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Kim B, Petrakis BA, Griesemer I, Sliwinski SK, Midboe AM, Raciborski RA, Byrne TH, Gingell MB, Blue-Howells J, Clark SC, Tsai J, Harvey KLL, McInnes DK. Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations' delivery of legal services to veterans. PLoS One 2024; 19:e0297424. [PMID: 38625878 PMCID: PMC11020365 DOI: 10.1371/journal.pone.0297424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND 1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one's legal needs met is known to improve one's health and its social determinants, many Veterans' legal needs remain unmet. Public Law 116-315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools' legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. METHODS Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. DISCUSSION The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV's outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA's LSV implementation.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Ida Griesemer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Samantha K. Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Amanda M. Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, United States of America
- University of California at Davis School of Medicine, Sacramento, California, United States of America
| | - Rebecca A. Raciborski
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, United States of America
- Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, United States of America
| | - Thomas H. Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Boston University School of Social Work, Boston, Massachusetts, United States of America
| | - Madolyn B. Gingell
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Jessica Blue-Howells
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Sean C. Clark
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Jack Tsai
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Kim L. L. Harvey
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - D. Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Boston University School of Public Health, Boston, Massachusetts, United States of America
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Kim B, Sullivan JL, Brown ME, Connolly SL, Spitzer EG, Bailey HM, Sippel LM, Weaver K, Miller CJ. Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study. Implement Sci 2024; 19:16. [PMID: 38373979 PMCID: PMC10875770 DOI: 10.1186/s13012-024-01342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/21/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4 years after implementation support had concluded. METHODS We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends. RESULTS CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability. CONCLUSIONS MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System, 385 Niagara Street, Providence, RI, 02907, USA
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Madisen E Brown
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Elizabeth G Spitzer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), 1700 N Wheeling Street, Aurora, CO, 80045, USA
| | - Hannah M Bailey
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA
| | - Lauren M Sippel
- VA Northeast Program Evaluation Center, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - Kendra Weaver
- VA Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC, 20420, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Fanfan D, Rodríguez C, Stacciarini JMR. Strès ak Pwoblèm Pap Janm Fini: Deciphering migration-related stress from the perspectives of Haitian immigrants in Florida. Transcult Psychiatry 2023; 60:717-732. [PMID: 37097922 DOI: 10.1177/13634615231164524] [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: 04/26/2023]
Abstract
Relocating and starting a new life in a foreign country may entail a constellation of new stressors for Haitian immigrants; thus, research that enhances our understanding of how this vulnerable population contextualizes migration-related stress is necessary. The objectives of this study were to: (a) identify what factors are associated with migration-related stress, and (b) describe which and why specific migration-related stressors were most significant from the perspective of those suffering from high migration-related stress post migration via the stress proliferation lens of the stress process model. In this mixed-methods, sequential, explanatory pilot study, first-generation Haitian immigrants (N = 76) were recruited to operationalize migration-related stress, using the Demands of Immigration Scale (DIS). Participants (n = 8), who scored 25 or higher on the DIS, completed an in-depth audio-recorded follow-up interview that consisted of open-ended questions and a stressor-ranking questionnaire. Descriptive statistics, Pearson correlations, multiple linear regression (quantitative), and thematic analysis with a double-coded approach (qualitative) were employed to analyze the data. Female gender, older age, English fluency, and migration after the age of 18 years were associated with higher migration-related stress. However, only gender and English fluency predicted migration-related stress. In interviews, participants ranked five migration-related stressors as most stressful: language barriers, financial strains, loss of social networks, family conflicts, and exposure to discrimination/stigma. A nuanced depiction of migration-related stressors and proliferation mechanisms of migration-related stress may help identify areas where support and preventive efforts should be directed to improve social integration, stress levels, and mental well-being among immigrants.
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Affiliation(s)
- Dany Fanfan
- College of Nursing, University of Florida, Gainesville, FL
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Kim B, Petrakis BA, Sliwinski SK, McInnes DK, Gifford AL, Smelson DA. Staff and Veteran Perspectives on Residential Treatment Programs' Responses to COVID-19: A Qualitative Study Guided by the WHO's After Action Review Framework. Community Ment Health J 2023; 59:600-608. [PMID: 36318435 PMCID: PMC9628288 DOI: 10.1007/s10597-022-01038-1] [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] [Received: 12/18/2021] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Healthcare must rapidly and systematically learn from earlier COVID-19 responses to prepare for future crises. This is critical for VA's Mental Health Residential Rehabilitation and Treatment Programs (RRTPs), offering 24/7 care to Veterans for behavioral health and/or homelessness. We adapted the World Health Organization's After Action Review (AAR) to conduct semi-structured small-group discussions with staff from two RRTPs and Veterans who received RRTP care during COVID-19, to examine COVID-19's impact on these programs. Six thematic categories emerged through qualitative analysis (participant-checked and contextualized with additional input from program leadership), representing participants' recommendations including: Keep RRTPs open (especially when alternative programs are inaccessible), convey reasons for COVID-19 precautions and programming changes to Veterans, separate recovery-oriented programming from COVID-19-related information-sharing, ensure Wi-Fi availability for telehealth and communication, provide technology training during orientation, and establish safe procedures for off-site appointments. AAR is easily applicable for organizations to debrief and learn from past experiences.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, 02130, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA.
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, 01730, Bedford, MA, USA
| | - Samantha K Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, 02130, Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, 01730, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, 02118, Boston, MA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, 02130, Boston, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, 02118, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, 72 East Concord Street, 02118, Boston, MA, USA
| | - David A Smelson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, 01730, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 North Lake Avenue, 01655, Worcester, MA, USA
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Anguera MT, Jonsson GK, Escolano-Pérez E, Sánchez-Lopez CR, Losada JL, Portell M. T-pattern detection in the scientific literature of this century: A systematic review. Front Psychol 2023; 14:1085980. [PMID: 36935977 PMCID: PMC10015708 DOI: 10.3389/fpsyg.2023.1085980] [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: 10/31/2022] [Accepted: 01/27/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Scientific literature contains mainly systematic reviews focused on substantial aspects, but there are also approaches that have combined both substantial and methodological aspects, which is our preferred option since it undeniably adds value. The aims of this study were: (1) to carry out a systematic review of the literatura on T-Pattern analysis (TPA), and (2) to explore the possible contribution of mixed methods research to the integration of qualitative and quantitative elements on a synthesis level. Methods Based on PRISMA guidelines, searches were carried out in the Scopus, PsycINFO, and Web of Science databases. The general search syntax was: "THEME" AND ("T-Patterns" OR "T Patterns") carried out in title, keywords and abstract. In addition, we included empirical articles on THEME and T-Patterns collected in other sources based on citations in several empirical works and consultations with different authors. This selection process resulted in 125 primary documents making up this systematic review. Results The results showed that the detection of structures in behavior patterns forms a nexus between studies carried out in very diverse fields and contexts. Most studies are observational, whilst the applicability and power of T-Pattern detection are extraordinary. It allows the researcher to go deeper in a robust analysis that responds to the integration of qualitative and quantitative elements which constitutes the leit motive of mixed methods; and also to discover the deep, hidden structure that underlies the respective databases, regardless of the methodology used in each study. The possibilities in assigning parameters notably increase the options for obtaining results and their interpretation. Discussion It is relevant the extraordinary strength and applicability of T-pattern detection. There is a high presence of T-pattern detection and analysis in studies using observational methodology. It is necessary commit to consolidating the methodological analysis of selected works, as taking individual and collective responsibility for improving methodological quality of TPA studies, taking advantage of the resources provided by the THEME program.
