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Algera E, Leusink P, Gerrits T, Pols J, Ravesloot JH. mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice. Eur J Gen Pract 2024; 30:2302435. [PMID: 38264977 PMCID: PMC10810654 DOI: 10.1080/13814788.2024.2302435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods' effectiveness and clarity on how healthcare professionals include them in contraceptive counselling. OBJECTIVES To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings. METHODS We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis. RESULTS In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods. CONCLUSION To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.
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Affiliation(s)
- Ellen Algera
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
- Institute for Interdisciplinary Studies, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Trudie Gerrits
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannette Pols
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
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Tolotti A, Sari D, Valcarenghi D, Bonetti L, Liptrott S, Bianchi M. Interprofessional Collaboration in Palliative Care-The Need for an Advanced Practice Nurse: An Ethnographic Study. Semin Oncol Nurs 2024; 40:151654. [PMID: 38763788 DOI: 10.1016/j.soncn.2024.151654] [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: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES The literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context. DATA SOURCES A focused ethnographic approach was taken involving participant observation and semistructured interviews. CONCLUSION From the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments. IMPLICATIONS FOR NURSING PRACTICE The study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.
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Affiliation(s)
- Angela Tolotti
- Nurse Researcher, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Davide Sari
- Head of Nursing, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Dario Valcarenghi
- Head of Nursing Research, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Loris Bonetti
- Nurse Researcher, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Sarah Liptrott
- Nurse Researcher, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Monica Bianchi
- Head of MSc of Science in Nursing, University of Applied Sciences and Arts of Southern Switzerland Department of Business, Economics, Health and Social Care, Manno, Switzerland.
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Teheux L, Kuijer-Siebelink W, Bus LL, Draaisma JMT, Coolen EHAJ, van der Velden JAEM. Unravelling underlying processes in intraprofessional workplace learning in residency. MEDICAL EDUCATION 2024; 58:939-951. [PMID: 37990961 DOI: 10.1111/medu.15271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND To deliver high-quality collaborative care, residents need to be trained across the boundaries of their medical specialty (intraprofessional learning). The current literature does not provide insights into the underlying processes that influence intraprofessional learning. The aim of this study was to gain insight into the processes that occur during intraprofessional workplace learning in residency training, by exploring everyday intraprofessional interactions experienced by residents, with the ultimate objective of improving collaborative practice. METHOD We conducted a focused ethnography using field observations and in-depth interviews with residents at an academic children's hospital in the Netherlands. In 2022, nine residents from four different medical specialties were shadowed and/or interviewed. In total, >120 hours of observation and 10 interviews were conducted. Data collection and analysis were conducted iteratively and discussed in a research team with diverse perspectives, as well as with a sounding board group of stakeholders. RESULTS Residents were involved in numerous intraprofessional interactions as part of their daily work. We identified three themes that shed light on the underlying processes that occur during intraprofessional workplace learning: (1) residents' agency, (2) ingroups and outgroups and (3) communication about intraprofessional collaboration. CONCLUSIONS Collaborative practice offers many intraprofessional learning opportunities but does not automatically result in learning from, with and about other specialties to improve intraprofessional collaborative care. Overarching the identified themes, we emphasise the pivotal role of the resident-supervisor dyad in facilitating residents' engagement in the learning opportunities of complex intraprofessional care. Furthermore, we propose that promoting deliberate practice and shared responsibility in collaborative care are crucial to better prepare residents for their roles and responsibilities in delivering high-quality collaborative patient care.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboud University Medical Center, Radboudumc Health Academy, Nijmegen, the Netherlands
- School of Education, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Lotte L Bus
- School of Education, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Ester H A J Coolen
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Janiëlle A E M van der Velden
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
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Achola R, Orach CG, Nabiwemba E, Atuyambe LM. Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study. BMC Womens Health 2024; 24:427. [PMID: 39061042 PMCID: PMC11282639 DOI: 10.1186/s12905-024-03272-z] [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: 04/04/2023] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Contraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake. METHODS A qualitative exploratory study was conducted among women of reproductive age (15-49 years) and men (15-60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14. RESULTS We found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out. CONCLUSIONS This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees. TRIAL REGISTRATION This study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number-SS809ES.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Lynn M Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Hedqvist AT, Praetorius G, Ekstedt M, Lindberg C. Entangled in complexity: An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs. J Adv Nurs 2024. [PMID: 38641975 DOI: 10.1111/jan.16203] [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: 01/27/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIM The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs. DESIGN An ethnographic design using multiple convergent data collection techniques. METHODS Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings. RESULTS Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed 'safe care transition pathway' addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions. CONCLUSION To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions. IMPLICATIONS The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes. REPORTING METHOD Findings are reported per the Consolidated Criteria for Reporting Qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Ambulance Service, Region Kalmar County, Västervik, Sweden
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
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Mills S, Kaner EFS, Ramsay SE, McKinnon I. What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? A focused ethnographic approach. BMJ Open 2024; 14:e079406. [PMID: 38553050 PMCID: PMC10982710 DOI: 10.1136/bmjopen-2023-079406] [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: 08/30/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients' physical and mental health. This study sought to identify the key influences and challenges around weight management in UK adult secure mental health settings. DESIGN Qualitative focused ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis. SETTING Low secure male mental health ward and associated patient activities and events, in a National Health Service Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK. PARTICIPANTS 12 males (primarily white British) on the low secure ward; additional male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a 6-month period from April 2022. RESULTS Secure mental healthcare delivered an environment predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and a ward culture that was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting. CONCLUSIONS Weight management in secure services is a complex challenge. In future, whole setting-based interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff.
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Affiliation(s)
- Susanna Mills
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eileen F S Kaner
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Iain McKinnon
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Celian C, Redd H, Smaller K, Ryali P, Patton JL, Reinkensmeyer DJ, Rafferty MR. Uncovering clinical rehabilitation technology trends: field observations, mixed methods analysis, and data visualization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.05.24303809. [PMID: 38496469 PMCID: PMC10942504 DOI: 10.1101/2024.03.05.24303809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Objective To analyze real-world rehabilitation technology (RT) use, with a view toward enhancing RT development and adoption. Design A convergent, mixed-methods study using direct field observations, semi-structured templates, and summative content analysis. Setting Ten neurorehabilitation units in a single health system. Participants 3 research clinicians (1OT, 2PTs) observed ∼60 OTs and 70 PTs in inpatient; ∼18 OTs and 30 PTs in outpatient. Interventions Not applicable. Main Outcome Measures Characteristics of RT, time spent setting up and using RT, and clinician behaviors. Results 90 distinct devices across 15 different focus areas were inventoried. 329 RT-uses were documented over 44 hours with 42% of inventoried devices used. RT was used more during interventions (72%) than measurement (28%). Intervention devices used frequently were balance/gait (39%), strength/endurance (30%), and transfer/mobility training (16%). Measurement devices were frequently used to measure vitals (83%), followed by grip strength (7%), and upper extremity function (5%). Device characteristics were predominately AC-powered (56%), actuated (57%), monitor-less (53%), multi-use (68%), and required little familiarization (57%). Set-up times were brief (mean ± SD = 3.8±4.21 and 0.8±1.3 for intervention and measurement, respectively); more time was spent with intervention RT (25.6±15) than measurement RT (7.3±11.2). RT nearly always involved verbal instructions (72%) with clinicians providing more feedback on performance (59.7%) than on results (30%). Therapists' attention was split evenly between direct attention towards the patient during clinician treatment (49.7%) and completing other tasks such as documentation (50%). Conclusions Even in a tech-friendly hospital, majority of available RT were observed un-used, but identifying these usage patterns is crucial to predict eventual adoption of new designs from earlier stages of RT development. An interactive data visualization page supplement is provided to facilitate this study.
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Aleshchenko E, Swart E, Voigt M, Langer T, Calaminus G, Glogner J, Baust K. VersKiK qualitative study design: actual follow-up needs of paediatric cancer survivors, their informal caregivers and follow-up stakeholder perceptions in Germany. BMJ Open 2024; 14:e072860. [PMID: 38326270 PMCID: PMC10860087 DOI: 10.1136/bmjopen-2023-072860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survivors and their informal caregivers, gaps in current follow-up care provision and trajectories of cancer survivors' transition from paediatric to adult healthcare. METHODS AND ANALYSIS We will conduct up to 30 interviews with survivors of childhood and adolescence cancer and their informal caregivers with up to 20 participant observations of follow-up appointments. The results of these will be discussed in up to four focus groups with healthcare professionals and representatives of self-help groups. The study design aims to evaluate follow-up care after childhood cancer considering perspectives from survivors, their informal caregivers as well as healthcare providers. The combination of different data sources will allow us to get an in-depth understanding of the current state of follow-up care after paediatric cancer in Germany and to suggest recommendations for care improvement. ETHICS AND DISSEMINATION The VersKiK study was approved by the Ethics Committee Otto von Guericke University on 2 July 2021 (103/21), by the Ethics Committee of Johannes Gutenberg University Mainz on 16 June 2021 (2021-16035), by the Ethics Committee University of Lübeck on 10 November 2021 (21-451), by the Ethics Committee University of Hospital Bonn on 28 February 2022 (05/22). For each part of the qualitative study, a separate written informed consent is prepared and approved accordingly by the ethics committees named above. TRIAL REGISTRATION NUMBER Registered at German Clinical Trial Register, ID: DRKS00026092.
