The social and organisational factors shaping acceptability of a self-management education and exercise intervention for people with hip or knee osteoarthritis in Greenland

This study aimed to explore the experiences and perspectives of people with osteoarthritis attending the "Osteoarthritis School" (OA School) in Nuuk, Greenland to generate insights and lessons that can inform the development of self-management education and exercise interventions for people with other lifestyle conditions in a Greenland context. We conducted a qualitative interpretive description (ID) study based on ten semi-structured interviews with people with hip or knee osteoarthritis. Interviews were audio-recorded, transcribed, and coded. Using ID, we identified three themes: 1) perceptions and experiences of how the OA School intervention was organised (time and place); 2) perspectives and experiences of the education and exercise components (social factors, motivation, and education); and 3) significant change stories (physical and mental improvements and increased knowledge of OA). Social and organisational factors, such as working out with peers and the time and place of the intervention, influenced the participants' acceptance of the OA School intervention. Knowledge from this study will help us gain insight into what to address when developing future self-management education and exercise interventions in the Greenlandic healthcare system.

"They feel shame sometime, but that is why we need to talk to them…we need to tell them how important it is not to feel shame": Hepatitis B related shame and improving hepatitis B care in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory, according to the Aboriginal health workforce

BACKGROUND

The Aboriginal health workforce has unique insights given their healthcare experience and interactions with their communities. The aims of this project were to explore their perceptions of hepatitis B related shame and ways to improve hepatitis B care in Aboriginal and Torres Strait Islander communities of Northern Territory's Top End, Australia.

METHODS

We conducted a qualitative study with guidance from the Menzies School of Health Research Infectious Diseases Indigenous Reference Group. The Aboriginal health workforce was asked to participate in semi-structured interviews exploring hepatitis B related shame and ways to improve hepatitis B care. Qualitative data were evaluated using reflexive thematic analysis.

RESULTS

There were fifteen semi-structured interviews with participants representing eight different communities. The experience of shame was reported by the Aboriginal health workforce to be common for individuals diagnosed with hepatitis B and comprised feelings of fear related to transmitting the virus, to being isolated, and to being at fault. Shame was mediated by poor health literacy, communication, the lack of culturally safe spaces and was perpetuated by intersecting stereotypes. Improvements in care can be achieved by utilising the Aboriginal health workforce more effectively, improving communication and the availability of culturally safe spaces, emphasising community connection, and reframing hepatitis B as a chronic condition.

CONCLUSIONS

Hepatitis B related shame was an important issue and impactful in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory. There were many facets to shame in these communities and it was mediated by several factors. The Aboriginal health workforce has emphasised several pathways to improve care and diminish the impact of shame, such as improving communication and the availability of culturally safe spaces.

Pre-implementation determinants for digital mental health integration in Chicago pediatric primary care

OBJECTIVE

Pediatric primary care (PPC) is a common treatment site for pediatric mental health, but it is currently unable to meet the needs of all teen patients, particularly those with minoritized identities and/or marginalized experiences. Digital mental health (DMH) low-intensity treatments (LITs) can increase mental health screening and care capacity in PPC, but how this is done successfully without burdening providers, patients, or families is unclear. This paper presents a pre-implementation study aimed at understanding the implementation context (PPCs in Chicago, IL) for a specific DMH LIT.

METHOD

Using a mixed-methods design, quantitative data from an online survey of providers assessed current DMH practices in PPC, and qualitative interviews with Pediatricians and Pediatric Psychologists examined implementation determinants for a specific DMH LIT. Quantitative data were analyzed using descriptive statistics, and interviews were analyzed using rapid qualitative assessment.

RESULTS

Survey reports (n = 105) and interviews (n = 6) indicated low current use of DMH. Providers in PPC clinics voiced multiple reasons for low usage and low perceived feasibility, including: Consolidated Framework for Implementation Research (CFIR) Inner Setting Domain (PPC clinic workflow, responsibility and ethical considerations, patient privacy and confidentiality), CFIR Outer Setting Domain (hospital and healthcare system factors), CFIR Innovation Domain (DMH design), and a cross-cutting theme of safety.

CONCLUSIONS

Provider-reported low feasibility for integrating DMH in PPC is a call to action to partner with interdisciplinary colleagues and identify how such settings can ethically and seamlessly deliver digital evidence-based and accessible screening and care prior to implementation.

Facilitators and barriers to "Positive Outcomes" from cognitive-behavioral therapy, according to young people: A thematic synthesis

OBJECTIVE

This qualitative review sought to explore how young people (YP) conceptualize positive outcomes from cognitive-behavioral therapy (CBT) and what YP perceive to be the facilitators and barriers to positive outcomes.

METHODS

A systematic literature search was conducted in June 2021 using six online databases. Studies were included if qualitative data were collected from participants who were aged up to 25, had internalizing mental health difficulties, and had received in-person CBT from trained practitioners.