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Affiliation(s)
- M. Teresa Anguera
- Faculty of Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Gudberg K. Jonsson
- Human Behavior Laboratory, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Carmen Rosa Sánchez-Lopez
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - José Luis Losada
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Mariona Portell
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Wamoyi J, Ranganathan M, Mugunga S, Stöckl H. Male and Female Conceptualizations of Sexual Harassment in Tanzania: The Role of Consent, Male Power, and Social Norms. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP17492-NP17516. [PMID: 34182809 DOI: 10.1177/08862605211028309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sexual harassment is pervasive worldwide, yet there is a lack of clarity on its conceptualization in many settings, especially in low-income countries. Context-specific conceptualization of sexual harassment is vital to develop effective measurement tools, estimate its magnitude, and the design of interventions to address it. We explored how different population groups in Mwanza, Tanzania, understood, conceptualized, and experienced sexual harassment. This study employed a qualitative research design involving 74 in-depth interviews and 13 focus group discussions with participants from educational, workplace, and public settings in Mwanza, Tanzania. Participants were adolescent girls and boys, adult women and men. We explored individual-level perceptions and experiences of sexual harassment, and community norms and expectations around sexual harassment. We analyzed the data using a thematic approach. Participants' perceptions of sexual harassment emphasized the critical role of consent, the expression of male power, and social norms with regard to sexual harassment. Sexual harassment was understood to be a result of men being in positions of power and in charge of material resources, school grades, or employment opportunities. These in turn enabled them to take advantage of girls and women. Social norms around male and female interactions, courtship and seduction, expressions of sexual interest were crucial in delineating what was and what was not considered sexual harassment. Sexual harassment is a fluid concept, and its definition is highly dependent on contextual factors. Consent underpins the conceptualization of sexual harassment and is a fundamental feature in the definition and measurement of sexual harassment in Tanzania. Consent is largely determined by sexual norms around male and female interactions and gendered power. There is a need for consensus in schools, workplaces, and communities about what constitutes sexual harassment in order to measure and address it appropriately.
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Affiliation(s)
- Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | | | - Samuel Mugunga
- National Institute for Medical Research, Mwanza, Tanzania
| | - Heidi Stöckl
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Drtilova H, Machackova H, Smahelova M. Evaluation of Web-Based Health Information From the Perspective of Women With Eating Disorders: Thematic Analysis. J Med Internet Res 2022; 24:e31148. [PMID: 35699984 PMCID: PMC9237763 DOI: 10.2196/31148] [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: 06/11/2021] [Revised: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Users with experience of eating disorders use the internet as a source of information, whether for prorecovery activities (such as web-based treatment, looking for information, support, and sharing) or activities that promote eating disorder behavior as a desirable lifestyle choice (such as pro–eating disorder communities and reading and creating pro–eating disorder posts). Their assessment of web-based eating disorder–related information is crucial for understanding the context of the illness and for health professionals and their web-based interventions. Objective This study aimed to understand the criteria young women with the experience of eating disorders use in evaluating eating disorder–related web-based information and what eating disorder–related characteristics of these women are involved in their evaluation. Methods We analyzed 30 semistructured individual interviews with Czech women aged 16 to 28 years with past or present eating disorder experience using a qualitative approach. Thematic analysis was adopted as an analytical tool. Results The specifics of eating disorder phases (the disorder stage and the treatment process) emerged as important aspects in the process of information assessment. Other specific characteristics of respondents (eg, motivation, abilities, and resources) addressed how the respondents arrived at certain web-based information and how they evaluated it. In addition, the respondents described some content cues as features of information (eg, novelty and social information pooling). Another finding is that other users’ attitudes, experiences, activities, and personal features are involved in the information evaluation of these users and the information presented by them. Finally, the respondents evaluated the websites’ visual look and graphic components. Conclusions This study shows that web-based information evaluation reported by women with experience of eating disorders is a complex process. The assessment is influenced by current personal characteristics related to the illness (mainly the motivation for maintaining or curing the eating disorder) using cues associated with information content, other users, and website look. The study findings have important implications for health professionals, who should ask their clients questions about web-based communities and their needs to understand what information and sources they choose.
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Affiliation(s)
- Hana Drtilova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Hana Machackova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Martina Smahelova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Dickson KS, Sklar M, Chen SZ, Kim B. Characterization of multilevel influences of mental health care transitions: a comparative case study analysis. BMC Health Serv Res 2022; 22:437. [PMID: 35366865 PMCID: PMC8976965 DOI: 10.1186/s12913-022-07748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts.
Methods
A comparative multiple case study design was used to characterize transition practices within the literature examining children’s, non-VA adult, and VA adult service contexts. Andersen’s (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems.
Results
Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity.
Conclusions
Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.
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Kim B, Rajagopalan A, Tabasky EM, Reddy SS, Topor DR. Sharing perspectives on feedback: a combined resident-faculty workshop. BMC MEDICAL EDUCATION 2022; 22:197. [PMID: 35317809 PMCID: PMC8939056 DOI: 10.1186/s12909-022-03253-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Feedback is essential to medical education. Although the need for effective feedback delivery is well known, more recent focus is on understanding and strengthening the faculty-trainee relationship within which the feedback process is carried out. The authors developed and implemented a combined resident-faculty feedback workshop within a psychiatry residency training program to enhance participants' understanding of challenges residents and faculty experience with the feedback process. METHODS The one-hour workshop consisted of small group activities and large group discussions, focused on (i) feedback challenges for both residents and faculty and (ii) potential ways to address identified challenges. Participants completed pre-and post-workshop questionnaires to rate their level of understanding of, and answer open-ended questions regarding, feedback challenges. Mixed-methods assessment of questionnaire responses examined quantitative rating changes from pre- to post-workshop, as well as emergent qualitative themes from the open-ended responses. RESULTS From a pool of 30 workshop participants, 26 completed each of the pre- and post-workshop questionnaires. Overall, participants were satisfied with the programming. Important considerations for the feedback process were (i) specific/constructive/timely feedback, (ii) meeting logistical/administrative feedback requirements, (iii) setting norms/expectations of effective/routine feedback, and (iv) relational/emotional considerations surrounding feedback. It appeared both faculty and residents were able to increase perspective taking about how the other group perceived the feedback process. CONCLUSIONS This pilot project is one of the first to examine a joint resident-faculty workshop focused on understanding how faculty and residents can interact to better understand each other's perspective on the feedback process. Further work in this area is needed to identify common misperceptions and design programming to help correct them. Further research is also needed to examine the impact of such programming on the feedback process.
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Affiliation(s)
- Bo Kim
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA.