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Affiliation(s)
- Ekaterina Aleshchenko
- Medical Faculty, Institut for Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Enno Swart
- Medical Faculty, Institut for Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Mathias Voigt
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Rheinland-Pfalz, Germany
| | | | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Juliane Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
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Stajduhar KI, Giesbrecht M, Mollison A, Whitlock K, Burek P, Black F, Gerke J, Dosani N, Colgan S. "You can't die here": an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in British Columbia, Canada. BMC Palliat Care 2024; 23:12. [PMID: 38200482 PMCID: PMC10782732 DOI: 10.1186/s12904-024-01340-7] [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: 07/27/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND One measure of quality in palliative care involves ensuring people approaching the end of life are able to receive care, and ultimately die, in the places they choose. Canadian palliative care policy directives stem from this tenet of autonomy, acknowledging that most people prefer to die at home, where they feel safe and comfortable. Limited research, however, considers the lack of 'choice' people positioned as structurally vulnerable (e.g., experiencing extreme poverty, homelessness, substance-use/criminalization, etc.) have in regard to places of care and death, with the option of dying-in-place most often denied. METHODS Drawing from ethnographic and participatory action research data collected during two studies that took place from 2014 to 2019 in an urban centre in British Columbia, Canada, this analysis explores barriers preventing people who experience social and structural inequity the option to die-in-place. Participants include: (1) people positioned as structurally vulnerable on a palliative trajectory; (2) their informal support persons/family caregivers (e.g., street family); (3) community service providers (e.g., housing workers, medical professionals); and (4) key informants (e.g., managers, medical directors, executive directors). Data includes observational fieldnotes, focus group and interviews transcripts. Interpretive thematic analytic techniques were employed. RESULTS Participants on a palliative trajectory lacked access to stable, affordable, or permanent housing, yet expressed their desire to stay 'in-place' at the end of life. Analysis reveals three main barriers impeding their 'choice' to remain in-place at the end of life: (1) Misaligned perceptions of risk and safety; (2) Challenges managing pain in the context of substance use, stigma, and discrimination; and (3) Gaps between protocols, policies, and procedures for health teams. CONCLUSIONS Findings demonstrate how the rhetoric of 'choice' in regard to preferred place of death is ethically problematic because experienced inequities are produced and constrained by socio-structural forces that reach beyond individuals' control. Ultimately, our findings contribute suggestions for policy, programs and practice to enhance inclusiveness in palliative care. Re-defining 'home' within palliative care, enhancing supports, education, and training for community care workers, integrating palliative approaches to care into the everyday work of non-health care providers, and acknowledging, valuing, and building upon existing relations of care can help to overcome existing barriers to delivering palliative care in various settings and increase the opportunity for all to spend their end of life in the places that they prefer.
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Affiliation(s)
- Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Piotr Burek
- Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Fraser Black
- Faculty of Medicine - Island Medical Program, University of British Columbia, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Jill Gerke
- Palliative and End of Life Care Program, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada
| | - Naheed Dosani
- Palliative Care Physician, Department of Family & Community Medicine, St Michael's Hospital at Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Simon Colgan
- Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
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Elliott J, van Wyk P, Butler R, Giosa JL, Sims Gould J, Tong CE, Taabazuing MM, Johnson H, Coyne P, Mitchell F, Whate A, Callon A, Carson J, Stolee P. Developing an in-depth understanding of patient and caregiver engagement across care transitions from hospital: protocol for a qualitative study exploring experiences in Canada. BMJ Open 2023; 13:e077436. [PMID: 37479510 PMCID: PMC10364181 DOI: 10.1136/bmjopen-2023-077436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Patient and caregiver engagement is critical, and often compromised, at points of transition between care settings, which are more common, and more challenging, for patients with complex medical problems. The consequences of poor care transitions are well-documented, both for patients and caregivers, and for the healthcare system. With an ageing population, there is greater need to focus on care transition experiences of older adults, who are often more medically complex, and more likely to require care from multiple providers across settings. The overall goal of this study is to understand what factors facilitate or hinder patient and caregiver engagement through transitions in care, and how these current engagement practices align with a previously developed engagement framework (CHOICE Framework). This study also aims to co-develop resources needed to support engagement and identify how these resources and materials should be implemented in practice. METHODS AND ANALYSIS This study uses ethnographic approaches to explore the dynamics of patient and caregiver engagement, or lack thereof, during care transitions across three regions within Ontario. With the help of a front-line champion, patients (n=18-24), caregivers (n=18-24) and healthcare providers (n=36-54) are recruited from an acute care hospital unit (or similar) and followed through their care journey. Data are collected using in-depth semi-structured interviews. Workshops will be held to co-develop strategies and a plan for future implementation of resources and materials. Analysis of the data will use inductive and deductive coding techniques. ETHICS AND DISSEMINATION Ethics clearance was obtained through the Western University Research Ethics Board, University of Windsor Research Ethics Board and the University of Waterloo Office of Research Ethics. The findings from this study are intended to contribute valuable evidence to further bridge the knowledge to practice gap in patient and caregiver engagement through care transitions. Findings will be disseminated through publications, conference presentations and reports.
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Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
- Specialized Geriatric Services, St. Joseph's Health Care London, London, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paula van Wyk
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Roy Butler
- Senior Leadership, St. Joseph's Health Care London, London, Ontario, Canada
| | - Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Toronto, Ontario, Canada
| | | | - Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Margaret Taabazuing
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Helen Johnson
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paige Coyne
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
- Henry Ford Health System, Detroit, Michigan, USA
| | - Fallon Mitchell
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Alexandra Whate
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne Callon
- Patient and Caregiver Partner, London, Ontario, Canada
| | - Judith Carson
- Patient and Caregiver Partner, Waterloo, Ontario, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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11
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Gittus M, Chong J, Sutton A, Ong ACM, Fotheringham J. Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review. Orphanet J Rare Dis 2023; 18:140. [PMID: 37286999 DOI: 10.1186/s13023-023-02667-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/11/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Rare diseases present a challenge to guideline implementation due to a low prevalence in the general population and the unfamiliarity of healthcare professionals. Existing literature in more common diseases references barriers and facilitators to guideline implementation. This systematic review aims to identify these barriers and facilitators in rare diseases from existing literature. METHODS A multi-stage strategy included searching MEDLINE PubMed, EMBASE Ovid, Web of Science and Cochrane library from the earliest date available to April 2021, Orphanet journal hand-search, a pearl-growing strategy from a primary source and reference/citation search was performed. The Integrated Checklist of Determinants of Practice which comprises of twelve checklists and taxonomies, informed by 57 potential determinants was selected as a screening tool to identify determinants that warrant further in-depth investigation to inform design of future implementation strategies. RESULTS Forty-four studies were included, most of which were conducted in the United States (54.5%). There were 168 barriers across 36 determinants (37 studies) and 52 facilitators across 22 determinants (22 studies). Fifteen diseases were included across eight WHO ICD-11 disease categories. Together individual health professional factors and guideline factors formed the majority of the reported determinants (59.5% of barriers and 53.8% of facilitators). Overall, the three most reported individual barriers were the awareness/familiarity with the recommendation, domain knowledge and feasibility. The three most reported individual facilitators were awareness/familiarity with the recommendation, agreement with the recommendation and ability to readily access the guidelines. Resource barriers to implementation included technology costs, ancillary staff costs and more cost-effective alternatives. There was a paucity of studies reporting influential people, patient advocacy groups or opinion leaders, or organisational factors influencing implementation. CONCLUSIONS Key barriers and facilitators to the implementation of clinical practice guidelines in the setting of rare diseases were at the individual health professional and guideline level. Influential people and organisational factors were relatively under-reported and warrant exploration, as does increasing the ability to access the guidelines as a potential intervention.
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Affiliation(s)
- Matthew Gittus
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK.
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK.
| | - Jiehan Chong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Albert C M Ong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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12
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Jackson J, Ferreira C, Scott M, Barah EJ, Upal Z, Phelps K, Mei C, Woo H, Tung M, Gadimova F, Ewanyshyn A, Perry S, Ens T, Ginn C. 'Just because something works doesn't mean it can't be improved': an ethnographic analysis of the health system in Black Panther's Wakanda. BMJ Glob Health 2023; 8:bmjgh-2023-011733. [PMID: 37028813 PMCID: PMC10083811 DOI: 10.1136/bmjgh-2023-011733] [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: 01/12/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023] Open
Abstract
The emergence of COVID-19 (SARS-CoV-2) has introduced significant global challenges for healthcare systems, healthcare professionals and patients. This current climate creates an opportunity to learn from equitable health systems and move toward making fundamental changes to healthcare systems. Our ethnographic analysis of Wakanda's healthcare system in Black Panther, from the Marvel Cinematic Universe, offers opportunities for system-level transformation across healthcare settings. We propose four healthcare system themes within the context of Wakandan identity: (1) technology as an instrument (blending bodies and technology, blending technology with tradition); (2) reimagining medication; (3) warfare and rehabilitation; and (4) preventative approaches to health (prioritising collective health, deprofessionalisation of healthcare services). The preceding themes represent core elements of Wakandan health systems that allow the people of Wakanda to thrive. Wakandans retain a strong identity and cultural traditions while embracing modern technologies. We found that effective upstream approaches to health for all are embedded in anti-colonial philosophies. Wakandans embrace innovation, embedding biomedical engineering and continuous improvement into care settings. For global health systems under strain, Wakanda's health system identifies equitable possibilities for system change, reminding us that culturally relevant prevention strategies can both decrease pressure on health services and allow all people to thrive.
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Affiliation(s)
- Jennifer Jackson
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Carla Ferreira
- School of Nursing, The University of British Columbia Faculty of Applied Science, Vancouver, British Columbia, Canada
| | - Melissa Scott
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elke Jaibeeh Barah
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Zahra Upal
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Krista Phelps
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Carol Mei
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Haneul Woo
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Megan Tung
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Farida Gadimova
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | | | | | - Twyla Ens
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, Calgary, Alberta Barah, Phelps, Mei, Woo, Tung, Gadimova, Ens, and Ginn, Canada
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13
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Nepali S, Einboden R, Rudge T. The Social Relations of Ethnographic Fieldwork: Access, Ethics and Research Governance. Glob Qual Nurs Res 2023; 10:23333936231193885. [PMID: 37694175 PMCID: PMC10492461 DOI: 10.1177/23333936231193885] [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: 02/10/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023] Open
Abstract
The focus of this methodological paper is to discuss the challenges of conducting fieldwork, using reflections from our experiences of accessing a research site for ethnographic data collection. The research project aimed to explore nurses' social relations in their workplace and the inequities between and within these relations among nurses of diverse social positions. Due to the sensitive nature of this topic, access to the research site posed several challenges and was further complicated by the bureaucratic ethics process that governs clinical sites in Australia. Although this study was considered a low and negligible risk research, negotiating the ethics process was full of hitches and hindrances resulting in the refusal of access. This paper offers ethnographers a reflection on challenges in accessing clinical sites to conduct research and a discussion of strategies that may be useful to navigate and counter these challenges by managing social relations in the field.