RESULTS

Nineteen studies were included. The Gough Weight of Evidence framework was used to assess methodological and topical quality and relevance. A thematic synthesis identified 34 conceptualizations of positive outcomes, 57 facilitators, and 49 barriers. Descriptive and analytical themes were identified. In line with the review's pragmatic perspective, the latter were worded as practice recommendations: acknowledge YP's perspectives on outcomes, teach tangible CBT techniques, balance autonomy and support, frame CBT as "upskilling," explore nuanced barriers to engagement, and consider the power of group dynamics.

CONCLUSIONS

This review established the range of YP's views about positive outcomes from CBT, as well as facilitators and barriers to achieving these. Findings should prompt CBT practitioners to reflect and consider how their practice might be shaped through reports from YP as experts by experience.

A Critical Sociocultural Understanding of Evidence-Based Research and Practice Paradigm in Contemporary Psychology

The paper aims to develop a critical sociocultural understanding on the epistemological and historical analysis of evidence-based (EB) paradigm in contemporary psychological knowledge-production (research) and knowledge-application (practice). It firstly retraces the emergence of EB in medical disciplines, its paradigmatic status, and its subsequent adoption by mainstream psychological sciences. The description of EB historical roots and key concepts leads to the second part, where the paper reflects on key epistemological criticalities scholars have raised toward the EB paradigm. Then, we develop our sociocultural perspective to enrich the epistemological analysis and critique of EB. Specifically, we propose a hermeneutic and interpretative understanding which frames EB as a re-enactment of the positivist scientific research ambition to reach for a complete formalization of biological/psychological phenomena (endo-genetical dynamics), and of new socioeconomic, political, and individual needs posed by contemporary Western societal institutions to scientific knowledge (exo-genetical dynamics). Furthermore, building on such understanding, we suggest that EB works as a contemporary epistemic indicator and threshold, serving two functions: selective filtering and exclusion. Finally, we speculate that EB endo-genetical and exo-genetical developmental dynamics can be interpreted as an expression of the contemporary presentist regime of temporality and as a shift towards the regime of performative techniques instead of context-specific and future-oriented relational competences, also tracing a determining factor that has directed, directs and will continue to direct scientific research in psychology.

Pragmatism and medical sociology: Three precepts

While medical sociology has long incorporated insights from pragmatist philosophy, recent contributions call for a more explicit engagement with this tradition. Complementing Greenhalgh and Engebretsen's (2022) call for a pragmatist analysis of public health policymaking and crisis, we systemize medical sociology's engagement with pragmatism. We suggest three precepts of pragmatist philosophy as they relate to medical sociology: First, a focus on consequences in action, or understanding medical phenomena through what is done rather than established definitions; Second, problem solving, or how medical actors move between habit and creativity; And third, negotiation of meaning, or analyzing patient-provider communication through ongoing action and interpretation. Such systematization, we argue, would enrich both new and existing topics in medical sociology, from medicalization to mask-wearing.

Co-design of the Spinal Cord Injury Health Maintenance Tool to Support Self-Management: A Mixed-Methods Approach

Background

There is a lack of consumer-friendly tools to empower and support people living with spinal cord injury (SCI) to self-manage complex health needs in community. This article describes the co-design process of the new SCI Health Maintenance Tool (SCI-HMT).

Methods

Co-design of the SCI-HMT using a mixed-methods approach included a rapid review, e-Delphi surveys with range of multidisciplinary health care professionals (n = 62), interviews of participants with SCI (n = 18) and general practitioners (n = 4), focus groups (n = 3 with 7, 4, and 4 participants with SCI, respectively), design workshops with stakeholders (n = 11, 8), and end-user testing (n = 41).

Results

The SCI-HMT (healthmaintenancetool.com) was developed based on participatory research with data synthesis from multiple sources. Five priority health maintenance issues for bladder, bowel, skin, pain, and autonomic dysreflexia were originally covered. Best practice recommendations, red flag conditions, referrals, and clinical pathways were agreed on through an e-Delphi technique. Qualitative analysis identified six broad key concepts for self-management, including early symptom recognition, role of SCI peers, knowledge sharing with primary care, general practitioners as gatekeepers, and shared decision-making and highlighted a need to place much stronger emphasis on mental health and well-being. Design workshops and end-user testing provided key insights about user experience, functionality, and content for the SCI-HMT.

Conclusion

The co-design process engaging end users, including people with SCI and general practitioners, enabled a shared understanding of the problem and identification of important needs and how to meet them. Informed by this process, the SCI-HMT is a freely accessible resource supporting SCI self-management, shared decision-making, and early problem identification.

The INSCHOOL project: Young people with long-term physical health conditions: An in-depth qualitative study of their needs at school

INTRODUCTION

The INSCHOOL project aimed to understand the school experiences and unmet needs of young people across a diversity of long-term physical health conditions.