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
| | - Aishwarya Rajagopalan
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Edward M Tabasky
- ICL East New York Health Hub, 2581 Atlantic Ave., Brooklyn, NY, 11207, USA
| | - Sparsha S Reddy
- VA Bedford Healthcare System, 200 Springs Rd., Bedford, MA, 01730, USA
| | - David R Topor
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
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Jackson SD, Wagner KR, Yepes M, Harvey TD, Higginbottom J, Pachankis JE. A pilot test of a treatment to address intersectional stigma, mental health, and HIV risk among gay and bisexual men of color. Psychotherapy (Chic) 2022; 59:96-112. [PMID: 35025569 PMCID: PMC9345305 DOI: 10.1037/pst0000417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We tested the feasibility and acceptability of a group therapy treatment that addresses the intersecting stigma-related stressors theorized to drive elevated mental health risk, sexual health risk, and their co-occurrence among Black and Latino gay, bisexual, and other men who have sex with men (GBM). First, we modified an existing 10-week, one-on-one, cognitive-behavioral treatment addressing co-occurring health risks among GBM to develop a group-based, intersectionally informed treatment for GBM of color. Then, an open pilot was conducted (n = 21, across two cohorts) with young Black and Latino GBM. An evaluation of feasibility metrics (e.g., eligibility-enrollment ratio, session attendance, rate of retention) supported overall treatment feasibility. Qualitative data suggest high acceptability of the treatment length, format, and content-and revealed a powerful theme: The treatment and group composition led participants to feel less alone as GBM of color. To further evaluate acceptability, baseline and 3-month posttreatment assessments and exit interviews were used to examine the treatment's impact on stigma coping, mental health, and sexual health. Expected changes were found for: (a) stigma coping, as demonstrated by decreases in perceived sexual minority stress, racial minority stress, and intersectional stress; (b) mental health, including depression, anxiety, stress, and suicidality, but not alcohol use; and (c) sexual health, including condom use efficacy, sexual compulsivity, and preexposure prophylaxis uptake; with partial support for decreased in human immunodeficiency virus; HIV-transmission risk acts. This study lays the groundwork for a group treatment to address intersectional stigma, mental health, and HIV risk among young Black and Latino GBM in the U.S. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Krystn R. Wagner
- Yale School of Public Health, Yale University
- Fair Haven Community Health Care, New Haven, Connecticut, United States
| | - Mike Yepes
- Yale School of Public Health, Yale University
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Agbadje TT, Rahimi SA, Côté M, Tremblay AA, Diallo MP, Elidor H, Herron AP, Djade CD, Légaré F. Evaluation of a prenatal screening decision aid: A mixed methods pilot study. PATIENT EDUCATION AND COUNSELING 2022; 105:474-485. [PMID: 34088585 DOI: 10.1016/j.pec.2021.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND We developed a decision aid (DA) to help pregnant women and their partners make informed decisions about prenatal screening for trisomy. We aimed to determine its usefulness for preparing for decision-making and its acceptability among end-users. METHODS In this mixed-methods pilot study, we recruited participants in three prenatal care settings in Quebec City. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. We asked them about the usefulness of the DA using an interview grid based on the Technology Acceptance Model. We performed descriptive statistics and deductive analysis. RESULTS Thirty-nine dyads or individuals participated in the study. Mean usefulness score was 86.2 ± 13. Most participants found the amount of information in the DA just right (79.5%), balanced (89.7%), and very useful (61.5%). They were less satisfied with the presentation and the values worksheet and suggested different values clarification methods. CONCLUSION Rigorous pilot tests of DAs with patients are an important stage in their development before the more formal assessments that precede scaling up the DA in clinical practice. PRACTICE IMPLICATIONS The next version of the DA will integrate the suggestions of end-users for better decision-making processes about prenatal screening for trisomy.
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Affiliation(s)
- Titilayo Tatiana Agbadje
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Mélissa Côté
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Andrée-Anne Tremblay
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada
| | - Mariama Penda Diallo
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada
| | - Hélène Elidor
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Alex Poulin Herron
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Codjo Djignefa Djade
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.
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12
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Ruiz B, Ceccolini CJ, Shah BB, Crump F, Girgis RR, Brucato G, Yang LH, Corcoran CM. Stigma and coping experiences in Latinx individuals at clinical high-risk for psychosis. Early Interv Psychiatry 2022; 16:34-41. [PMID: 33543593 DOI: 10.1111/eip.13126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/10/2021] [Accepted: 01/21/2021] [Indexed: 01/22/2023]
Abstract
AIM The experiences of culturally diverse individuals at clinical high-risk for psychosis (CHR) is not well studied. Exploratory research needs to examine whether differences exist between racial/ethnic groups within the CHR population. Understanding experiences of Latinx patients is of importance, as the Latinx population represents the most rapidly growing paediatric population in the United States and they face significant barriers to mental health treatment. Because Latinx persons experience high rates of mental illness-based stigma and discrimination in their communities, they may face additional stigma-based barriers to CHR treatment. METHOD Twenty-six participants (15 Latinx, 11 non-Latinx white/NLW) who met CHR criteria based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) were interviewed regarding stigma associated with CHR identification and symptoms. Using a consensus-based open-coding thematic analysis approach, data were analysed for stigma, discrimination, and coping responses. RESULTS Instances of internalization of stereotypes appeared to be more salient to NLW participants than Latinx participants, and Latinx participants reported seemingly more anticipated rejection from stereotypes than NLW participants. Experiences of discrimination also appeared to be more salient to Latinx participants than NLW participants. Moreover, Latinx participants reported evidently greater instances of discrimination across anticipated, individual, and structural discrimination. Finally, while covering strategies appeared to be more salient to NLW's, Latinx clients more often described using secrecy as well as a greater range of coping responses, including empowerment. CONCLUSION While the experience of anticipated rejection appeared to be more salient to Latinx CHR participants and they seemingly report more secrecy than NLW, they also engaged in empowerment-related coping strategies. Future research should continue to explore the roles of cultural values in influencing coping strategies among CHR individuals.
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Affiliation(s)
- Bernalyn Ruiz
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Christopher J Ceccolini
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts, USA
| | - Binoy B Shah
- Department of Psychology, Lewis College of Human Sciences, Illinois Institute of Technology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Francesca Crump
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
| | - Ragy R Girgis
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Gary Brucato
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, Broadway, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Cheryl M Corcoran
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York, USA
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13
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González-González AI, Brünn R, Nothacker J, Schwarz C, Nury E, Dinh TS, Brueckle MS, Dieckelmann M, Müller BS, van den Akker M. Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:6. [PMID: 35010264 PMCID: PMC8751163 DOI: 10.3390/ijerph19010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023]
Abstract
The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden.
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Affiliation(s)
- Ana Isabel González-González
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28035 Madrid, Spain
| | - Robin Brünn
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Julia Nothacker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.N.); (E.N.)
| | | | - Edris Nury
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.N.); (E.N.)
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Mirjam Dieckelmann
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Beate Sigrid Müller
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (R.B.); (T.S.D.); (M.-S.B.); (M.D.); (B.S.M.); (M.v.d.A.)