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Affiliation(s)
| | - Rochelle Einboden
- The University of Ottawa School of Nursing and Children’s Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, ON, Canada
| | - Trudy Rudge
- The University of Sydney, Camperdown, NSW, Australia
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14
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Ramsey L, Lawton R, Sheard L, O’Hara J. Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts. Digit Health 2022; 8:20552076221129085. [PMID: 36276183 PMCID: PMC9580083 DOI: 10.1177/20552076221129085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Patients are increasingly reporting about their healthcare experiences online and NHS Trusts are adopting different approaches to responding. However, the sociocultural contexts underpinning these organisational approaches remain unclear. Therefore, we aimed to explore the sociocultural contexts underpinning three organisations who adopted different approaches to responding to online patient feedback. Methods Recruitment of three NHS Trusts was theoretically guided, and determined based on their different approaches to responding to online patient feedback (a nonresponding organisation, a generic responding organisation and an organisation providing transparent, conversational responses). Ethnographic methods were used during a year of fieldwork involving staff interviews, observations of practice and documentary analysis. Three in-depth case studies are presented. Findings The first organisation did not respond to or use online patient feedback as staff were busy firefighting volumes of concerns received in other ways. The second organisation adopted a generic responding style due to resource constraints, fears of public engagement and focus on resolving known issues raised via more traditional feedback sources. The final organisation provided transparent, conversational responses to patients online and described a 10-year journey enabling their desired culture to be embedded. Conclusions We identified a range of barriers facing organisations who ignore or provide generic responses to patient feedback online. We also demonstrated the sociocultural context in which online interactions between staff and patients can be embraced to inform improvement. However, this represented a slow and difficult organisational journey. Further research is needed to better establish how organisations can recognise and overcome barriers to engaging with online patient feedback, and at pace.
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Affiliation(s)
- Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,Lauren Ramsey, Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ UK.
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,School of Psychology, University of Leeds, Leeds, UK
| | | | - Jane O’Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,School of Healthcare, University of Leeds, Leeds, UK
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15
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Jackson J, Iacovides J. Using a Serious Game as an Elicitation Tool in Interview Research: Reflections on Methodology. Games Health J 2022; 11:307-311. [DOI: 10.1089/g4h.2021.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer Jackson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jo Iacovides
- Department of Computer Science, University of York, York, United Kingdom
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16
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Al-Hamad A, Forchuk C, Oudshoorn A, Mckinley GP. Listening to the Voices of Syrian Refugee Women in Canada: an Ethnographic Insight into the Journey from Trauma to Adaptation. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022; 24:1-21. [PMID: 36186909 PMCID: PMC9510543 DOI: 10.1007/s12134-022-00991-w] [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] [Accepted: 09/17/2022] [Indexed: 11/15/2022]
Abstract
Syrian refugee women face many obstacles when accessing health services in host countries that are influenced by various cultural, structural, and practical factors. This paper is based on critical ethnographic research undertaken in Canada, to explore Syrian refugee women migration experiences. Also, we aim at critically examining how the intersection of gender, trauma, and violence, and the political and economic conditions of Syrian refugee women shapes their everyday lives and health. The study also investigates the strategies and practices by which Syrian refugee women are currently addressing their healthcare needs and the models of care that are suggested for meeting their physical and mental health needs. Findings show that these women experienced constant worries, hardship, vulnerability, and intrusion of dignity. These experiences and challenges were aggravated by the structure of the Canadian social and healthcare system. This study offers a better understanding of the impact of migration and trauma on Syrian refugee women's roles, responsibilities, gender dynamics, and interaction with Ontario's healthcare system to improve interaction and outcomes. Healthcare models should address these challenges among Syrian refugee families in Canada.
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Affiliation(s)
- Areej Al-Hamad
- Daphne Cockwell School of Nursing, Faculty of Community Services, DCC544, Toronto Metropolitan University, 288 Church St., Toronto, M5B 1Z5 Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FIMS & Nursing Building Room 2356, London, ON N6A 5B9 Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FIMS & Nursing Building Room 2356, London, ON N6A 5B9 Canada
| | - Gerald Patrick Mckinley
- Western Centre for Public Health and Family Medicine, Western University, Room 4115, London, ON N6A 5B9 Canada
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17
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Agudelo-Suárez AA, Vargas-Valencia MY, Vahos-Arias J, Ariza-Sosa G, Rojas-Gutiérrez WJ, Ronda-Pérez E. A qualitative study of employment, working and health conditions among Venezuelan migrants in Colombia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2782-e2792. [PMID: 35023594 DOI: 10.1111/hsc.13722] [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: 02/24/2021] [Revised: 11/29/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
This study aims to explore the perceptions of the Venezuelan immigrant population in Medellín, Colombia, regarding their employment, working and health conditions (physical, mental and psychosocial). A qualitative study was conducted (focused ethnography perspective). Semi-structured interviews were carried out with 31 Venezuelans and 12 key informants from different social organisations that work with the immigrant population. A narrative content analysis was carried out (Atlas.Ti 8.0 software). The migratory process for Venezuelans is caused for political, economical and social aspects in Venezuela and Colombia is offered as the first destination for labour establishing. Access to the labour market is limited to certain occupations, in many cases in the informal economy. Participants referring low salaries, working long hours and reduced social benefits. Occupational risks are evidenced by low experience in the labour market. Some health problems are perceived, and a good part of the interviewed population referred to signs and symptoms related to mental health problems. Barriers to access health and social protection services were found. Finally, future expectations depend on their adaptation to Colombia, the improvement of social conditions in Venezuela or having chances of improving their social and living conditions in another country. A high labour and social vulnerability were found in Venezuelan participants that impact on physical and mental health. Political and strategies from a public health perspective are required and the implementation of systems for monitoring and evaluating the labour and health situation in the working immigrant population.
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Affiliation(s)
- Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Medellín, Colombia
- Public Health Research Group, University of Alicante, Alicante, Spain
| | - Mary Y Vargas-Valencia
- The National Training Service (Servicio Nacional de Aprendizaje-SENA), Medellín, Colombia
| | | | | | | | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, Alicante, Spain
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18
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Nepali S, Einboden R, Rudge T. Control of resources in the nursing workplace: Power and patronage relations. Nurs Inq 2022; 30:e12523. [PMID: 36043330 DOI: 10.1111/nin.12523] [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: 05/11/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
Immigrant nurses make up a large percentage of the Australian nursing workforce. Since the support in the workplace is expected to be inclusive for all nurses, the aim of this article is to explore how support and opportunities for professional growth, learning and development are distributed across different categories of nurses working in a neonatal intensive care unit (NICU). An ethnographic approach has opened an examination of the everyday workplace practices in the NICU to gain insight into how nurses made sense of the social and power relations occurring between themselves and their senior colleagues and how they experienced the support and opportunities they received in their workplace. As today's workplaces such as the NICU are diverse in races, culture and experiences, the concepts of intersectionality and cultural safety assisted in identifying inequality and injustice related to such diversity. The results showed how patronage relations rendered nurses with immigrant status with major disadvantage and left them clinically and culturally vulnerable. Such inequity defeats the reasons for encouraging skilled migration of nurses and poses questions on the cultural competency of recruiting organisations. Considering how cultural safety might guide staff development offers opportunities for authentic support to culturally diverse nurses.
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Affiliation(s)
- Shobha Nepali
- Cumberland Hospital, Mental Health Service, Westmead, New South Wales, Australia
| | - Rochelle Einboden
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, Ontario, Canada.,School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Trudy Rudge
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
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19
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Wang YW, Carnevale FA, Ezcurra M, Chougui K, Bilodeau C, Siedlikowski S, Tsimicalis A. The moral experiences of children with osteogenesis imperfecta. Nurs Ethics 2022; 29:1773-1791. [PMID: 35801828 DOI: 10.1177/09697330221105635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Serious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs. RESEARCH AIMS To explore children's actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression. RESEARCH DESIGN A focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured interviews, and practice-based research (art-making) with 10 children with OI; and local documents. PARTICIPANTS AND RESEARCH CONTEXT The study was conducted at a pediatric, orthopedic hospital. ETHICAL CONSIDERATIONS This study was approved by McGill University Institutional Review Board. FINDINGS/RESULTS Children expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children's voice and participation in health-related discussions. CONCLUSIONS Healthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children's actual and desired participation in care and promote positive moral experiences.
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Affiliation(s)
- Yi Wen Wang
- 5620McGill University, Canada.,70357Shriners Hospital for Children®-Canada, Canada
| | - Franco A Carnevale
- 5620McGill University, Canada.,70357Shriners Hospital for Children®-Canada, Canada
| | - Maria Ezcurra
- 5620McGill University, Canada.,70357Shriners Hospital for Children®-Canada, Canada
| | | | | | - Sophia Siedlikowski
- 5620McGill University, Canada.,70357Shriners Hospital for Children®-Canada, Canada
| | - Argerie Tsimicalis
- 5620McGill University, Canada.,70357Shriners Hospital for Children®-Canada, Canada
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20
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Cupit C, Paton A, Boyle E, Pillay T, Armstrong N. Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27-31 weeks gestation in England. BMJ Open 2022; 12:e059428. [PMID: 35760541 PMCID: PMC9237905 DOI: 10.1136/bmjopen-2021-059428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Preterm babies born between 27 and 31 weeks of gestation in England are usually born and cared for in either a neonatal intensive care unit or a local neonatal unit-with such units forming part of Operational Delivery Networks. As part of a national project seeking to optimise service delivery for this group of babies (OPTI-PREM), we undertook qualitative research to better understand how decisions about place of birth and care are made and operationalised. DESIGN Qualitative analysis of ethnographic observation data in neonatal units and semi-structured interviews with neonatal staff. SETTING Six neonatal units across two neonatal networks in England. Two were neonatal intensive care units and four were local neonatal units. PARTICIPANTS Clinical staff (n=15) working in neonatal units, and people present in neonatal units during periods of observation. RESULTS In the context of real-world neonatal practice, with multiple (and rapidly-evolving) uncertainties relating to mothers, babies and unit/network capacity, 'best place of care' protocols were only one element of much more complex decision-making processes. Staff often made judgements from a less-than-ideal starting point, and were forced to respond to evolving clinical and organisational factors. In particular, we report that managerial considerations relating to demand and capacity organised decision-making; demand and capacity management was time-consuming and generated various pressures on families, and tensions between staff. CONCLUSIONS Researchers and policymakers should take account of the organisational context within which place of care decisions are made. The dominance of demand and capacity management considerations is likely to limit the impact of other improvement interventions, such as initiatives to integrate families into the neonatal care provision. Demand and capacity management is an important element of neonatal care that may be overlooked, but significantly organises how care is delivered.