METHODS

Young people aged 11-18 years, in mainstream secondary school in the United Kingdom, with one of 11 physical health conditions were invited to unique participant-driven interviews, focus groups, or written activities. Creative preparation activities were provided to give participants increased control over the data collection and prioritize their voices. A needs analysis, in combination with participatory analysis sessions with young people, identified the common needs of participants in relation to their school lives.

RESULTS

Eighty-nine young people participated from April 2022 to 2023. Analysis of their transcripts defined six common needs across all the health conditions: Need to safely manage my health at school; need for a flexible education pathway; need to be acknowledged and listened to in the right way; need to be included in and supported by the school community; need to build toward my future; need to develop attitudes and approaches to help me cope in school.

CONCLUSIONS

This study has generated new, actionable knowledge by identifying six major needs that young people have in relation to the intersection of their health condition and their school life. This paper shows that a commonalities approach to research and policy development is warranted given the similarities in experiences and needs. The common needs identified in the INSCHOOL project highlight six areas where future interventions could be targeted to begin making meaningful changes for all young people with long-term health conditions.

"The Ability to Go Out into the World Is the Most Important Thing"-A Qualitative Study of Important Exercise Outcomes for People with Lung Cancer

Whilst existing quantitative research identifies outcomes believed to be important by researchers and clinicians, it may neglect outcomes that are meaningful to patients. This study aimed to explore the outcomes of exercise that are important to people with lung cancer and their carers. Data collection involved a qualitative methodology including semi-structured interviews and focus groups. Question guide development was informed by the International Classification of Functioning (ICF) framework. Data were analyzed by two researchers with NVivo (v12) software using a conventional content analysis process, followed by directed content analysis to map outcomes to the ICF. Conduct and reporting adhered to COREQ guidelines. Fifteen participants provided data. Most participants had received their diagnoses 24 months prior to study involvement (n = 9), and one-third had completed treatment (n = 5). Important outcomes were reported by participants across all domains of the ICF: activity and participation (n = 24), body function (n = 19), body structure (n = 5), environmental factors (n = 5), and personal factors (n = 1). Additional code categories pertained to the impacts of non-cancer factors such as age, frailty, and comorbidities; identifying barriers to exercise; and individualizing outcome measures. Clinicians and researchers should consider selecting outcomes from all relevant domains of the ICF, with a focus on the activity and participation domain, in addition to non-cancer factors such as ageing, frailty, and co-morbidities. Feedback should be provided to patients following outcome measures collection and reassessment.

Perceived Factors Influencing Blue-Collar Workers' Participation in Worksite Health Promotion Programs in Freight Transport: A Qualitative Investigation Using the TDF and COM-B

Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs.

Epistemic injustice and mental health research: A pragmatic approach to working with lived experience expertise

"Epistemic injustice" refers to how people from marginalized groups are denied opportunities to create knowledge and derive meaning from their experiences. In the mental health field, epistemic injustice occurs in both research and service delivery systems and particularly impacts people from racialized communities. Lived experience involvement and leadership are often proposed as methods of combatting epistemic injustice, a tool for ensuring the views of people at the center of an issue are heard and can inform decision-making. However, this approach is not without challenges. In this paper, we draw on our work as intermediary organizations that center lived experience perspectives to challenge epistemic injustice. We highlight two problems we have identified in working in the mental health research field: "elite capture" and "epistemic exploitation". We believe that these problems are barriers to the radical and structural change required for epistemic justice to occur. We propose a pragmatic approach to addressing these issues. Based on our work we suggest three considerations for researchers and our own organizations to consider when involving people with lived experience. These include reflecting on the purpose of creating knowledge, with a focus on impact. Embedding lived experience roles, with appropriate employment, support and remuneration, and acknowledging that it may be necessary to work alongside existing systems as a "critical friend" while developing new spaces and structures for alternative forms of knowledge. Finally, the mental health research system needs to change. We believe these three considerations will help us better move toward epistemic justice in mental health research.

Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework

OBJECTIVES

This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care.

DESIGN

Qualitative interview study.

METHODS

Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified.

RESULTS

GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities).

CONCLUSIONS

Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.

Recruiting and Engaging Women of Reproductive Age with Obesity: Insights from A Mixed-Methods Study within A Trial

Engaging women with obesity in health-related studies during preconception is challenging. Limited data exists relating to their participation. The aim of this study is to explore the experiences and opinions of women participating in a weight-related, preconception trial. This is an explanatory sequential (quan-QUAL) mixed-methods Study Within A Trial, embedded in the GetGutsy randomized controlled trial (ISRCTN11295995). Screened participants completed an online survey of eight questions (single or multiple choice and Likert scale) on recruitment, motivations and opinions on study activities. Participants with abdominal obesity (waist circumference ≥ 80 cm) were invited to a subsequent semi-structured, online focus group (n = 2, 9 participants) that was transcribed and analyzed using inductive thematic analysis, with a pragmatic epistemological approach. The survey (n = 102) showed the main research participation motivations were supporting health research (n = 38, 37.3%) and wanting health screening (n = 30, 29.4%). Most participants were recruited via email (n = 35, 34.7%) or social media (n = 15, 14.7%). In the FGs, participants valued flexibility, convenience and. research methods that aligned with their lifestyles. Participants had an expanded view of health that considered emotional well-being and balance alongside more traditional medical assessments. Clinical trialists should consider well-being, addressing the interconnectedness of health and incorporate a variety of research activities to engage women of reproductive age with obesity.