- Department of Family Medicine, School CAPHRI, Maastricht University, 6200 Maastricht, The Netherlands
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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14
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González-González AI, Schmucker C, Nothacker J, Nury E, Dinh TS, Brueckle MS, Blom JW, van den Akker M, Röttger K, Wegwarth O, Hoffmann T, Gerlach FM, Straus SE, Meerpohl JJ, Muth C. End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review. J Clin Med 2020; 10:E91. [PMID: 33383951 PMCID: PMC7795676 DOI: 10.3390/jcm10010091] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.
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Affiliation(s)
- Ana I. González-González
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (T.S.D.); (M.-S.B.); (M.v.d.A.); (F.M.G.); (C.M.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28035 Madrid, Spain
| | - Christine Schmucker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (C.S.); (J.N.); (E.N.); (J.J.M.)
| | - Julia Nothacker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (C.S.); (J.N.); (E.N.); (J.J.M.)
| | - Edris Nury
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (C.S.); (J.N.); (E.N.); (J.J.M.)
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (T.S.D.); (M.-S.B.); (M.v.d.A.); (F.M.G.); (C.M.)
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (T.S.D.); (M.-S.B.); (M.v.d.A.); (F.M.G.); (C.M.)
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (T.S.D.); (M.-S.B.); (M.v.d.A.); (F.M.G.); (C.M.)
- Department of Family Medicine, School CAPHRI, Maastricht University, 6200 Maastricht, The Netherlands
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
| | - Kristian Röttger
- Patient Representative, Federal Joint Committee “Gemeinsamer Bundseausschuss”, 10587 Berlin, Germany;
| | - Odette Wegwarth
- Center for Adaptive Rationality, Max Planck-Institute for Human Development, 14195 Berlin, Germany;
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia;
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (T.S.D.); (M.-S.B.); (M.v.d.A.); (F.M.G.); (C.M.)
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany; (C.S.); (J.N.); (E.N.); (J.J.M.)
- Cochrane Germany, Cochrane Germany Foundation, 79110 Freiburg, Germany
| | - Christiane Muth
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (T.S.D.); (M.-S.B.); (M.v.d.A.); (F.M.G.); (C.M.)
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, 33615 Bielefeld, Germany
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15
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Garvelink MM, Agbadjé TT, Freitas A, Bergeron L, Petitjean T, Dugas M, Blair L, Archambault P, Roy N, Jones A, Légaré F. Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e16979. [PMID: 32412908 PMCID: PMC7407259 DOI: 10.2196/16979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/28/2020] [Accepted: 05/14/2020] [Indexed: 01/16/2023] Open
Abstract
Background Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ≥65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors’ accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website—Support for Older Adults to Stay Independent at Home (SUSTAIN)—will be implemented and made available to better assist older adults and caregivers in staying independent at home.
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Affiliation(s)
- Mirjam Marjolein Garvelink
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada
| | - Titilayo Tatiana Agbadjé
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Adriana Freitas
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Lysa Bergeron
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Thomas Petitjean
- Centre for Digital Media, Simon Fraser University, Vancouver, BC, Canada
| | - Michèle Dugas
- Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR SUPPORT Unit, Laval University, Québec, QC, Canada
| | - Louisa Blair
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Patrick Archambault
- Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada.,Centre de recherche intégré pour un système apprenant en santé et services sociaux, Lévis, QC, Canada.,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Noémie Roy
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,School of Architecture, Faculty of Planning, Architecture, Arts and Design, Université Laval, Québec, QC, Canada
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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16
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van Grootel L, Balachandran Nair L, Klugkist I, van Wesel F. Quantitizing findings from qualitative studies for integration in mixed methods reviewing. Res Synth Methods 2020; 11:413-425. [PMID: 32104971 PMCID: PMC7317911 DOI: 10.1002/jrsm.1403] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/28/2020] [Accepted: 02/20/2020] [Indexed: 11/12/2022]
Abstract
In mixed methods reviewing, data from quantitative and qualitative studies are combined at the review level. One possible way to combine findings of quantitative and qualitative studies is to quantitize qualitative findings prior to their incorporation in a quantitative review. There are only a few examples of the quantification of qualitative findings within this context. This study adds to current research on mixed methods review methodology by reporting the pilot implementation of a new four‐step quantitizing approach. We report how we extract and quantitize the strength of relationships found in qualitative studies by assigning correlations to vague quantifiers in text fragments. This article describes (a) how the analysis is prepared; (b) how vague quantifiers in text fragments are organized and transformed to numerical values; (c) how qualitative studies as a whole are assigned effect sizes; and (d) how the overall mean effects size and variance can be calculated. The pilot implementation shows how findings from 26 primary qualitative studies are transformed into mean effect sizes and corresponding variances.
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Affiliation(s)
- Leonie van Grootel
- Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Lakshmi Balachandran Nair
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Tilburg, Netherlands
| | - Irene Klugkist
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Tilburg, Netherlands
| | - Floryt van Wesel
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Tilburg, Netherlands
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17
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Tugwell-Allsup J, England A. Imaging neonates within an incubator - A survey to determine existing working practice. Radiography (Lond) 2020; 26:e18-e23. [PMID: 31902464 DOI: 10.1016/j.radi.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is limited and confusing evidence within the literature regarding the optimal techniques when imaging neonates within incubators; in particular, whether to place the image receptor directly behind the neonate or in the incubator tray. For this reason, radiology departments across Wales and North West England were surveyed to explore existing working practice with regards to incubator imaging. METHOD A self-designed survey was developed using a systematic approach. The survey was sent to 31 radiology departments across Wales and North West England whom had a neonatal unit in order to assess existing techniques used when imaging neonates within the incubator. The survey was split into three main domains: 1) general/demographics, 2) exposure factors and technique, and 3) incubator design. RESULTS Nineteen departments responded (64%) demonstrating a wide variation in practice for incubator imaging. The minimum and maximum exposure factors used for neonatal chest x-ray imaging varied from 55 kV to 65 kV and 0.5 mAs-2 mAs. Fifty-eight percent of departments used the incubator tray as standard practice with the remaining forty two percent not using the tray for various reasons including, image quality, artefacts and misalignment. Sixty-three percent of departments use the maximum achievable SID for incubator imaging which demonstrates wide variability as the SID would be dependent upon: incubator design, portable machine and radiographer height. CONCLUSION The survey demonstrates a wide variation in existing practice for neonatal incubator imaging. IMPLICATIONS FOR PRACTICE This study supports the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.
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Affiliation(s)
- J Tugwell-Allsup
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penhosgarnedd Road, Bangor, Gwynedd, LL57 2PW, United Kingdom.
| | - A England
- Salford University, Manchester, Greater Manchester, United Kingdom.