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Affiliation(s)
- Caroline Cupit
- Department of Health Sciences, University of Leicester, Leicester, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexis Paton
- Sociology and Policy, Aston Medical School, Aston University, Birmingham, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thillagavathie Pillay
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Research Institute for Health Related Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
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21
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Mescouto K, Olson RE, Hodges PW, Costa N, Patton MA, Evans K, Walsh K, Lonergan K, Setchell J. Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis. QUALITATIVE HEALTH RESEARCH 2022; 32:902-915. [PMID: 35341400 DOI: 10.1177/10497323221084358] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite recommendations to incorporate physical and psychosocial factors when providing care for people with back pain, research suggests that physiotherapists continue to focus on biological aspects. This study investigated how interpersonal and institutional norms influence this continued enactment of the biological aspects of management. We used theoretically-driven analysis, drawing from Foucauldian notions of power, to analyse 28 ethnographic observations of consultations and seven group discussions with physiotherapists. Analysis suggested that physiotherapy training established expectations of what a physiotherapist 'should' focus on, and institutional circumstances strongly drew the attention of physiotherapists towards biological aspects. Resistance to these forces was possible when, for example, physiotherapists reflected upon their practice, used silences and pauses during consultations, and actively collaborated with patients. These circumstances facilitated use of non-biomedical management approaches. Findings may assist physiotherapists to rework the enduring normative focus on biomedical aspects of care when providing care for patients with back pain.
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Affiliation(s)
- Karime Mescouto
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca E Olson
- School of Social Science, 144911The University of Queensland, Brisbane, QLD, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Nathalia Costa
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
- 4334The University of Sydney, Sydney, NSW, Australia
| | - Mary Anne Patton
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Kerrie Evans
- 4334The University of Sydney, Sydney, NSW, Australia
- Healthia Limited, Brisbane, QLD, Australia
| | - Kelly Walsh
- Persistent Pain Management Service, 157829Metro South Health, Brisbane, QLD, Australia
| | | | - Jenny Setchell
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
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22
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The Potential of Merging Intersectionality and Critical Ethnography for Advancing Refugee Women's Health Research. ANS Adv Nurs Sci 2022; 45:143-154. [PMID: 34879023 DOI: 10.1097/ans.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Critical ethnography and intersectionality are increasingly engaged in nursing and refugee research. Both approaches study marginalized populations and explore how their daily experiences of inequality and marginalization are influenced by various forms of oppression, power structures, and cultural context. A blended approach of critical ethnography with intersectionality can inform research with marginalized groups as both have much in common, including the call for social justice and change. This article outlines the potential of using the blended theoretical approach in advancing refugee women's health research and to inform a particular methodological approach for nursing research and health care practice.
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23
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Grant MP, Philip JAM, Deliens L, Komesaroff PA. Understanding Complexity in Care: Opportunities for Ethnographic Research in Palliative Care. J Palliat Care 2022:8258597221078375. [PMID: 35167402 DOI: 10.1177/08258597221078375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ethnography has been used to address a broad range of research questions in health care. With ethnographic research methods it is possible to gain access to the complex realities of health care practice as it occurs, through interpreting the nuances of individual and team behaviours, the roles and dynamics of care provision, and the social impacts and influences of illness. The provision of clinical palliative care is complex, involving multidisciplinary collaboration across different health systems, and is subject to a multitude of personal, cultural and environmental influences. This complexity demands creative methodological approaches to research in palliative care, of which ethnography plays an important, if infrequently utilised, role. Aim: This article aims to explore potential opportunities of ethnographic methods for palliative care research. Findings: Ethnographic methods focuses on behaviour in the 'natural' setting of participants, to create theoretical descriptions of events, cultures, interactions and experiences. In palliative care these methods may provide nuanced understandings of illness, relationships and teams, communication, medical education, complex care provision, and novel or changing health practices. Of particular importance is the potential of these methods to understand complex practices and processes, and engage with under-represented population groups who may be excluded from interview research. Conclusion: Ethnography offers important opportunities for future research in palliative care and should be considered as part of the 'research toolbox' to improve understanding of the complex nature of care provision and the experiences of illness and loss.
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Affiliation(s)
- Matthew P Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Monash University
| | - Jennifer A M Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Lee RR, McDonagh JE, Farre A, Peters S, Cordingley L, Rapley T. Data protection, information governance and the potential erosion of ethnographic methods in health care? SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:211-217. [PMID: 34811764 DOI: 10.1111/1467-9566.13408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
With the most recent developments to the European General Data Protection Regulations (GDPR) introduced in May 2018, the resulting legislation meant a new set of considerations for study approvers and health-care researchers. Compared with previous legislation in the UK (The Data Protection Act, 1998), it introduced more extensive and directive principles, requiring anybody 'processing' personal data to specifically define how this data will be obtained, stored, used and destroyed. Importantly, it also emphasised the principle of accountability, which meant that data controllers and processors could no longer just state that they planned to adhere to lawful data protection principles, they also had to demonstrate compliance. New questions and concerns around accountability now appear to have increased levels of scrutiny in all areas of information governance (IG), especially with regards to processing confidential patient information. This article explores our experiences of gaining required ethical and regulatory approvals for an ethnographic study in a UK health-care setting, the implications that the common law duty of confidentiality had for this research, and the ways in which IG challenges were overcome. The purpose of this article was to equip researchers embarking on similar projects to be able to navigate the potentially problematic and complex journey to approval.
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Affiliation(s)
- Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Royal Manchester Children's Hospital, Central Manchester University Hospitals Trust, Manchester, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Northumbria, UK
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Kobeissi LH, Ashna M, Messier K, Moran AC, Say L, Strong KL, Foster A. Exploring the feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child and adolescent health indicators in humanitarian settings: a multimethods, multicountry qualitative study protocol. BMJ Open 2021; 11:e041270. [PMID: 34907036 PMCID: PMC8671919 DOI: 10.1136/bmjopen-2020-041270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2019, over 70 million people were forcibly displaced worldwide. Women and girls comprise nearly half of this population and are at heightened risk of negative sexual and reproductive health outcomes. With the collapse of health systems, reduced resources and increased vulnerabilities from displacement, there is a need to strengthen current practices and ensure the delivery of comprehensive sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services. Recognising the need for consistency in data collection, analysis and use, the WHO developed a list of core SRMNCAH monitoring and evaluation indicators for services and outcomes in humanitarian settings. This research will explore the feasibility of collecting this core set of SRMNCAH indicators in displacement contexts. METHODS AND ANALYSIS We will undertake a multimethods qualitative study in seven humanitarian settings: Afghanistan, Albania, Bangladesh, Cameroon, the Democratic Republic of the Congo, Iraq and Jordan. We selected sites that reflect diversity in geographic region, sociocultural characteristics, primary location(s) of displaced persons and nature and phase of the crisis. Our study consists of four components: key informant interviews, facility assessments, observational sessions at select facilities and focus group discussions with front-line healthcare personnel. We will analyse our data using descriptive statistics and for content and themes. We will begin by analysing data from each setting separately and will then combine these data to explore concordant and discordant results, triangulate findings and develop global recommendations. ETHICS AND DISSEMINATION The University of Ottawa's Research Ethics Board and the Research Project Review Panel (RP 2) of the World Health Organization-Department of Sexual and Reproductive Health as well as local IRBs of PIs' research institutions reviewed and approved this protocol. We intend to disseminate findings through workshops at the WHO country, regional and headquarter levels, as well as through local, national and international conferences, workshops, peer-reviewed publications, and reports.
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Affiliation(s)
- Loulou Hassan Kobeissi
- Sexual and Reproductive Health and Research, Organisation mondiale de la Sante, Geneve, Switzerland
| | - Manizha Ashna
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kassandre Messier
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Cambridge Reproductive Health Consultants, Cambridge, Massachusetts, USA
| | - Allisyn C Moran
- Department of Maternal, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kathleen Louise Strong
- Department of Maternal, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Angel Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Black GB, van Os S, Machen S, Fulop NJ. Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review. BMC Med Res Methodol 2021; 21:274. [PMID: 34865630 PMCID: PMC8647364 DOI: 10.1186/s12874-021-01466-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement. METHODS We used a scoping review methodology drawing on Arksey and O'Malley's methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 - April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills. RESULTS We included 283 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking. CONCLUSIONS We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.