A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying

Objective: To ascertain palliative physicians’ and consultation-liaison psychiatrists’ perceptions of depression care processes in patients with very poor prognoses, exploring key challenges and postulating solutions. Methods: A qualitative focus group study involving three 1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted between November-December 2020. Fellows and trainees were recruited from Australian and New Zealand Society of Palliative Medicine (n  =  11) and Royal Australian and New Zealand College of Psychiatrists (n  =  4). Data underwent conventional qualitative content analysis. Results: Participants perceived depression care to be complex and challenging. Perceived barriers included: inadequate palliative care psychiatry skills with variation in clinical approaches; lack of supportive health infrastructure (poor access to required interventions and suboptimal linkage between palliative care and psychiatry); lack of research support; and societal stigma. Suggested solutions included integrating care processes between palliative care and psychiatry to improve clinician training, establish supportive health systems and promote innovative research designs. Conclusions: Developing clinician training, supportive health systems and innovative research strategies centering on integrating palliative care and psychiatry care processes may be integral to optimising depression care when providing care to people with very poor prognoses.

“Machine-Dependent”: The Lived Experiences of Patients Receiving Hemodialysis in Pakistan

This study aimed to explore the lived experiences of patients receiving maintenance hemodialysis in Pakistan. Purposive sampling was used to recruit 24 patients and six healthcare professionals, each participated in a semi-structured interview. Interpretive Phenomenological Analysis was used to analyze interviews’ data. Two superordinate themes, “The experience of hemodialysis” and “The conceptualizations of hemodialysis” as well as six sub-themes were identified. The experience of hemodialysis was related to, the implications of HD procedure on everyday life, social, cognitive, emotional, financial, and occupational influences. While all participants recognized the importance of hemodialysis for their survival, their conceptualizations of the treatment varied. Despite facing multiple challenges, optimism and independence were observed among participants. Stigma related to hemodialysis, and role adaptation, which appear unique to the Pakistani context, highlight a need for tailored interventions designed to enhance and maintain the mental health of patients receiving hemodialysis in Pakistan.

Pragmatism as a paradigm for patient-oriented research

BACKGROUND

Mixed methods research studies continue to pervade the field of health care, where pragmatism as a research paradigm and patient-oriented research (POR) as an engagement strategy are combined to strengthen the process and outcomes of the research. Pragmatists use the most appropriate research methods to address issues at hand, where complex social problems need multipronged approaches. As an emerging healthcare research strategy, POR actively engages individuals with lived experience across all stages of the research process. While POR continues to garner attention within mixed-methods research designs, there is a paucity of literature that considers POR in relation to pragmatism.

OBJECTIVE

As POR grows in popularity within the field of health care, there is a need to explore the theoretical and epistemological alignment with pragmatism and the implications to research.

METHODS

To address this need, we provide a critical review of the literature to examine the synergies between POR and pragmatism, and argue for the adoption of pragmatism as a paradigm for conducting POR.

MAIN RESULTS

This article begins with a discussion of the philosophical underpinnings informing the pragmatic paradigm. It then identifies key alignments between POR and pragmatism across three intersecting concepts: democratic values, collaborative approaches to problem-solving and the pursuit of social justice.

DISCUSSION AND CONCLUSIONS

Reflecting on our experiences engaging with patient partners in a mixed-methods POR study titled READY2Exit, we illustrate the relevance of pragmatism to POR by applying these concepts to practice. Implications and considerations for conducting POR within the pragmatic paradigm are also described.

PATIENT OR PUBLIC CONTRIBUTION

This paper provides a critical review of the literature and did not directly involve patients or the public. The authors reflected on their experiences collaborating with five young adult patient partners in the READY2Exit study (case exemplar described in this article) to demonstrate the relevance of the pragmatic paradigm to POR. We acknowledge and thank the young adult patient partners for their contributions to the research, for encouraging us to think critically about patient engagement in research, and for sharing their experiences.

Boundary-Work and the Distribution of Care for Survivors of Domestic Violence and Abuse in Primary Care Settings: Perspectives From U.K. Clinicians

Health care encounters are opportunities for primary care practitioners to identify women experiencing domestic violence and abuse (DVA). Increasing DVA support in primary care is a global policy priority but discussion about DVA during consultations remains rare. This article explores how primary care teams in the United Kingdom negotiate the boundaries of their responsibilities for providing DVA support. In-depth interviews were undertaken with 13 general practitioners (GPs) in two urban areas of the United Kingdom. Interviews were analyzed thematically. Analysis focused on the boundary practices participants undertook to establish their professional remit regarding abuse. GPs maintained permeable boundaries with specialist DVA support services. This enabled ongoing negotiation of the role played by clinicians in identifying DVA. This permeability was achieved by limiting the boundaries of the GP role in the care of patients with DVA to identification, with the work of providing support distributed to local specialist DVA agencies.

