childbearing, family support, and staying in school in a Northern Plains American Indian reservation. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2022; 17:510-535. [PMID: 37427389 PMCID: PMC10328454 DOI: 10.1080/15546128.2022.2053258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
American Indian youth experience teen birth and school dropout at higher rates than other racial and ethnic groups in the United States. Early childbearing is associated with adverse health and socioeconomic outcomes, including attenuated education. However, kinship childrearing norms among Northern Plains tribes can support positive experiences of early childbearing. Using a community based participatory research framework, this mixed methods exploratory study engaged high school students from a Northern Plains reservation community to examine youth perceptions of family support and belief in ability to stay in school should they have a child. We elicited youth observations of facilitators and inhibitors to academic achievement for young parents. This research supports the need for strengths-based, gender specific, and family inclusive sexuality education to support young people in their reproductive choices in reservation settings. We highlight the utility of including youth as co-authors and co-researchers in future studies.
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Affiliation(s)
- Malory Peterson
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Mark Schure
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
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Stoecker R, Witkovsky B. Elder Civic Engagement and Rural Community Development. AGEING INTERNATIONAL 2022; 48:526-546. [PMID: 35287374 PMCID: PMC8907901 DOI: 10.1007/s12126-022-09488-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Rural areas are becoming more and more concerned about their aging population and perceived loss of youth. Analysts see the older members of communities as a burden, and focus their development strategies on attracting and retaining the young. In doing so, they may be missing the value that elders’ civic engagement can provide to rural community development. This qualitative study, based on interviews with 40 elders in mostly rural areas of Wisconsin, in the United States, shows the benefits that their civic engagement brings to rural areas. They have biographical availability, political and economic freedom, and life-long experience to offer. They do face some challenges, including occasional health issues, lack of technological agility, and change-resistant peers. The paper concludes by considering how communities can better access and honour elder civic engagement, including understanding elders’ motivations and skills for civic engagement.
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Affiliation(s)
- Randy Stoecker
- Department of Community and Environmental Sociology, 350 Agricultural Hall, 1450, Linden Drive, Madison, WI 53706 USA
| | - Benny Witkovsky
- Department of Community and Environmental Sociology, 350 Agricultural Hall, 1450, Linden Drive, Madison, WI 53706 USA
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Longden E, Branitsky A, Jones W, Peters S. 'It's like having a core belief that's able to speak back to you': Therapist accounts of dialoguing with auditory hallucinations. Psychol Psychother 2022; 95:295-312. [PMID: 34762756 DOI: 10.1111/papt.12373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the clinical perspectives and experiences of therapists when engaging in direct dialogue with auditory hallucinations. METHOD Therapist accounts were explored via a qualitative study nested within a pilot randomized controlled trial of a novel intervention for supporting distressed voice-hearers (Talking with Voices). Five therapists were involved, none of whom had substantive previous experience of the technique. All agreed to take part in two semi-structured, in-depth interviews which were arranged prior to delivering therapy and again after therapists had experience of conducting dialogues. Data were analysed using inductive thematic analysis. RESULTS Participants described their impressions of seeking to improve the relationship between voice(s) and voice-hearer using dialogue. The findings are organized within three main themes and associated subthemes: (1) Commitment to delivery (professional values, mentorship, professional growth); (2) Communication and collaboration (therapeutic alliance, relationships with voices, managing clinical perceptions); and (3) Challenges of delivery (client/voice engagement, impact of trauma, systemic issues). A series of recommendations are derived from the findings to support implementation and guide the practice of therapists undertaking dialogue work with clients who hear voices. CONCLUSION Despite clinical challenges, therapists also identified professional gains from conducting their work. Their accounts demonstrate that it is possible for practitioners with no previous formal experience to engage in direct communication with voices within a context of appropriate training and supervision. PRACTITIONER POINTS Therapists with no previous experience of dialogue work can be trained and supported to verbally engage with the voices heard by people experiencing psychosis. Therapeutic alliance and therapist values are important components of successful therapy. Confidence for dialoguing with voices can be increased through drawing on therapist's existing transferable clinical skills. The emotional and practical needs of therapists undertaking such work should be addressed through training and regular group supervision.
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Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Wendy Jones
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, UK
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Ehrenzeller S, Durovic A, Kuehl R, Martinez AE, Bielser M, Battegay M, von Rotz M, Fringer A, Tschudin-Sutter S. A qualitative study on safety perception among healthcare workers of a tertiary academic care center during the SARS-CoV-2 pandemic. Antimicrob Resist Infect Control 2022; 11:30. [PMID: 35135617 PMCID: PMC8821840 DOI: 10.1186/s13756-022-01068-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/23/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Protecting healthcare workers (HCWs) from exposure to SARS-CoV-2 during patient care is central to managing the current pandemic. Higher levels of trust in personal protective equipment (PPE) and infection prevention and control (IPC) strategies have been previously related to lower levels of emotional exhaustion, yet little is known on how to achieve such a perception of safety. We thus sought to identify institutional actions, strategies and policies related to HCWs' safety perception during the early phase of the pandemic at a tertiary care center in Switzerland by interviewing HCWs from different clinics, professions, and positions. METHODS For this qualitative study, 36 face-to-face semi-structured interviews were performed. Interviews were based on a guide that addressed the perception of institutional strategies and policies during the first phase of the pandemic in March 2020. The participants included doctors (n = 19) and nurses (n = 17) in senior and non-senior positions from eight clinics in the University Hospital Basel, Switzerland, all involved in patient care. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis and organized using MAXQDA (VERBI Software GmbH, Berlin). FINDINGS Five recurring themes were identified to affect HCWs' perception of their safety during the SARS-CoV-2 pandemic: (1) transparency and clarity of information, (2) communication on the availability of PPE (with the provision of information alone increasing the feeling of safety even if supplies of PPE were reported as low), (3) uniformity and consistency of guidelines, (4) digital resources to support face-to-face teaching (although personal information transfer is still being considered superior in terms of strengthening safety perception) and (5) support and appreciation for the work performed. CONCLUSIONS This study identifies institutional policies and actions influencing HCWs' safety perception during the first wave of the COVID-19 pandemic, the most important of which is the factor of transparent communication. This knowledge reveals potential areas of action critical to improving preparedness and management in hospitals faced with an infectious disease threat.