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Affiliation(s)
| | - Sandra van Os
- Department of Applied Health Research, UCL, London, UK
| | | | - Naomi J Fulop
- Department of Applied Health Research, UCL, London, UK
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Sawicki JG, Nystrom D, Purtell R, Good B, Chaulk D. Diagnostic error in the pediatric hospital: a narrative review. Hosp Pract (1995) 2021; 49:437-444. [PMID: 34743667 DOI: 10.1080/21548331.2021.2004040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diagnostic error is a prevalent type of medical error that is associated with considerable patient harm and increased medical costs. The majority of literature guiding the current understanding of diagnostic error in the hospital setting is from adult studies. However, there is research to suggest this type of error is also prevalent in the pediatric specialty. OBJECTIVES The primary objective of this study was to define the current understanding of diagnostic error in the pediatric hospital through a structured literature review. METHODS We searched PubMed and identified studies focusing on three aspects of diagnostic error in pediatric hospitals: the incidence or prevalence, contributing factors, and related interventions. We used a tiered review, and a standardized electronic form to extract data from included articles. RESULTS Fifty-nine abstracts were screened and 23 full-text studies were included in the final review. Seventeen of the 23 studies focused on the incidence or prevalence, with only 3 studies investigating the utility of interventions. Most studies took place in an intensive care unit or emergency department with very few studies including only patients on the general wards. Overall, the prevalence of diagnostic error in pediatric hospitals varied greatly and depended on the measurement technique and specific hospital setting. Both healthcare system factors and individual cognitive factors were found to contribute to diagnostic error, with there being limited evidence to guide how best to mitigate the influence of these factors on the diagnostic process. CONCLUSION The general knowledge of diagnostic error in pediatric hospital settings is limited. Future work should incorporate structured frameworks to measure diagnostic errors and examine clinicians' diagnostic processes in real-time to help guide effective hospital-wide interventions.
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Affiliation(s)
- Jonathan G Sawicki
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel Nystrom
- Clinical Risk Management, Intermountain Healthcare, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Rebecca Purtell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brian Good
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Chaulk
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Saharan A, Balachander M, Sparke M. Sharing the burden of treatment navigation: social work and the experiences of unhoused women in accessing health services in Santa Cruz. SOCIAL WORK IN HEALTH CARE 2021; 60:581-598. [PMID: 34749592 DOI: 10.1080/00981389.2021.1986457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/28/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
This paper explores the challenges faced by unhoused women in accessing general and reproductive health care services in Santa Cruz, CA. Semi-structured interviews with women experiencing houselessness were conducted in Santa Cruz, CA with a focus on their narrative experiences as patients. The overwhelming majority of participants expressed appreciation for clinics that provided support through longer hours, alternative therapies, and appointment reminders. Overall, the interviews indicated that women who had access to a social worker were much more likely to report improved access to satisfactory treatment. These findings suggest that there is not a tangible lack of healthcare services for unhoused women in the local community, but rather a burden of treatment navigation caused by a dearth of information on how to access care. The interviews suggest that this burden can be reduced with social work interventions and service centers that offer health navigation support. By adapting theories of the "burden of treatment," we argue that additional attention must be paid to overcoming the "burden of treatment navigation." For related reasons, we suggest that increasing the availability of social workers would concretely improve health outcomes for unhoused women.
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Pozniak K, Buchanan F, Cross A, Crowson J, Galuppi B, Grahovac D, Gorter JW, Hlyva O, Ketelaar M, Kraus de Camargo O, Krpan Mesic M, Martens R, McCauley D, Nguyen L, Palisano RJ, Phoenix M, Putterman C, Rosenbaum P, Sprung J, Strohm S, Teplicky R, Thomson D, Wright M. Building a culture of engagement at a research centre for childhood disability. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:78. [PMID: 34742354 PMCID: PMC8572501 DOI: 10.1186/s40900-021-00319-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Engaging patients and family members as partners in research studies has become a widespread practice in healthcare. However, relatively little has been documented about what happens after the research study ends. For example, is patient and family engagement embedded in the wider infrastructure of organizations, and if so how? What are the long-term effects of engaging parents on research teams on the culture of how research is conducted? This study seeks to address these two gaps by examining how a culture of family engagement has been built over time at CanChild Centre for Childhood Disability Research at McMaster University in Ontario, Canada. METHODS This study is based on ethnographic research methodology and combines elements of organizational ethnography, interviews, and collaborative auto-ethnography with parent partners, researchers, staff, and trainees. RESULTS Since the inception of CanChild Centre for Childhood Disability Research at McMaster University in 1989, parents have been involved in research studies. Over time, this involvement evolved from being consulted on research studies to undertaking decision-making roles as partners and most recently as co-principal investigators. A growing infrastructure fosters a community of engagement that goes beyond the individual research study, and often beyond CanChild. This infrastructure consists of training, knowledge mobilization and social networking. In addition, the "softer" building blocks of CanChild's culture of engagement are an openness to learning from others, a commitment to relationship building, and a drive to grow and improve. These values are espoused by the leadership and are instilled in the next generation of researchers to inform both research and clinical work. While some challenges should be acknowledged when researchers and family partners work together on research studies, we identify a number of strategies that we have used in our studies to foster authentic and meaningful family-researcher partnerships. CONCLUSION Engaging patients and families as partners in research constitutes a culture shift in health research, whereby studies about patients and families are carried out with them. Developing a community of engagement that transcends an individual research study is a step towards creating a culture of research that is truly shaped by the people about whom the research is being done.
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Affiliation(s)
- Kinga Pozniak
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Francine Buchanan
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Andrea Cross
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Jennifer Crowson
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Down Syndrome Association of Hamilton, Hamilton, Canada
| | - Barb Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Danijela Grahovac
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Oksana Hlyva
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine Utrecht, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Olaf Kraus de Camargo
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Manda Krpan Mesic
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Rachel Martens
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Linda Nguyen
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Robert J. Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Drexel University, Philadelphia, PA USA
| | - Michelle Phoenix
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Holland Bloorview Kids Rehabilitation Centre, Toronto, Canada
| | - Connie Putterman
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Jennifer Sprung
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Sonya Strohm
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Donna Thomson
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Marilyn Wright
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Hayre CM, Blackman S, Hackett PMW, Muller D, Sim J. Ethnography and medicine: the utility of positivist methods in research. Anthropol Med 2021; 29:338-344. [PMID: 34523375 DOI: 10.1080/13648470.2021.1893657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This commentary discusses the methodological utility of ethnography within the medical space. Whilst a general consensus affirms that ethnography aligns with qualitative approaches, as identified within the existing medical literature, here, we demonstrate how quantitative [positivist] methods can also be incorporated. This paper begins by contextualising ethnographic approaches within medical contexts by demonstrating its empirical value within the existing literature. Next, we discuss the interconnection between the practice of 'doctoring' and ethnographic research, whereby doctors themselves use forms of inductive and deductive reasoning to treat and manage patients in their everyday context. This philosophical discussion not only links to the everyday practice of medical practitioners, but also critically reflects on the role of the first author, as a diagnostic radiographer. Lastly, this paper identifies the virtues of ethnographic research for medical students and/or medical doctors whereby the combination of qualitative and quantitative methods (within an ethnographic methodology) can lead to new empirical and methodological insights, enabling the creation of alternate research strategies and evidence. This methodological strategy may be best considered amongst medical students and/or early career medical researchers, but we also anticipate it to resonate and open further discussion with experienced medical practitioners and researchers transnationally.
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Affiliation(s)
- C M Hayre
- School of Dentistry and Health Sciences, Faculty of Science, Charles Sturt University, Albury, Australia
| | - S Blackman
- School of Creative Arts & Industries, Canterbury Christ Church University, Canterbury, UK
| | - P M W Hackett
- Marketing Communication Department, Emerson College, Boston, MA, USA
| | - D Muller
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | - J Sim
- School of Primary and Allied Health Care, Monash University, Clayton, Australia
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Cubellis L, Schmid C, von Peter S. Ethnography in Health Services Research: Oscillation Between Theory and Practice. QUALITATIVE HEALTH RESEARCH 2021; 31:2029-2040. [PMID: 34286610 PMCID: PMC8552374 DOI: 10.1177/10497323211022312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The well-known divergence between what policy and protocol look like on paper, and what happens in the actual practice of daily life remains a central challenge in health services provision and research. This disparity is usually referred to as the theory-practice gap and contributes to concerns that scientific evidence fails to make substantial impacts on the processes of service delivery. In this article, we present an argument for the inclusion of ethnographic methods in health services research and show that this approach enables researchers to address this divergence by working within it. We trace how ethnography, through generative processes of oscillation, can take us beyond lamenting the gap and capture the relational dynamics of people working together in complex systemic arrangements. By moving from example to methodological reflection, to principle of research, we demonstrate how the oscillation of ethnographic research between theory and practice can productively contribute to the field of health service research.
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Affiliation(s)
- Lauren Cubellis
- Freie Universität Berlin, Berlin, Germany
- Lauren Cubellis, Freie Universität Berlin, Ehrenbergstr. 26/28, 14195 Berlin, Germany.
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"Everybody in this community is at risk of dying": An ethnographic exploration on the potential of integrating a palliative approach to care among workers in inner-city settings. Palliat Support Care 2021; 18:670-675. [PMID: 32378499 DOI: 10.1017/s1478951520000280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE At the end of life, the need for care increases. Yet, for structurally vulnerable populations (i.e., people experiencing homelessness and poverty, racism, criminalization of illicit drug use, stigma associated with mental health), access to care remains highly inaccessible. Emerging research suggests that enhancing access to palliative care for these populations requires moving care from traditional settings, such as the hospital, into community settings, like shelters and onto the street. Thus, inner-city workers (ICWs) (e.g., housing support and community outreach) have the potential to play pivotal roles in improving access to care by integrating a "palliative approach to care" in their work. METHOD Drawing upon observational field notes and interview data collected for a larger critical ethnographic study, this secondary thematic analysis examines ICWs' (n = 31) experiences providing care for dying clients and garners their perspectives regarding the constraints and facilitators that exist in successfully integrating a palliative approach to care in their work. RESULTS Findings reveal three themes: (1) Approaches, awareness, and training; (2) Workplace policies and filling in the gaps; and (3) Grief, bereavement, and access to supports. In brief, ICWs who draw upon harm reduction strategies strongly parallel palliative approaches to care, although more knowledge/training on palliative approaches was desired. In their continuous work with structurally vulnerable clients, ICWs have the opportunity to build trusting relationships, and over time, are able to identify those in need and assist in providing palliative support. However, despite death and dying is an everyday reality of ICWs, many described a lack of formal acknowledgement by employers and workplace support as limitations. SIGNIFICANCE OF RESULTS Findings contribute promising practices for enhancing equitable access to palliative care for society's most vulnerable populations by prioritizing front-line workers' perspectives on how best to integrate a palliative approach to care where structurally vulnerable populations live and die.