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18
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Kim B, Bolton RE, Hyde J, Fincke BG, Drainoni ML, Petrakis BA, Simmons MM, McInnes DK. Coordinating across correctional, community, and VA systems: applying the Collaborative Chronic Care Model to post-incarceration healthcare and reentry support for veterans with mental health and substance use disorders. HEALTH & JUSTICE 2019; 7:18. [PMID: 31832790 PMCID: PMC6909453 DOI: 10.1186/s40352-019-0099-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/20/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Between 12,000 and 16,000 veterans leave incarceration annually. As is known to be the case for justice-involved populations in general, mental health disorders (MHDs) and substance use disorders (SUDs) are highly prevalent among incarcerated veterans, and individuals with MHDs and SUDs reentering the community are at increased risk of deteriorating health and recidivism. We sought to identify opportunities to better coordinate care/services across correctional, community, and VA systems for reentry veterans with MHDs and SUDs. METHODS We interviewed 16 veterans post-incarceration and 22 stakeholders from reentry-involved federal/state/community organizations. We performed a grounded thematic analysis, and recognizing consistencies between the emergent themes and the evidence-based Collaborative Chronic Care Model (CCM), we mapped findings to the CCM's elements - work role redesign (WRR), patient self-management support (PSS), provider decision support (PDS), clinical information systems (CIS), linkages to community resources (LCR), and organizational/leadership support (OLS). RESULTS Emergent themes included (i) WRR - coordination challenges among organizations involved in veterans' reentry; (ii) PSS - veterans' fear of reentering society; (iii) PDS - uneven knowledge by reentry support providers regarding available services when deciding which services to connect a reentry veteran to and whether he/she is ready and/or willing to receive services; (iv) CIS - lapses in MHD/SUD medications between release and a first scheduled health care appointment, as well as challenges in transfer of medical records; (v) LCR - inconsistent awareness of existing services and resources available across a disparate reentry system; and (vi) OLS - reentry plans designed to address only immediate transitional needs upon release, which do not always prioritize MHD/SUD needs. CONCLUSIONS Applying the CCM to coordinating cross-system health care and reentry support may contribute to reductions in mental health crises and overdoses in the precarious first weeks of the reentry period.
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Affiliation(s)
- Bo Kim
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Rendelle E. Bolton
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Brandeis University The Heller School for Social Policy and Management, Waltham, MA USA
| | - Justeen Hyde
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - B. Graeme Fincke
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - Beth Ann Petrakis
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
| | | | - D. Keith McInnes
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
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Ent MR, Gergis MA. The most common end-of-life reflections: A survey of hospice and palliative nurses. DEATH STUDIES 2018; 44:256-260. [PMID: 30541400 DOI: 10.1080/07481187.2018.1539053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To identify the most common end-of-life reflections among terminally ill patients, 124 nurses from the Hospice and Palliative Nurses Association (HPNA) completed an online, open-ended survey. Common themes of these reflections included concern for loved ones, regret, morbidity and mortality, gratitude, spirituality, legacy, and thoughts about acceptance or non-acceptance of impending death. Nurses reported that their patients were more concerned about their loved ones than their own morbidity and mortality. Common end-of-life reflections may serve as cues that hospice and palliative patients are self-initiating therapeutic life review.
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Affiliation(s)
- Michael R Ent
- Department of Psychology, Towson University, Towson, MD, USA
| | - Mary A Gergis
- Department of Nursing, Towson University, Towson, MD, USA
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Solomon DN, Hansen L, Baggs JG. It's All About the Relationship: Cognitively Intact Mother-Daughter Care Dyads in Hospice at Home. THE GERONTOLOGIST 2018; 58:625-634. [PMID: 28329822 DOI: 10.1093/geront/gnw263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Adult daughters providing care to aging, ill mothers comprise the most prevalent caregiving dyad. Little is known, however, regarding relationship quality and its impact on care in these dyads, particularly in the context of cognitively intact patients at end of life in hospice. This interpretive descriptive work privileges voices of terminally ill mothers and care-partnering daughters in the home hospice context. Specific aims were to describe and interpret how mothers and daughters: (a) perceive relationship quality and (b) perceive how relationships have developed over time through health, chronic illness, and hospice. Design and Methods Semistructured interviews were used to explore interdependent perceptions of relationship quality in 10 terminally-ill mother-adult daughter care dyads. A novel method of qualitative dyadic analysis was developed to analyze dyads in close parallel at both individual/descriptive and dyadic/interpretive levels, staying true to qualitative rigor. Results A relationship quality spectrum emerged, from Close Friendship to Doing My Duty dyads. Women in Close Friendships revealed concordant narratives and emotionally satisfying relationships; women in neutral or troubled relationships revealed discordant relational stories. In these latter dyads, mothers reported more positive narratives; daughters spoke of relational problems. Implications This work suggests deeper exploration of mother-daughter dyads within the hospice context and interventions at both individual and dyadic levels to serve relational needs of the dying and their families. The qualitative dyadic approach also offers utility for relational investigations of any dyad.
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Affiliation(s)
- Diane N Solomon
- School of Nursing, Oregon Health & Science University, Portland.,Private Psychiatry Practice, Oregon, Portland
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland
| | - Judith G Baggs
- School of Nursing, Oregon Health & Science University, Portland
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Nzabonimpa JP. Quantitizing and qualitizing (im-)possibilities in mixed methods research. METHODOLOGICAL INNOVATIONS 2018. [DOI: 10.1177/2059799118789021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mixed methods research has gained momentum over the past decade, but critics rightly charge that the integration of qualitative and quantitative data remains an unresolved methodological issue. While each of the dualistic and canonized methodological paradigms has its own way of handling analysis, researchers in mixed methods as a new paradigm have invested considerable efforts in more complex mixed analysis. They use the quantitizing of qualitative data and qualitizing of quantitative data as the strategies to effect data integration in mixed methods research. While attempts have been made to achieve quantitizing and qualitizing of data, few empirical studies have been conducted in a two-phase convergent parallel mixed methods design to investigate such data conversion approaches, especially dichotomization, within a single inquiry. To contribute to this ongoing methodological quest, this article explores the possibilities and impossibilities offered by either strategy to convert narratives into numerical data and numerical data into narratives.
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Affiliation(s)
- Jean Providence Nzabonimpa
- The African Capacity Building Foundation, Harare, Zimbabwe
- Department of Sociology & Social Anthropology, Stellenbosch University, South Africa
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Parental Perspectives of Barriers to Physical Activity in Urban Schoolchildren With Asthma. Acad Pediatr 2018; 18:310-316. [PMID: 29309846 PMCID: PMC5889757 DOI: 10.1016/j.acap.2017.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Physical activity (PA) levels are low in today's youth and may even be lower in those with asthma. Barriers to PA have not been well studied in inner-city minority children with asthma. We conducted a qualitative study to characterize parental perceptions of barriers to PA and ways to improve PA levels in children with asthma. METHODS We used the socioecologic model to inform development of our interview guide. Questions fell into 2 socioecologic model domains: interpersonal (parent, family) barriers and community (neighborhood, school) barriers. Qualitative semistructured interviews were conducted with 23 parents (21 mothers, 2 fathers) of inner-city children with asthma (aged 8-10 years) from 10 Bronx, New York, elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. Emerging themes were discussed and agreed on by investigators. RESULTS Three themes surrounding interpersonal barriers to PA emerged: 1) parental fear of exercise-induced asthma due to lack of child symptom awareness, 2) nonadherence and refusal to take medications, and 3) challenges with asthma management. Four themes around community barriers to PA emerged: 1) lack of trust in school management of asthma, 2) lack of school PA facilities, 3) unsafe neighborhoods, and 4) financial burden of PA. CONCLUSIONS A complex, multilevel set of barriers to PA exist in children with asthma. Addressing these barriers by involving stakeholders at the family, school, and community levels may improve PA levels in children with asthma.