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Affiliation(s)
- Selina Ehrenzeller
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ana Durovic
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Richard Kuehl
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Aurélien Emmanuel Martinez
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michèle Bielser
- University of Applied Sciences and Arts Northwestern Switzerland FHNW, Olten, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Matthias von Rotz
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - André Fringer
- Institute of Nursing, School of Health Professions, Zürich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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Wodtke L, Hayward A, Nychuk A, Doenmez C, Sinclair S, Cidro J. The need for sustainable funding for Indigenous doula services in Canada. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221093928. [PMID: 35438029 PMCID: PMC9021521 DOI: 10.1177/17455057221093928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To interview representatives from Indigenous doulas across Canada in order to document how they manage the logistics of providing community-based doula care and understand their challenges. These objectives inform the development of an Indigenous doula pilot programme as part of the project, 'She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas'. METHODS In 2020, semi-structured interviews were conducted with members of five Indigenous doula collectives across Canada. Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS Our article explores one of the main themes that emerged from these interviews: sustainable funding for Indigenous doula services. Within this theme we identified two sub-themes: (1) limitations on and regulations for available funding and (2) negative impacts of limited funding on doula service. CONCLUSION A major challenge to providing Indigenous community-based doula services is sustainable funding. Current models of funding for this work often do not provide livable wages and are bound by limited durations and regulations that are unsustainable and can be culturally inappropriate. Due to this lack of sustainable funding, Indigenous doula service in Canada faces challenges that include high staff turnover and burnout and lack of time and resources to provide culturally safe care, pursue professional development and additional training, and keep their services affordable for the families who need them. Future research is needed to ascertain potential programmes and funding streams for sustainable Indigenous doula support in Canada, including possible integration of doula care into the universal public health care system despite the jurisdictional challenges in providing health care for Indigenous peoples.
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Affiliation(s)
- Larissa Wodtke
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
| | - Ashley Hayward
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
- Department of Peace and Conflict Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Alexandra Nychuk
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
| | - Caroline Doenmez
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
- Department of Anthropology, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Sinclair
- Department of Native Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Jaime Cidro
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
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50
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Szpunar M, Vanderloo LM, Bruijns BA, Truelove S, Burke SM, Gilliland J, Irwin JD, Tucker P. Children and parents' perspectives of the impact of the COVID-19 pandemic on Ontario children's physical activity, play, and sport behaviours. BMC Public Health 2021; 21:2271. [PMID: 34903197 PMCID: PMC8666344 DOI: 10.1186/s12889-021-12344-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background The COVID-19 pandemic and associated public health measures have resulted in the closure of many physical activity-supporting facilities. This study examined Ontario parents’ and children’s perspectives of COVID-19’s impact on children’s physical activity behaviours, return to play/sport during COVID-19, as well as barriers/facilitators to getting active amid extended closures of physical activity venues. Methods Parents/guardians of children aged 12 years and under living in Ontario, Canada were invited to participate in an interview. 12 parent/guardian and 9 child interviews were conducted via Zoom between December 2020 – January 2021, were audio-recorded, and transcribed verbatim. Thematic content analysis was undertaken to identify pronounced themes. Results Themes for both parent and child interviews fell into one of three categories: 1) barriers and facilitators for getting children active amid COVID-19 closures of physical activity-supporting facilities; 2) changes in children’s activity levels; and, 3) perspectives on return to play/sport during and post-pandemic. Various subthemes were identified and varied between parents and children. The most common facilitator for dealing with children’s inactivity voiced by parents/guardians was getting active outdoors. Parents/guardians noted their willingness to have their children return to play/sport in the community once deemed safe by public health guidelines, and children’s willingness to return stemmed primarily from missing their friends and other important authority figures (e.g., coaches) and sporting events (e.g., tournaments). Conclusions Findings from this study could inform families of feasible and realistic strategies for increasing children’s physical activity during community closures, while also providing public health experts with information regarding what supports, or infrastructure might be needed during future lockdown periods and/or pandemics. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12344-w.
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Affiliation(s)
- Monika Szpunar
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Leigh M Vanderloo
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Brianne A Bruijns
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Stephanie Truelove
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Shauna M Burke
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Jason Gilliland
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Geography, Faculty of Social Sciences, University of Western Ontario, London, Ontario, Canada
| | - Jennifer D Irwin
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Patricia Tucker
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. .,School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. .,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.
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