'It's quite a complex trail for families now' - Provider understanding of access to services for Aboriginal children with a disability

Aboriginal and Torres Strait Islander children experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention from across the health, education and social service sectors is vital for improving outcomes, but families face a number of barriers to service access which impede intervention. This study aimed to inform ways to improve access to services for families of urban-dwelling Aboriginal children with a range of disabilities. A qualitative approach was taken to explore providers' perceptions of factors that either impeded or enabled families' access to services. In this research, the term 'provider' refers to individuals who are employed in a range of sectors to deliver a service involving assessment or management of an individual with a disability. Semi-structured in-depth interviews with 24 providers were conducted. Data analysis was informed by the general inductive approach and then applied deductively to the candidacy framework to generate additional insights. Candidacy focuses on how potential users access the services they need and acknowledges the joint negotiation between families and providers regarding such access. Our research identified that candidacy was influenced by the historical legacy of colonisation and its ongoing socio-cultural impact on Aboriginal people, as well as funding and current policy directives. Enacting culturally sensitive and meaningful engagement to better understand families' needs and preferences for support, as well as support for providers to develop their understanding of family contexts, will contribute to facilitating service access for Aboriginal children with a disability.

"It only takes two minutes to ask"-a qualitative study with women on using the FIGO Nutrition Checklist in pregnancy

Objective

To gain an in‐depth understanding of how the FIGO Nutrition Checklist could work in clinical practice, from the perspective of pregnant women.

Methods

This qualitative study was part of a pilot study of the FIGO Nutrition Checklist in the antenatal department of a tertiary‐level university maternity hospital in Dublin, Ireland. Individual semistructured phone interviews were conducted with pregnant women who had completed the FIGO Nutrition Checklist as part of the pilot. Interviews were transcribed verbatim and analyzed using content analysis after manual coding of transcripts. Themes and subthemes are described.

Results

Ten interviews were completed. Subthemes related to the FIGO Nutrition Checklist emerged including ease of use and comprehension. Participants discussed how the tool could add value to their appointment by supporting initiation of nutrition conversations and highlighting nutritional issues. The first trimester was identified as the highest priority for using the FIGO Nutrition Checklist. The convenience of having nutrition addressed as part of standard care, rather than a separate appointment, also emerged.

Conclusion

Women in this study had a desire for nutrition and weight to be addressed by clinicians during routine antenatal appointments. The findings support using the FIGO Nutrition Checklist to address this.

Pregnant women want to discuss nutrition and weight with their doctors during routine care. The FIGO Nutrition Checklist is an acceptable tool to support this.

Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study

UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.

Operationalist and inferentialist pragmatism: Implications for nursing knowledge development and practice

Philosophical inquiries in nursing are useful for analysing and critiquing existing practices, exploring contextual factors affecting practice, adapting to and sustaining ongoing changes in knowledge development, and facilitating the linkages between theory, research and practice. Nurse scholars used several philosophical schools of thought to guide knowledge development and practice. Pragmatism has been described as essential for bridging the theory-practice gap, for engaging in the inquiry-based practice and for translating knowledge into practice. The existing descriptions of pragmatism rely on rudimentary descriptions of "what works" and "inquiry-based action" aspects. However, the operationalist and inferentialist aspects of pragmatism and their worth for nursing knowledge development and practice are yet to be discussed. This paper explores the operationalist and inferentialist pragmatism and highlights the implications of these aspects for nursing knowledge development and practice. It has been argued that the dual aspect of pragmatism offers an approach to develop practical lines of action, evaluate actions in terms of their usefulness and assimilate already learned actions with the new actions. I suggested that moving beyond the rudimentary understanding of pragmatism and embracing and utilizing the dual aspect of pragmatism can bring more significant benefits for nursing. Embracing the dual aspect of pragmatism can enable nurses in developing philosophical reflexivity, emphasizing the experiential context of nursing, generating actionable and ready to use knowledge, and utilizing nursing theories to their fullest potential.

Distinguishing factors that influence attendance and behaviour change in family-based treatment of childhood obesity: A qualitative study

OBJECTIVES

For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)).

DESIGN

Focus groups with children and parents/carers as part of a broader mixed-methods evaluation.

METHODS

Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change.

RESULTS

Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others.

CONCLUSIONS

Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family's change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention.