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Bandyopadhyay M. Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia. BMC Pregnancy Childbirth 2021; 21:500. [PMID: 34243754 PMCID: PMC8272384 DOI: 10.1186/s12884-021-03981-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Asian women are at a high risk of developing gestational diabetes mellitus than other women in Australia. Gestational diabetes affects up to 14-19% of all pregnancies among South Asian, South East Asian, and Arabic populations placing women at risk of adverse pregnancy outcomes. Although, gestational diabetes resolves after childbirth, women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within five to ten years of the index pregnancy. Increasingly, South Asian women are being diagnosed with gestational diabetes in Australia. Therefore, we aimed to gain a better understanding of the lived experiences of South Asian women and their experiences of self-management and their health care providers' perspectives of treatment strategies. METHODS Using an ethnographic qualitative research methodology, semi-structured one-on-one, face-to-face interviews were conducted with 21 health care providers involved in gestational diabetes management and treatment from the three largest tertiary level maternity hospitals in Melbourne, Victoria, Australia. In-depth interviews were conducted with 23 South Asian women post diagnosis between 24-28 weeks gestation in pregnancy. RESULTS Health care providers had challenges in providing care to South Asian women. The main challenge was to get women to self-manage their blood glucose levels with lifestyle modification. Whilst, women felt self-management information provided were inadequate and inappropriate to their needs. Women felt 'losing control over their pregnancy', because of being preoccupied with diet and exercise to control their blood glucose level. CONCLUSIONS The gestational diabetes clinical practice at the study hospitals were unable to meet consumer expectations. Health care providers need to be familiar of diverse patient cultures, rather than applying the current 'one size fits all' approach that failed to engage and meet the needs of immigrant and ethnic women. Future enabling strategies should aim to co-design and develop low Glycaemic Index diet plans of staple South Asian foods and lifestyle modification messages.
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Affiliation(s)
- Mridula Bandyopadhyay
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville Victoria, 3052, Australia.
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Haines ER, Kirk MA, Lux L, Smitherman AB, Powell BJ, Dopp A, Stover AM, Birken SA. Ethnography and user-centered design to inform context-driven implementation. Transl Behav Med 2021; 12:6315391. [PMID: 34223893 DOI: 10.1093/tbm/ibab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite pervasive findings pointing to its inextricable role in intervention implementation, context remains poorly understood in implementation science. Existing approaches for describing context (e.g., surveys, interviews) may be narrow in scope or superficial in their elicitation of contextual data. Thus, in-depth and multilevel approaches are needed to meaningfully describe the contexts into which interventions will be implemented. Moreover, many studies assess context without subsequently using contextual information to enhance implementation. To be useful for improving implementation, though, methods are needed to apply contextual information during implementation. In the case example presented in this paper, we embedded an ethnographic assessment of context within a user-centered design approach to describe implementation context and apply that information to promote implementation. We developed a patient-reported outcome measure-based clinical intervention to assess and address the pervasive unmet needs of young adults with cancer: the Needs Assessment & Service Bridge (NA-SB). In this paper, we describe the user-centered design process that we used to anticipate context modifications needed to deliver NA-SB and implementation strategies needed to facilitate its implementation. Our ethnographic contextual inquiry yielded a rich understanding of local implementation context and contextual variation across potential scale-up contexts. Other methods from user-centered design (i.e., translation tables and a design team prototyping workshop) allowed us to translate that information into specifications for NA-SB delivery and a plan for implementation. Embedding ethnographic methods within a user-centered design approach can help us to tailor interventions and implementation strategies to their contexts of use to promote implementation.
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Affiliation(s)
- Emily R Haines
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Andrew B Smitherman
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Alex Dopp
- RAND Corporation, Santa Monica, CA, USA
| | - Angela M Stover
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Jones M, Falkmer M, Milbourn B, Tan T, Bölte S, Girdler S. Identifying the Essential Components of Strength-based Technology Clubs for Adolescents with Autism Spectrum Disorder. Dev Neurorehabil 2021; 24:323-336. [PMID: 33684320 DOI: 10.1080/17518423.2021.1886192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Strength-based technology clubs for adolescents with autism spectrum disorder (ASD) have become increasingly popular; however, they remain poorly described in the literature. Before the impact and benefit of strength-based technology clubs can be measured, consistency in their design and delivery must be established. This study aimed to identify the essential components of strength-based technology clubs by exploring context, mechanisms, and outcomes of existing strength-based technology clubs.Method: Twenty-three adolescents with ASD (mean age 12.96 years, SD = 1.86, range = 10-18 years), 25 parents (mean age 46.08 years, SD = 8.27, range = 33-69 years), and 20 facilitators (mean age 27.93 years, SD = 6.55, range = 20-46 years) were purposively sampled from three established strength-based technology clubs. Data were obtained via ethnographic methods, including participant observations, interviews, and focus groups. Data analysis was underpinned by a realist evaluation, which provided the context-mechanism-outcome framework.Results: Data analysis revealed that strength-based technology clubs had four context themes (personal factors of adolescents, personal factors of facilitators, personal factors of parents, institution), three mechanism themes (activity design, strengths and abilities, environment), and three outcome themes (skill building, connection with others, emotion).Conclusion: The results highlighted the importance of understanding the personal context of adolescents, providing an individualized approach, leveraging individual interests, and modifying the environment to suit the individual. The findings contributed to defining a strength-based approach within ASD, and have demonstrated that positive outcomes can be achieved by focusing on strengths rather than deficits. Future ASD services can use the results as a framework for applying a strength-based approach. The efficacy of newly designed strength-based programs can then be tested.
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Affiliation(s)
- Matthew Jones
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin Autism Research Group, Curtin University, Perth, Australia
| | - Marita Falkmer
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin Autism Research Group, Curtin University, Perth, Australia.,School of Education and Communication, Swedish Institute for Disability Research, Jönköping University, Gjuterigatan, Sweden
| | - Ben Milbourn
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin Autism Research Group, Curtin University, Perth, Australia
| | - Tele Tan
- School of Mechanical Engineering, Faculty of Science and Engineering, Curtin University, Perth, Australia
| | - Sven Bölte
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin Autism Research Group, Curtin University, Perth, Australia.,Centre of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden
| | - Sonya Girdler
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin Autism Research Group, Curtin University, Perth, Australia.,Centre of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden
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Coates D, Catling C. The Use of Ethnography in Maternity Care. Glob Qual Nurs Res 2021; 8:23333936211028187. [PMID: 34263014 PMCID: PMC8243125 DOI: 10.1177/23333936211028187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research.
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Johansson E, Jonsson F, Rapo E, Lundgren AS, Hörnsten Å, Nilsson I. Let's Try Social Prescribing in Sweden (SPiS) - an Interventional Project Targeting Loneliness among Older Adults Using a Model for Integrated Care: A Research Protocol. Int J Integr Care 2021; 21:33. [PMID: 34220397 PMCID: PMC8231464 DOI: 10.5334/ijic.5609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/23/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Loneliness and social isolation among older adults (≥65) are an emerging issue of public concern, associated with increased morbidity and mortality. Today there is no systematic intervention developed, implemented or evaluated in Sweden addressing loneliness. The overall aim for this project is to develop, test and refine a person-centred Swedish model for social prescribing (SPiS), and to assess whether and how it reduces loneliness, promotes health and improves well-being among older adults. DESCRIPTION The focus will be to develop, culturally adapt, evaluate and refine the SPiS model. Following the sequential structure of realist evaluation in three consecutive phases qualitative and quantitative data along with subsequent analysis methods will be collected and utilized. The project will provide knowledge of what works with the social prescribing model, for whom, in what conditions and why, in relation to loneliness, health and well-being among older adults. DISCUSSION SPiS has the unique position of providing initial knowledge regarding how to reduce loneliness in the Swedish context. However, evaluation is complex as this research goes beyond the unidimensional question "Is it working?". CONCLUSION Developing, implementing and evaluating such a complex program needs systematic and close evaluation.
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O'Carroll A, Wainwright D. Doctor-patient interactions that exclude patients experiencing homelessness from health services: an ethnographic exploration. BJGP Open 2021; 5:BJGPO.2021.0031. [PMID: 33785567 PMCID: PMC8278504 DOI: 10.3399/bjgpo.2021.0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND People experiencing homelessness have poor health indices and poor access to health care. Their health service utilisation (HSU) is typified by: late illness presentations; poor attendance rates at appointments; low usage of primary care services and outpatient departments; and high utilisation of emergency departments and inpatient services. Why people experiencing homelessness have these particular HSU patterns is poorly understood. AIM This research sought to explore barriers to health service usage for people experiencing homelessness. DESIGN & SETTING The authors conducted critical realist ethnography over 13 months in Dublin with people experiencing homelessness at four purposively chosen sites (a food hall, a drop-in centre, an emergency department, and an outreach service for rough sleepers). METHOD Ethnographic research was supplemented with focus groups of hospital doctors and people experiencing homelessness, and with 50 semi-structured interviews with people experiencing homelessness. The epistemological framework was critical realism. RESULTS One of the factors identified in the research as contributing to the HSU pattern of people experiencing homelessness was recurrent interactions between health professionals and patients, whereby patients were either excluded or discouraged from attending health services, or self-excluded themselves from services. These interactions were described as 'conversations of exclusion'. Four such conversations were described: 'the benzodiazepine conversation'; 'the mistrustful conversation'; 'the blaming conversation'; and 'the assertive conversation'. CONCLUSION There are certain recurrent interactions between people experiencing homelessness and doctors that result in the exclusion of people experiencing homelessness from health services.