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Goodman LA, Wilson JM, Helms JE, Greenstein N, Medzhitova J. Becoming an Advocate: Processes and Outcomes of a Relationship-Centered Advocacy Training Model. COUNSELING PSYCHOLOGIST 2018. [DOI: 10.1177/0011000018757168] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Counseling programs across the country are increasingly incorporating social justice advocacy training into their curricula. However, much remains to be learned about the developmental processes by which students develop advocacy skills and apply those skills after they graduate. To address these questions and drive further innovation in the field of advocacy training, we conducted an evaluation of the Community Advocacy Project, a yearlong microlevel advocacy training model that teaches mental health counseling master’s students to use relationship-centered advocacy with individuals in marginalized communities. We interviewed 19 counselors within 2.5 years of their graduation from the project about their experiences of the program and their current advocacy work. Using qualitative description, we developed a model describing processes of Internal Grappling, Building the Advocacy Relationship, and Integrating the Advocate Identity that highlights the importance of a yearlong one-on-one advocacy relationship, intensive reflection and supervision, and community collaboration.
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Cain A, Reznik M. The Principal and Nurse Perspective on Gaps in Asthma Care and Barriers to Physical Activity in New York City Schools: A Qualitative Study. HEALTH EDUCATION & BEHAVIOR 2017; 45:410-422. [PMID: 29084455 DOI: 10.1177/1090198117736351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND School officials and nurses play an important role in facilitating asthma management in schools. Little is known about their perspectives on in-school asthma management and barriers to physical activity (PA) at school. AIMS The goal of this study is to explore school officials' and nurses' perspectives on asthma care and barriers to PA in children with asthma attending New York City schools. METHOD We conducted qualitative, semistructured interviews with 10 principals, 3 assistant principals, and 9 nurses in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and coded for common themes. The thematic and content review was subsequently used to analyze interview data. Emerging themes were discussed and agreed on by both investigators. RESULTS Three main categories arose from the analysis: (1) procedures and policies around asthma management in school, (2) barriers to effective medication administration in school, and (3) barriers to PA in children with asthma. DISCUSSION Participants identified gaps to in-school asthma management and barriers to PA participation: ineffective ways of identifying students with asthma; lack of written procedures for asthma management; difficulty in meeting the administrative requirements to administer asthma medication; lack of knowledge and training on asthma management for the parents, students, and school staff; parental limitation of children's PA; and schools not meeting the state physical education requirement. CONCLUSIONS Our findings suggest the need for policy reform on asthma management and PA in urban schools and should be considered in the design of future interventions.
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Affiliation(s)
- Agnieszka Cain
- 1 Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Reznik
- 1 Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
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Cain A, Reznik M. Asthma management in New York City schools: A classroom teacher perspective. J Asthma 2016; 53:744-50. [PMID: 27031532 DOI: 10.3109/02770903.2015.1135946] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Classroom teachers play an important role in facilitating asthma management in school but little is known about their perspectives around asthma management. We examined the perspectives of classroom teachers around barriers to school asthma management. METHODS We conducted key informant interviews with 21 inner-city classroom teachers from 3rd to 5th grades in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. We used thematic and content review to analyze interview data. RESULTS Seven themes representing teachers' perspectives on in-school asthma management emerged: (1) the problematic process of identifying students with asthma; (2) poor familiarity with the city health department's asthma initiative and poor general knowledge of school policies on asthma management; (3) lack of competency in managing an acute asthma attack in the classroom and poor recognition of symptoms of an asthma attack; (4) lack of confidence in dealing with a hypothetical asthma attack in the classroom; (5) lack of quick access to asthma medication in school; (6) limited communication between school staff; and (7) enthusiasm about learning more about asthma management. CONCLUSIONS Our results revealed several barriers contributing to suboptimal in-school asthma management: ineffective ways of identifying students with asthma, lack of teacher knowledge of guidelines on asthma management, lack of comfort in managing students' asthma, inadequate access to asthma medication in school, and limited communication between school staff. These issues should be considered in the design of interventions to improve in-school asthma management.
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Affiliation(s)
- Agnieszka Cain
- a Medical School, Albert Einstein College of Medicine , Bronx , NY , USA
| | - Marina Reznik
- b Department of Pediatrics , Children's Hospital at Montefiore, Albert Einstein College of Medicine , Bronx , NY , USA
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Rush KL, Hatt L, Shay M, Gorman N, Laberge CG, Reid RC, Wilson R. The Stressors and Coping Strategies of Older Adults With Persistent Atrial Fibrillation Prior to and Following Direct Current Cardioversion. J Appl Gerontol 2015; 36:1145-1165. [DOI: 10.1177/0733464815608495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective:The purpose of this study was to explore the stressors and coping strategies of older adults with persistent atrial fibrillation (AF) before and after direct current cardioversion. Method: The study used a qualitative descriptive design. Sixteen patients were recruited through an AF clinic to participate in individual interviews prior to the cardioversion and at 6 and 12 weeks post procedure. Results: Pre-cardioversion, older adults experienced symptom and health care–related stressors superimposed on existing non-AF stressors. They used a range of emotion and problem-focused coping. Non-AF stressors increased post procedure at the same time that participants perceived less need for coping strategies with a return to regular rhythm. Discussion: There was a shift from AF to non-AF related stressors following the cardioversion but a decrease in coping strategies. Older adults with AF should be encouraged to maintain use of coping strategies to manage ongoing stress and reduce the risk of AF recurrence.
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Affiliation(s)
- Kathy L. Rush
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Linda Hatt
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Matt Shay
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Nicole Gorman
- Atrial Fibrillation Clinic, Kelowna, British Columbia, Canada
| | - Carol G. Laberge
- University of British Columbia–Okanagan, Kelowna, Canada
- Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - R. Colin Reid
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Ryan Wilson
- University of British Columbia–Okanagan, Kelowna, Canada
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Abstract
There are an increasing number of published single-method systematic reviews that focus on different types of evidence related to a particular topic. As policy makers and practitioners seek clear directions for decision-making from systematic reviews, it is likely that it will be increasingly difficult for them to identify 'what to do' if they are required to find and understand a plethora of syntheses related to a particular topic.Mixed-methods systematic reviews are designed to address this issue and have the potential to produce systematic reviews of direct relevance to policy makers and practitioners.On the basis of the recommendations of the Joanna Briggs Institute International Mixed Methods Reviews Methodology Group in 2012, the Institute adopted a segregated approach to mixed-methods synthesis as described by Sandelowski et al., which consists of separate syntheses of each component method of the review. Joanna Briggs Institute's mixed-methods synthesis of the findings of the separate syntheses uses a Bayesian approach to translate the findings of the initial quantitative synthesis into qualitative themes and pooling these with the findings of the initial qualitative synthesis.