Service users' experiences of contacting NHS patient medicines helpline services: a qualitative study

OBJECTIVES

Patient medicines helpline services (PMHS) are available from some National Health Service (NHS) Trusts in the UK to provide medicines information to hospital patients and carers. To date, studies of PMHS have examined the views of service users via satisfaction surveys. This study used qualitative methods to explore service users' experiences of using a PMHS, including perceived benefits and areas for improvement.

DESIGN

Qualitative, using semi-structured interviews.

SETTING

This study was conducted across seven NHS Trusts in England.

PARTICIPANTS

Forty users of PMHS were individually interviewed over the telephone. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke's inductive reflexive thematic analysis. Ethical approval was obtained before study commencement.

RESULTS

Participants predominantly called a PMHS for themselves (82%; carers: 18%). Two main themes were generated. Theme 1: timeliness-PMHS provide support during the uncertain transition of care period from hospital to home, when patients and carers often feel vulnerable because support is less available. PMHS met service users' needs for timely and easily accessible support, and quick resolution of their issues. PMHS could be improved with staffing beyond typical work week hours, and by having staff available to answer calls instead of using an answerphone. Theme 2: PMHS are best-placed to help-PMHS were perceived as best-placed to answer enquiries that arose from hospital care. Service users felt reassured from speaking to pharmacy professionals, and PMHS were perceived as the optimal service in terms of knowledge and expertise regarding medicines-related questions. However, several participants were initially unaware that their PMHS existed.

CONCLUSIONS

PMHS are perceived to be a valuable means of accessing timely medicines-related support when patients and carers may be feeling particularly vulnerable. However, their availability and promotion could be improved. We recommend that providers of PMHS consider whether this is achievable, in order to better meet the needs of service users.

What is the functional/organic distinction actually doing in psychiatry and neurology?

The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms 'functional' and 'organic' varies considerably by context. Techniques for differentially diagnosing 'functional' and 'organic' diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of 'zero sum' causality and encourages classification of syndromes into discrete 'functional' and 'organic' versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note 'functional' and 'organic' have loaded social meanings, creating the potential for social disempowerment. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other in neuropsychiatric thinking. We also note that the contribution of people who experience the interaction between 'functional' and 'organic' factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority.

Ultrasociality and Intersubjectivity

Multidisciplinary studies of evolution are pointing toward an intersubjective understanding of human cognition, belief, and behavior. Contrary to classical views of reason and knowledge, human mental capacity should not be thought of as an individually based tool for independent judgment and logical problem-solving. Instead, key aspects of learning and cognition were likely shaped to facilitate our species' greatest relative advantage from the standpoint of natural selection: large-scale collaboration. Much of what appears to be faulty reasoning or inaccurate belief when viewed at the level of individuals makes more sense when considered in terms of intersubjectivity and group-level processes. Yet, distributed cognition also has shortcomings. Among these is, paradoxically, the propensity toward individualistic understandings of human thinking and behavior. Moreover, our intersubjective thought processes tend to be biased in favor of our in-groups and maintaining existing systems. Taken together, these premises correspond with some of the theoretical underpinnings of community research and social action. Yet, they challenge or complicate others. Further consideration of humans' intersubjective cognition and learning may yield improved results in a variety of practices, including education and efforts to catalyze social and systemic changes.

Practising Pragmatism: The Framing of Gender Among Development Professionals in India

This article identifies the ways in which researchers and practitioners situated in different institutions engage with different systems of knowledge in their study of gender in the context of development, and the implications it has on how these professionals work together. Key informant interviews with 25 gender specialists from universities, research organizations, NGOs, UN agencies and donors undertaken in Delhi, India, are used as an illustration. The study finds that researchers/practitioners perceive that they study gender in dissimilar ways based on differences in academic training, professional roles and explicit affiliation with feminism. In practice, however, they have adopted ‘pragmatic’ ways to bridge the epistemological divide between the perspectives of ‘gender and development’ and ‘feminism’. These pragmatic practices are visible in the ways in which they work with the government, academia and donor organizations. I voice their need to traverse the quantitative–qualitative divide in order to strengthen our understanding of gender. The study demonstrates that researchers can negotiate epistemological differences for the sake of achieving the common goal of gender justice. This is important as the field of research on gender expands globally, with the emergence of new sites of knowledge production and emphasis on numerical evidence.

"I Just Like the Feeling of It, Outside Being Active": Pupils' Experiences of a School-Based Running Program, a Qualitative Study

INTRODUCTION

School-based running programs that promote daily (or regular) walking/jogging/running are an emerging public health initiative. However, evaluation of these programs has predominantly used quantitative measures that limit understanding and explanations of contextual influences on pupil participation. Therefore, the aim of this study was to qualitatively explore pupils' experiences of participating in a primary-school-based running program (Marathon Kids) to provide relevant insights and inform program developments.

METHODS

Nine semistructured focus groups were conducted with a purposeful sample of 50 pupils (26 girls and 24 boys) between 6 and 10 years of age from 5 primary schools in England. All schools had delivered the running program for 5-9 months during the 2015-16 academic year. Transcripts were analyzed using an inductive thematic approach.