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Affiliation(s)
- Austin O'Carroll
- Programme Director, North Dublin City General Practice Training Programme, Catherine McAuley Centre, Dublin, Republic of Ireland
- Doctoral Graduate, University of Bath, Department for Health, Bath, UK
- GP, Grangegorman Primary Care Centre, Dublin, Republic of Ireland
| | - David Wainwright
- Senior Lecturer, University of Bath, Department for Health, Bath, UK
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Boye S, Bouaré S, Ky-Zerbo O, Rouveau N, Simo Fotso A, d'Elbée M, Silhol R, Maheu-Giroux M, Vautier A, Breton G, Keita A, Bekelynck A, Desclaux A, Larmarange J, Pourette D. Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project. Front Public Health 2021; 9:653543. [PMID: 34095059 PMCID: PMC8170018 DOI: 10.3389/fpubh.2021.653543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/19/2021] [Indexed: 12/04/2022] Open
Abstract
Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners. Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis. Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status. Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.
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Affiliation(s)
- Sokhna Boye
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France
| | | | - Odette Ky-Zerbo
- TransVIHMI (IRD, Université de Montpellier, INSERM), Montpellier, France
| | - Nicolas Rouveau
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France
| | - Arlette Simo Fotso
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France
| | - Marc d'Elbée
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Romain Silhol
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Abdelaye Keita
- Département qualité sécurité et sécurité biologique, Institut National de Santé Publique, Bamako, Mali
| | - Anne Bekelynck
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Alice Desclaux
- Institut de Recherche pour le Développement, Transvihmi (IRD, INSERM, Montpellier University), Montpellier, France.,CRCF, Dakar, Sénégal
| | - Joseph Larmarange
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France
| | - Dolorès Pourette
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France
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The effects of webcams on German neonatal intensive care units - study protocol of a randomised crossover trial (Neo-CamCare). BMC Health Serv Res 2021; 21:456. [PMID: 33980220 PMCID: PMC8117291 DOI: 10.1186/s12913-021-06387-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background The separation of parents and their prematurely born children during care in a neonatal intensive care unit (NICU) can have far-reaching consequences for the well-being of the parents and also of the children. The aim of this study is to evaluate the use of webcams on NICUs and to conduct a systematic assessment of their possible effects on parents and clinical staff. In addition, it aims at determining the need for webcams in German NICUs and to identify possible barriers and moderators. The development and evaluation of practical guidance for the use of webcams will enable the comprehensive education of clinical staff and parents and, as a result, is intended to mitigate any potential undesirable consequences. Methods The study will be based on a mixed methods approach including all groups concerned in the care. Qualitative data will be collected in interviews and focus groups and evaluated using content analysis. The collection of quantitative data will be based on written questionnaires and will aim to assess the status quo as regards the use of webcams on German NICUs and the effects on parents, physicians, and nursing staff. These effects will be assessed in a randomised cross-over design. Four NICUs will be involved in the study and, in total, the parents of 730 premature babies will be invited to take part in the study. The effects on the nursing staff, such as additional workload and interruptions in workflows, will be evaluated on the basis of observation data. Discussion This study will be the largest multicentre study known to us that systematically evaluates the use of webcams in neonatal intensive care units. The effects of the implementation of webcams on both parents and care providers will be considered. The results provide evidence to decide whether to promote the use of webcams on NICUs or not and what to consider when implementing them. Trial registration The trial has been registered at the German Clinical Trial Register (DRKS). Number of registration: DRKS00017755, date of registration: 25.09.2019,
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Bentz HH, Madsen SH, Pilegaard MS, Østergaard LG, Brandt Å, Offersen SMH, la Cour K. Occupations creating joy for people living with advanced cancer: A qualitative descriptive study. Br J Occup Ther 2021. [DOI: 10.1177/03080226211009419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction For people living with advanced cancer, the possibilities for experiences of joy are seriously influenced by the consequences of the illness. Due to the limited expected lifetime, the need to support such experiences that may entail joy and contribute to quality of life are of importance. Research shows that people with advanced cancer experience quality of life through occupations they are able to perform and enjoy. The aim of this study was to describe which occupations contribute to joy for people living with advanced cancer and explore how they reflect upon these occupations during an occupational therapy intervention. Methods In total, 111 people with advanced cancer from the intervention group in a randomised controlled trial participated in the present study. Thirty-six of these participants were interviewed, and for 10 participants, this was combined with participant observations. A directed and a conventional content analysis were applied. Results 148 occupations contributing to joy were categorised into self-care, leisure and productivity. Most occupations were placed into leisure (89%). Participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; having an all or nothing approach; and hoping to resume occupations contributing to joy. Conclusion This study found a wide range of occupations contributing to joy and shows the importance of focusing on enabling leisure occupations for people living with advanced cancer. The wide range of occupations as well as participants’ approaches to occupations may be useful to inform future interventions to enable enjoyment for people living with advanced cancer.
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Affiliation(s)
- Hannah Holt Bentz
- Department of Occupational Therapy, University College Absalon, Næstved, Denmark
| | | | - Marc Sampedro Pilegaard
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative care, Odense University Hospital, Nyborg, Denmark
| | - Lisa Gregersen Østergaard
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Åse Brandt
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Karen la Cour
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Murillo-Pedrozo AM, Martínez-Herrera E, Ronda-Pérez E, Agudelo-Suárez AA. A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3897. [PMID: 33917688 PMCID: PMC8068052 DOI: 10.3390/ijerph18083897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.
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Affiliation(s)
| | - Eliana Martínez-Herrera
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín 050010, Colombia;
- Research Group on Health Inequalities, Environment, Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain;
- CIBERESP, 28029 Madrid, Spain
| | - Andrés A. Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Medellín 050010, Colombia;
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain;
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Willis C, Elliott C, Reid S, Nyquist A, Jahnsen R, Bölte S, Rosenberg M, Girdler S. "Capturing the magic": identifying the active ingredients of a physical activity participation intervention for children and youth with disabilities. Disabil Rehabil 2021; 44:1650-1659. [PMID: 33820452 DOI: 10.1080/09638288.2021.1907458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to define the active ingredients of a participation-focused physical activity intervention for children and youth with disabilities. MATERIALS AND METHODS An ethnographic approach was employed, triangulating participant observation, interviews and focus groups. Participant recruitment occurred through purposive sampling of staff employed at Beitostolen Healthsports Centre (BHC), and paediatric service providers visiting the centre. Interviews were transcribed verbatim and coded together with observation data. Secondary coding linked data to corresponding categories of the International Classification of Functioning, Disability and Health: Child and Youth version. RESULTS Thirteen staff from BHC and 7 paediatric service providers participated in the study. Fourteen active ingredients were identified and were characterised at the level of the intervention (k = 8), the organisation (k = 4), and the individual (k = 2). Within the ingredients, 53 unique ICF-CY categories were identified. Twenty-six categories belonged to the ICF-CY component of "environment," and 26 categories to "activities and participation." No categories related to "body functions" or "body structures." CONCLUSIONS The role of the environment, and specifically support and relationships, may be an essential consideration for enabling physical activity participation. Outcomes may guide program design and implementation to promote and sustain physical activity behaviours for children and youth with disabilities.Implications for rehabilitationThe active ingredients identified in this study may guide the design and implementation of programs to promote and sustain physical activity behaviours of children and youth with disabilities.Leadership qualities and strength-based attitudes may be key characteristics of organisational practice that optimise outcomes for children and families.A "relationship-centred" approach, i.e., a network of children, families, health professionals, peers, mentors, and services in the community, may support children and young people with disabilities to achieve their physical activity participation goals.
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Affiliation(s)
- Claire Willis
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,School of Human Sciences (Exercise Science), The University of Western Australia, Perth, Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
| | - Siobhan Reid
- School of Human Sciences (Exercise Science), The University of Western Australia, Perth, Australia
| | | | - Reidun Jahnsen
- Beitostolen Healthsports Centre, Beitostolen, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services, University of Oslo, Oslo, Norway
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Michael Rosenberg
- School of Human Sciences (Exercise Science), The University of Western Australia, Perth, Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia.,Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Smart K, Ma E, Qu H, Ding L. COVID-19 impacts, coping strategies, and management reflection: A lodging industry case. INTERNATIONAL JOURNAL OF HOSPITALITY MANAGEMENT 2021; 94:102859. [PMID: 34785846 PMCID: PMC8586796 DOI: 10.1016/j.ijhm.2021.102859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 05/23/2023]
Abstract
The COVID-19 pandemic has hit the global tourism and hospitality industry with drastic results. Hotels have been experiencing unprecedented challenges, leaving many to temporarily or permanently closed. Employing a case study approach supported by both quantitative and qualitative analysis, this study examined how two hotels in Oklahoma City had coped with challenges presented by the COVID-19 pandemic, from day to day operations, health and safety measures to marketing, human resources and cost-saving strategies. The study contributes to the tourism crisis and disaster literature by providing micro-level coping strategies, a literature gap that needs to be addressed, particularly under the current pandemic.