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Pugach MR, Goodman LA. Low-income women’s experiences in outpatient psychotherapy: A qualitative descriptive analysis. COUNSELLING PSYCHOLOGY QUARTERLY 2015. [DOI: 10.1080/09515070.2015.1053434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hershberger PE, Gallo AM, Molokie R, Thompson AA, Suarez ML, Yao Y, Wilkie DJ. Perception of young adults with sickle cell disease or sickle cell trait about participation in the CHOICES randomized controlled trial. J Adv Nurs 2015; 72:1430-40. [PMID: 26073718 DOI: 10.1111/jan.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS To gain an in-depth understanding of the perceptions of young adults with sickle cell disease and sickle cell trait about parenthood and participating in the CHOICES randomized controlled trial that used computer-based, educational programmes. BACKGROUND In the USA, there is insufficient education to assure that all young adults with sickle cell disease or sickle cell trait understand genetic inheritance risks and reproductive options to make informed reproductive decisions. To address this educational need, we developed a computer-based, multimedia program (CHOICES) and reformatted usual care into a computer-based (e-Book) program. We then conducted a two-year randomized controlled trial that included a qualitative component that would deepen understanding of young adults' perceptions of parenthood and use of computer-based, educational programmes. DESIGN A qualitative descriptive approach completed after a randomized controlled trial. METHODS Sixty-eight men and women of childbearing age participated in semi-structured interviews at the completion of the randomized controlled trial from 2012-2013. Thematic content analysis guided the qualitative description. RESULTS/FINDINGS Three main themes were identified: (1) increasing knowledge and new ways of thinking and behaving; (2) rethinking parenting plans; and (3) appraising the program design and delivery. Most participants reported increased knowledge and rethinking of their parenting plans and were supportive of computer-based learning. Some participants expressed difficulty in determining individual transmission risks. CONCLUSION Participants perceived the computer programs as beneficial to their learning. Future development of an Internet-based educational programme is warranted, with emphasis on providing tailored education or memory boosters about individual transmission risks.
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Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing, Illinois, USA.,University of Illinois at Chicago, College of Medicine, Illinois, USA
| | - Agatha M Gallo
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Robert Molokie
- University of Illinois at Chicago, College of Medicine, Illinois, USA.,University of Illinois at Chicago, College of Pharmacy, Illinois, USA.,University of Illinois Hospital and Health Sciences System Comprehensive Sickle Cell Center, Chicago, Illinois, USA
| | - Alexis A Thompson
- Northwestern University-Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Hematology/Oncology/Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois, USA
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing, Illinois, USA.,University of Illinois Hospital and Health Sciences System Comprehensive Sickle Cell Center, Chicago, Illinois, USA
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Pluye P, Hong QN. Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews. Annu Rev Public Health 2013; 35:29-45. [PMID: 24188053 DOI: 10.1146/annurev-publhealth-032013-182440] [Citation(s) in RCA: 681] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article provides an overview of mixed methods research and mixed studies reviews. These two approaches are used to combine the strengths of quantitative and qualitative methods and to compensate for their respective limitations. This article is structured in three main parts. First, the epistemological background for mixed methods will be presented. Afterward, we present the main types of mixed methods research designs and techniques as well as guidance for planning, conducting, and appraising mixed methods research. In the last part, we describe the main types of mixed studies reviews and provide a tool kit and examples. Future research needs to offer guidance for assessing mixed methods research and reporting mixed studies reviews, among other challenges.
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Affiliation(s)
- Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, H3S 1Z1, Canada; ,
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Rissanen ML, Kylmä J, Hintikka J, Honkalampi K, Tolmunen T, Laukkanen E. Factors helping adolescents to stop self-cutting: descriptions of 347 adolescents aged 13-18 years. J Clin Nurs 2013; 22:2011-9. [DOI: 10.1111/jocn.12077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Jari Kylmä
- School of Health Sciences, Nursing Science; University of Tampere; Tampere Finland
| | - Jukka Hintikka
- Department of Psychiatry; School of Medicine and Paijat-Hame Central Hospital; University of Tampere; Lahti Finland
| | | | - Tommi Tolmunen
- Department of Adolescent Psychiatry; Kuopio University Hospital and University of Eastern-Finland; Kuopio Finland
| | - Eila Laukkanen
- Department of Adolescent Psychiatry; Kuopio University Hospital and University of Eastern-Finland; Kuopio Finland
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Sandelowski M, Leeman J, Knafl K, Crandell JL. Text-in-context: a method for extracting findings in mixed-methods mixed research synthesis studies. J Adv Nurs 2013; 69:1428-37. [PMID: 22924808 PMCID: PMC3535067 DOI: 10.1111/jan.12000] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 10/28/2022]
Abstract
AIM Our purpose in this paper is to propose a new method for extracting findings from research reports included in mixed-methods mixed research synthesis studies. BACKGROUND International initiatives in the domains of systematic review and evidence synthesis have been focused on broadening the conceptualization of evidence, increased methodological inclusiveness and the production of evidence syntheses that will be accessible to and usable by a wider range of consumers. Initiatives in the general mixed-methods research field have been focused on developing truly integrative approaches to data analysis and interpretation. DATA SOURCE The data extraction challenges described here were encountered, and the method proposed for addressing these challenges was developed, in the first year of the ongoing (2011-2016) study: Mixed-Methods Synthesis of Research on Childhood Chronic Conditions and Family. DISCUSSION To preserve the text-in-context of findings in research reports, we describe a method whereby findings are transformed into portable statements that anchor results to relevant information about sample, source of information, time, comparative reference point, magnitude and significance and study-specific conceptions of phenomena. IMPLICATIONS FOR NURSING The data extraction method featured here was developed specifically to accommodate mixed-methods mixed research synthesis studies conducted in nursing and other health sciences, but reviewers might find it useful in other kinds of research synthesis studies. CONCLUSION This data extraction method itself constitutes a type of integration to preserve the methodological context of findings when statements are read individually and in comparison to each other.
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Affiliation(s)
- Margarete Sandelowski
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA.
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Understanding smokers’ beliefs and feelings about smoking and quitting during a quit attempt: a preliminary evaluation of the SNAP model. J Smok Cessat 2013. [DOI: 10.1017/jsc.2013.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study sought to obtain a preliminary assessment of whether a new model of behaviour change (SNAP) could provide a useful conceptual framework for classifying smokers’ reports of their beliefs and feelings about the process of stopping smoking. Eight smokers’ clinic attendees in Malaysia underwent semi-structured interviews before and four weeks after the start of their quit attempt. A variant of Template Analysis found support for the view that smokers’ inferred identities could be reliably classified in the terms Smoker, Non-smoker, Attempter or Planner (SNAP) using self-statements about their motivation and behaviour as well as identity. There was evidence for wide variation in the coherence of smokers’ beliefs and feelings defined in terms of the proportion that fitted their modal SNAP category. As would be expected there was a shift in SNAP categories pre- to post-quit in those who were not smoking but only so far as ‘attempter’. An important next step is to assess how far lack of coherence in a given identity predicts transitions to other categories.