RESULTS

Pupils identified a range of organizational, interpersonal, and intrapersonal factors that they believed influenced their participation in the program. Six themes were identified as being important to pupils' experiences: Marathon Kids as an enabling program, pupils' autonomy to participate, peer influence on participation (e.g., development of social cohesion), teacher influence on delivery (e.g., fidelity of implementation), logistics and suitability of the school environment, and appropriateness of program resources.

CONCLUSIONS

School-based running programs can offer an enjoyable physical activity experience for children; however, it is important to understand how current delivery approaches influence pupils' participation. Aspects that were believed to facilitate enjoyment included pupil autonomy to participate, perceived benefits of participation (including psychosocial outcomes), and a supportive school environment. Further research is required to identify the type and level of support required by schools to sustain pupil participation in running programs so that their perceived value is maintained.

Collaborating across sectors to provide early intervention for Aboriginal and Torres Strait Islander children with disability and their families: a qualitative study of provider perspectives

Aboriginal and Torres Strait Islander children experience a higher prevalence of disability than other Australian children. Early intervention from across the health, education, and social service sectors is vital for improving outcomes, but families face lack of coordination between services. This study aimed to inform improvements in service access for families of urban-dwelling Aboriginal children with disability through exploring providers' perceptions of factors that influenced working together across sectors. Semi-structured interviews were conducted. Data analysis was informed by the general inductive approach and the Collaborative Practice to Enhance Patient Care Outcomes framework. Twenty-four providers participated. Interprofessional collaborative practice was influenced by interdependent interactional and organizational factors. Interactional factors fit within one of two dimensions: the ability of providers to share common goals and vision within a complex cross-sector service landscape, and influence of interpersonal relationships on their sense of belonging working in a cross-cultural space. Organizational factors also fit within one of two dimensions: the influence of governance in relation to its role in coordination and unlocking the strength of schools as service settings, and the need to formalize processes for effective interprofessional communication. Interprofessional collaborative practice was managed within the context of systemic factors relating to policy and funding. These findings demonstrate the complex interplay of factors related to the cross-sector involvement of providers in early intervention service provision. Consideration of these factors is required to facilitate collaborative cross-sector responses to improve service access for Aboriginal families.Abbreviations: WHO: world health organization; ACCHS: aboriginal community controlled health service; GP: general practitioner; NDIS: national disability insurance scheme.

A Sociocultural Psychological Approach to Religion

Sociocultural psychology can contribute to the understanding of religion, as it examines the dynamics by which the social and cultural world creates the conditions for the lives of unique people. This approach focuses especially on semiotic dynamics, by which religion can both guide practices and sense-making, but also become an object of shared representations. Drawing on a series of past studies, I first adopt an ontogenetic perspective, to explore early development into a sociocultural environment in which religion is present, and then to address young adults' religious bricolage. I especially show people's creativity in using various symbolic resources, linked to religious elements or not. Second, I consider more sociogenetic dynamics: boundary making processes taking place in intergroup dynamics. This leads me, third, to consider the resonances between social discourses on religion and more subjective experiences: I especially show how public discourses may create confusing fields of meaning which find deep resonances in emotional experiences, which may have dramatic consequences, both at the individual and collective levels. For each point, I try to show how such this theoretical perspective and empirical evidence may illuminate contemporary issues and debates.

Delivering to 'that list': the challenges of working with learning outcomes

Dental education providers have raised concerns around the challenges experienced when trying to demonstrate student attainment of 'professionalism', as described in the General Dental Council (GDC) document 'Preparing for practice'. This manuscript describes a documentary analysis of each 'outcome' within the dentist professionalism domain section, with an assessment of whether it met the criteria of a functional learning outcome. In addition, outcomes were scrutinised in terms of application within undergraduate degree programmes. Key challenges identified were: the 'outcome list' included standards and objectives as well as outcomes; not all statements were specific and focused, some were broad and multi-faceted; determining attainment where there was no identifiable endpoints; and judging achievability within the supervised and confined environment of undergraduate programmes. We conclude that issues have been created through the way that these learning outcomes have been expressed. Also, it is evident that there are ideological and philosophical issues about accurately articulating the attainment of complex phenomena like professionalism. The findings from this study reflect the challenges associated with using learning outcomes to adequately capture professionalism, the values that underpin it and the behaviours that manifest its existence in clinical practice.

Distributed Health Literacy in the Maternal Health Context in Vietnam

BACKGROUND

Previous health literacy research has often focused on individual functional health literacy, ignoring the cultural contexts through which many people experience health care.

OBJECTIVE

We aimed to explore the nature of maternal health literacy among ethnic minority women in a low-resource setting in Vietnam.

METHODS

Using a qualitative approach, we conducted focus groups with 42 pregnant women, mothers, and grandmothers of children younger than age 5 years from the Thai and Hmong ethnic groups. Semi-structured interviews were conducted with key informants and thematic analysis was performed.