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Affiliation(s)
- Kaleb Smart
- School of Hospitality and Tourism Management, Spears School of Business, Oklahoma State University, United States
| | - Emily Ma
- Department of Hospitality and Tourism Management, University of Massachusetts, United States
| | - Hailin Qu
- William E. Davis Distinguished Chair Emeritus, School of Hotel and Restaurant Administration, Oklahoma State University, Stillwater, OK, 74078, United States
| | - Li Ding
- Institute Paul Bocuse, BP 25, Chateau du Vivier, Ecully, 69131, France
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Gertner AK, Franklin J, Roth I, Cruden GH, Haley AD, Finley EP, Hamilton AB, Palinkas LA, Powell BJ. A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34056611 PMCID: PMC8153409 DOI: 10.1177/2633489521992743] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Researchers have argued for the value of ethnographic approaches to implementation science (IS). The contested meanings of ethnography pose challenges and possibilities to its use in IS. The goal of this study was to identify sources of commonality and variation, and to distill a set of recommendations for reporting ethnographic approaches in IS. Methods: We included in our scoping review English-language academic journal articles meeting two criteria: (1) IS articles in the healthcare field and (2) articles that described their approach as ethnographic. In March 2019, we implemented our search criteria in four academic databases and one academic journal. Abstracts were screened for inclusion by at least two authors. We iteratively develop a codebook for full-text analysis and double-coded included articles. We summarized the findings and developed reporting recommendations through discussion. Results: Of the 210 articles whose abstracts were screened, 73 were included in full-text analysis. The number of articles increased in recent years. Ethnographic approaches were used within a wide variety of theoretical approaches and research designs. Articles primarily described using interviews and observational methods as part of their ethnographic approaches, though numerous other methods were also employed. The most cited rationales for using ethnographic approaches were to capture context-specific phenomena, understand insiders’ perspective, and study complex interactions. In reporting on ethnographic approaches, we recommend that researchers provide information on researcher training and position, reflect on researchers’ positionality, describe observational methods in detail, and report results from all the methods used. Conclusion: The number of IS studies using ethnography has increased in recent years. Ethnography holds great potential for contributing further to IS, particularly to studying implementation strategy mechanisms and understanding complex adaptive systems. Researchers have proposed that ethnographic methods may be valuable to implementation research and practice. Ethnographic approaches have their roots in the field of anthropology, but they are now used in many fields. These approaches often involve a researcher spending time in “real-world” settings, conducting interviews and observation to understand a group of people. That said, researchers disagree on the meaning of ethnography, which presents a challenge to its use in implementation science (IS). We searched for articles in the field of IS that described their methods as ethnographic. We then reviewed the articles, looking for similarities and differences in how and why ethnographic approaches were used. Many of these articles said they used ethnographic methods because they were interested in issues like context, research participants’ views, and complex interactions. We found a large amount of variation in how ethnographic methods were used. We developed recommendations for describing ethnographic methods in a way that readers can clearly understand. We also made several observations of the value ethnographic approaches can bring to IS. Ethnographic methods may be especially useful to studying unplanned and unexpected changes that take place during implementation. These recommendations and observations could be helpful to implementation researchers wishing to use ethnographic methods.
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Affiliation(s)
- Alex K Gertner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua Franklin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | | | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin P Finley
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, University of Southern California, Los Angeles, CA, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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46
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Taking sides with patients using institutional ethnography. JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2021. [DOI: 10.1108/joe-12-2019-0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe main purpose of this paper is to document the first author's experience of using institutional ethnography (IE) to “take sides” in healthcare research. The authors illustrate the points with data and key findings from a study of cardiovascular disease prevention.Design/methodology/approachThe authors use Dorothy E Smith's IE approach, and particularly the theoretical tool of “standpoint”.FindingsStarting with the development of the study, the authors trouble the researcher's positionality, highlighting tensions between institutional knowledge of “prevention” and other locations where knowledge about patients' health needs materialises. The authors outline how IE's theoretically and methodologically integrated toolkit became a framework for “taking sides” with patients. They describe how the researcher used IE to take a standpoint and map institutional relations from that standpoint. They argue that IE enabled an innovative analysis but also reflect on the challenges of conducting an IE – the conceptual unpicking and (re)thinking, and demarcating boundaries of investigation within an expansive dataset.Originality/valueThis paper illustrates IE's relevance for organisational ethnographers wishing to find a theoretically robust approach to taking sides, and suggests ways in which the IE approach might contribute to improving services, particularly healthcare. It provides an illustration of how taking a patient standpoint was accomplished in practice, and reflects on the challenges involved.
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O’Mara Sage E, Munguambe KR, Blevins J, Guilaze R, Kosia B, Maixenchs M, Bassat Q, Mandomando I, Kaiser R, Kone A, Jambai A, Myburgh ND, Ngwenya N, Madhi SA, Degefa K, Ackley C, Breiman RF, Raghunathan PL. Investigating the Feasibility of Child Mortality Surveillance With Postmortem Tissue Sampling: Generating Constructs and Variables to Strengthen Validity and Reliability in Qualitative Research. Clin Infect Dis 2020; 69:S291-S301. [PMID: 31598657 PMCID: PMC6785679 DOI: 10.1093/cid/ciz564] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS. Methods Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting. Results Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability. Conclusions These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS.
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Affiliation(s)
- Elizabeth O’Mara Sage
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Correspondence: E. O’Mara Sage, US Centers for Disease Control and Prevention, Center for Global Health, 1600 Clifton Rd, MS H21-9, Atlanta, GA 30333 ()
| | - Khátia R Munguambe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Eduardo Mondlane University, Faculty of Medicine, Community Health Department, Maputo, Mozambique
| | - John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Rui Guilaze
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Reinhard Kaiser
- FOCUS 1000, Makeni, Sierra Leone
- US Centers for Disease Control and Prevention--Sierra Leone, Freetown, Sierra Leone
| | - Ahoua Kone
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Amara Jambai
- FOCUS 1000, Makeni, Sierra Leone
- Ministry of Health and Sanitation, Sierra Leone
| | - Nellie D Myburgh
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Noni Ngwenya
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Ketema Degefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Caroline Ackley
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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48
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Wang WY, Han GS, Forbes-Mewett H. Community stakeholder and opinion formation toward end-of-life planning in Chinese community in Australia. DEATH STUDIES 2020; 46:1253-1265. [PMID: 32877310 DOI: 10.1080/07481187.2020.1815101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We examine the role of stakeholders in constructing new socio-cultural narratives of advance care planning in the Chinese community in Australia. Applying the communication theory of opinion leader(ship) and drawing on data from 41 interviews and field observation notes, we explore how stakeholders establish their authority and perform their expertise. Data analysis shows stakeholders have gained their opinion leadership status through demonstrating their ability to link the Chinese cultural values of family harmony and parental duty and the notions of self-empowerment and independence in official advance care planning promotions in Australia.
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Affiliation(s)
- Wilfred Yang Wang
- School of Culture and Communication, the University of Melbourne, Melbourne, Australia
| | - Gil-Soo Han
- School of Media, Film and Journalism, Monash University, Melbourne, Australia
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49
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Sibeoni J, Verneuil L, Manolios E, Révah-Levy A. A specific method for qualitative medical research: the IPSE (Inductive Process to analyze the Structure of lived Experience) approach. BMC Med Res Methodol 2020; 20:216. [PMID: 32847514 PMCID: PMC7449004 DOI: 10.1186/s12874-020-01099-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This paper reports the construction and use of a specific method for qualitative medical research: The Inductive Process to Analyze the Structure of lived Experience (IPSE), an inductive and phenomenological approach designed to gain the closest access possible to the patients' experience and to produce concrete recommendations for improving care. This paper describes this innovative method. METHODS IPSE has five steps: 1) set up a research group, 2) ensure the originality of the research, 3) organize recruitment and sampling intended to optimize exemplarity, 4) collect data that enable entry into the subjects' experience, and 5) analyze the data. This final stage is composed of one individual descriptive phase, followed by two group phases: i) structure the experience, and ii) translate the findings into concrete proposals that make a difference in care. RESULTS This innovative method has provided original findings that have opened up new avenues of research and have important practical implications, including (1) the development of patient-reported outcomes, (2) clinical recommendations concerning assessment and treatment, (3) innovative ways to improve communication between patients and doctors, and (4) new insights for medical pedagogy. CONCLUSIONS IPSE is a qualitative method specifically developed for clinical medical research to reach concrete proposals, easily combined with quantitative research within a mixed-method study design and then directly integrated within evidence-based medicine.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prud'hon, 95107 ARGENTEUIL Cedex, France. .,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France.
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Anne Révah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prud'hon, 95107 ARGENTEUIL Cedex, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
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50
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Simister R, Black GB, Melnychuk M, Ramsay AIG, Baim-Lance A, Cohen DL, Eng J, Xanthopoulou PD, Brown MM, Rudd AG, Morris S, Fulop NJ. Temporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of the day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units.
Objectives
To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units, and to identify factors influencing such variations.
Design
This was a prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. Factors influencing variations in care and outcomes were studied through interview and observation data.
Setting
The setting was acute stroke services in London hyperacute stroke units.
Participants
A total of 7094 patients with a primary diagnosis of stroke took part. We interviewed hyperacute stroke unit staff (n = 76), including doctors, nurses, therapists and administrators, and 31 patients and carers. We also conducted non-participant observations of delivery of care at different times of the day and week (n = 45, ≈102 hours).
Intervention
Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards was designed to deliver uniform access to high-quality hyperacute stroke unit care across the week.
Main outcome measures
Indicators of quality of acute stroke care, mortality at 3 days after admission, disability at the end of the inpatient spell and length of stay.
Data sources
Sentinel Stroke National Audit Programme data for all patients in London hyperacute stroke units with a primary diagnosis of stroke between 1 January and 31 December 2014, and nurse staffing data for all eight London hyperacute stroke units for the same period.
Results
We found no variation in quality of care by day and time of admission across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor in 3-day mortality nor disability at hospital discharge. Other quality-of-care measures significantly varied by day and time of admission. Quality of care was better if the nurse in charge was at a higher band and/or there were more nurses on duty. Staff deliver ‘front-door’ interventions consistently by taking on additional responsibilities out of hours, creating continuities between day and night, building trusting relationships and prioritising ‘front-door’ interventions.
Limitations
We were unable to measure long-term outcomes as our request to the Sentinel Stroke National Audit Programme, the Healthcare Quality Improvement Partnership and NHS Digital for Sentinel Stroke National Audit Programme data linked with patient mortality status was not fulfilled.
Conclusions
Organisational factors influence 24 hours a day, 7 days a week (24/7), provision of stroke care, creating temporal patterns of provision reflected in patient outcomes, including mortality, length of stay and functional independence.
Future work
Further research would help to explore 24/7 stroke systems in other contexts. We need a clearer understanding of variations by looking at absolute time intervals, rather than achievement of targets. Research is needed with longer-term mortality and modified Rankin Scale data, and a more meaningful range of outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Robert Simister
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgia B Black
- Department of Applied Health Research, University College London, London, UK
| | - Mariya Melnychuk
- Department of Applied Health Research, University College London, London, UK
| | - Angus IG Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - Abigail Baim-Lance
- Center for Innovation in Mental Health, City University of New York, New York, NY, USA
| | - David L Cohen
- Stroke Service, Haldane and Herrick Wards, Northwick Park Hospital, London, UK
| | - Jeannie Eng
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Martin M Brown
- Queen Square Institute of Neurology, University College London, London, UK
| | - Anthony G Rudd
- King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steve Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
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