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Abstract
BACKGROUND Few studies have examined changes in siblings after the death of a brother or sister, particularly from mother, father, and sibling perspectives within the first year after death. OBJECTIVE This descriptive study identified and assessed the frequency of changes in siblings after a child's death from cancer. METHODS Participants were recruited from cancer registries at 3 hospitals in the United States and Canada 3 to 12 months after the child's death. Thirty-six mothers, 24 fathers, and 39 siblings from 40 families were included. Semistructured interviews using open-ended questions were conducted with each parent and sibling separately in the home. Content analysis identified emerging themes, and the McNemar tests compared frequencies between each paired set of reports (sibling vs mother, sibling vs father, mother vs father). RESULTS Sixty-nine percent of participants reported personal changes in siblings (eg, changes in personality, school work, goals/life perspective, activities/interests). Forty-seven percent noted changes in siblings' relationships with family members and peers. Only 21% of participants reported no changes attributed to the death. Comparisons of frequencies across informants were not significant. CONCLUSIONS Most siblings experienced changes in multiple areas of their lives after the death of a brother or sister to cancer. Some changes reflected siblings that were positively adapting to the death, whereas other changes reflected difficulties. IMPLICATIONS FOR PRACTICE Our findings offer guidance to improve aftercare for bereaved siblings and their families. Additional research is needed to further delineate the needs of bereaved siblings and to develop strategies to promote adaptation to loss.
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Sandelowski M, Voils CI, Leeman J, Crandell JL. Mapping the Mixed Methods-Mixed Research Synthesis Terrain. JOURNAL OF MIXED METHODS RESEARCH 2012; 6:317-331. [PMID: 23066379 PMCID: PMC3467952 DOI: 10.1177/1558689811427913] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Mixed methods-mixed research synthesis is a form of systematic review in which the findings of qualitative and quantitative studies are integrated via qualitative and/or quantitative methods. Although methodological advances have been made, efforts to differentiate research synthesis methods have been too focused on methods and not focused enough on the defining logics of research synthesis-each of which may be operationalized in different ways-or on the research findings themselves that are targeted for synthesis. The conduct of mixed methods-mixed research synthesis studies may more usefully be understood in terms of the logics of aggregation and configuration. Neither logic is preferable to the other nor tied exclusively to any one method or to any one side of the qualitative/quantitative binary.
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Affiliation(s)
| | - Corrine I. Voils
- Durham Veterans Affairs Medical Center & Duke University Medical Center, Durham, NC, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hall M, McFarlane LA, Mulholland S. Positive clinical placements: perspectives of students and clinical educators in rehabilitation medicine. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.10.549] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark Hall
- Clinical Education, Department of Physical Therapy, University of Alberta
| | - Lu-Anne McFarlane
- Clinical Education, Department of Speech Language Pathology University of Alberta and; at the time of the study,
| | - Susan Mulholland
- Clinical Education, Department of Occupational Therapy University of Alberta
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Voils CI, Crandell JL, Chang Y, Leeman J, Sandelowski M. Combining adjusted and unadjusted findings in mixed research synthesis. J Eval Clin Pract 2011; 17:429-34. [PMID: 21040243 PMCID: PMC3063329 DOI: 10.1111/j.1365-2753.2010.01444.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Finding ways to incorporate disparate types of evidence into research syntheses has the potential to build a better evidence base for clinical practice and policy. Yet conducting such mixed research synthesis studies is challenging. Researchers have to determine whether and how to use adjusted and unadjusted quantitative findings in combination with each other and with qualitative findings. METHODS Among quantitative findings, adjustment for confounding, either via study design or statistical analysis, can be a considerable source of heterogeneity. Yet there is no consensus about the best way to synthesize findings resulting from different methods for addressing confounding. When synthesizing qualitative and quantitative findings, additional considerations include determining whether findings are amenable to synthesis by aggregation or configuration, which, in turn, depends on the degree of interpretive transformation of findings. RESULTS Qualitative survey findings appear similar in form to unadjusted or minimally adjusted quantitative findings and, when addressing the same relationship, can be summed. More interpreted qualitative findings appear similar in form to adjusted findings found in, for example, structural equation models specifying the relationship among a host of latent variables. An option for synthesis of conceptually similar models is reciprocal translation. CONCLUSIONS These decisions will ultimately be judged on the meaningfulness of their results to practice or policy.
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Affiliation(s)
- Corrine I Voils
- Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, North Carolina, USA.
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Crandell JL, Voils CI, Chang Y, Sandelowski M. Bayesian data augmentation methods for the synthesis of qualitative and quantitative research findings. ACTA ACUST UNITED AC 2010; 45:653-669. [PMID: 21572970 DOI: 10.1007/s11135-010-9375-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The possible utility of Bayesian methods for the synthesis of qualitative and quantitative research has been repeatedly suggested but insufficiently investigated. In this project, we developed and used a Bayesian method for synthesis, with the goal of identifying factors that influence adherence to HIV medication regimens. We investigated the effect of 10 factors on adherence. Recognizing that not all factors were examined in all studies, we considered standard methods for dealing with missing data and chose a Bayesian data augmentation method. We were able to summarize, rank, and compare the effects of each of the 10 factors on medication adherence. This is a promising methodological development in the synthesis of qualitative and quantitative research.
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Affiliation(s)
- Jamie L Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, #7460 Carrington Hall, Chapel Hill, NC 27599, USA; School of Nursing, University of North Carolina at Chapel Hill, #7460 Carrington Hall, Chapel Hill, NC 27599, USA
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Voils C, Hassselblad V, Crandell J, Chang Y, Lee E, Sandelowski M. A Bayesian method for the synthesis of evidence from qualitative and quantitative reports: the example of antiretroviral medication adherence. J Health Serv Res Policy 2009; 14:226-33. [PMID: 19770121 DOI: 10.1258/jhsrp.2009.008186] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Bayesian meta-analysis is a frequently cited but very little-used method for synthesizing qualitative and quantitative research findings. The only example published to date used qualitative data to generate an informative prior probability and quantitative data to generate the likelihood. We developed a method to incorporate both qualitative and quantitative evidence in the likelihood in a Bayesian synthesis of evidence about the relationship between regimen complexity and medication adherence. METHODS Data were from 11 qualitative and six quantitative studies. We updated two different non-informative prior distributions with qualitative and quantitative findings to find the posterior distribution for the probabilities that a more complex regimen was associated with lower adherence and that a less complex regimen was associated with greater adherence. RESULTS The posterior mode for the qualitative findings regarding more complex regimen and lesser adherence (using the uniform prior with Jeffreys' prior yielding highly similar estimates) was 0.588 (95% credible set limits 0.519, 0.663) and for the quantitative findings was 0.224 (0.203, 0.245); due to non-overlapping credible sets, we did not combine them. The posterior mode for the qualitative findings regarding less complex regimen and greater adherence was 0.288 (0.214, 0.441) and for the quantitative findings was 0.272 (0.118, 0.437); the combined estimate was 0.299 (0.267, 0.334). CONCLUSIONS The utility of Bayesian methods for synthesizing qualitative and quantitative research findings at the participant level may depend on the nature of the relationship being synthesized and on how well the findings are represented in the individual reports.
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Affiliation(s)
- Corrine Voils
- Health Services Research & Development Service, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA.
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