KEY RESULTS

The findings of our thematic analysis aligned well with the concept of distributed health literacy. We found that ethnic minority women drew upon family and social networks of health literacy mediators to share knowledge and understanding, assess and evaluate information, communicate with health professionals, and support decision-making. Family members were also involved in making health decisions that had the potential to negatively affect women and children's health.

CONCLUSIONS

Family members are an important source of information for ethnic minority women, and they influence decision-making. Relatives and husbands of pregnant women could be included in maternal health education programs to potentially strengthen the health literacy of the whole community. The distributed health literacy concept can be used to strengthen health promotion messages and to reduce the risk of negative health outcomes. [HLRP: Health Literacy Research and Practice. 2019;3(1):e31-e42.].

PLAIN LANGUAGE SUMMARY

Distributed health literacy refers to how health literacy skills and practices are distributed through social networks. This concept applies well to the maternal health context in Vietnam. Older women are trusted sources of information, and family influences decision-making during pregnancy. Women's limited autonomy increases the importance of family involvement. Distributed health literacy could be used to strengthen health promotion messages.

In Defence of Machine Learning: Debunking the Myths of Artificial Intelligence

There has been much hype, over the past few years, about the recent progress of artificial intelligence (AI), especially through machine learning. If one is to believe many of the headlines that have proliferated in the media, as well as in an increasing number of scientific publications, it would seem that AI is now capable of creating and learning in ways that are starting to resemble what humans can do. And so that we should start to hope – or fear – that the creation of fully cognisant machine might be something we will witness in our life time. However, much of these beliefs are based on deep misconceptions about what AI can do, and how. In this paper, I start with a brief introduction to the principles of AI, machine learning, and neural networks, primarily intended for psychologists and social scientists, who often have much to contribute to the debates surrounding AI but lack a clear understanding of what it can currently do and how it works. I then debunk four common myths associated with AI: 1) it can create, 2) it can learn, 3) it is neutral and objective, and 4) it can solve ethically and/or culturally sensitive problems. In a third and last section, I argue that these misconceptions represent four main dangers: 1) avoiding debate, 2) naturalising our biases, 3) deresponsibilising creators and users, and 4) missing out some of the potential uses of machine learning. I finally conclude on the potential benefits of using machine learning in research, and thus on the need to defend machine learning without romanticising what it can actually do.

Developing an integrated rehabilitation model for thoracic cancer services: views of patients, informal carers and clinicians

Background

Access to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis. Models to integrate rehabilitation within oncology services as cancer treatment commences are required, but must be informed by those they are intended to support. We aimed to identify views of patients, carers and clinicians to develop and refine a rehabilitation model to be tested in a feasibility trial for people newly diagnosed with lung cancer or mesothelioma.

Methods

We conducted a focus group study with people affected by lung cancer or mesothelioma, their carers and clinicians providing their care to identify priorities for rehabilitation in this period. We sought views on core intervention components, processes and outcomes and integration with oncology services. Data were analysed using thematic analysis.

Results

Fifteen clinicians (oncologists, nurse specialists, physiotherapists and occupational therapists), nine patients and five carers participated. A proposed outline rehabilitation model was perceived as highly relevant for this population. Participants recommended prompt and brief rehabilitation input, delivered whilst people attend for hospital appointments or at home to maximise accessibility and acceptability. Participants recognised variation in need and all prioritised tailored support for symptom self-management, daily activities and the involvement of carers. Clinicians also prioritised achieving fitness for oncology treatment. Patients and carers prioritised a sensitive manner of approach, positivity and giving hope for the future. Participant's recommendations for outcome measurement related to confidence in usual daily activities, symptom control and oncology treatment completion rates over objective measures of cardiorespiratory fitness.

Conclusion

The importance of providing tailored rehabilitation around the time of diagnosis for people with lung cancer or mesothelioma was affirmed by all participants. The refined model of rehabilitation recommended for testing in a feasibility trial is flexible, tailored and short-term. It aims to support people to self-manage symptoms, tolerate cancer treatments and to remain active and independent in daily life. It is delivered alongside scheduled hospital appointments or at home by an expert practitioner sensitive to the psycho-social sequelae that follow a diagnosis of thoracic cancer.

How healthcare professionals experience patient participation in designing healthcare services and products. A qualitative study in the field of spinal cord injury in Switzerland

OBJECTIVES

This study explored healthcare professionals' accounts of patient participation, focusing particularly on aspects related to patients' contributions to the planning and design of healthcare services and products. It aimed to determine (1) how healthcare professionals experience patient participation, (2) what factors, in their view, may inhibit or promote it; and (3) through what channels they think it can take place.

METHODS

This study adopted a pragmatic epistemological approach. Data was collected through semi-structured interviews with healthcare professionals at four specialized centers for spinal cord injury in Switzerland.

RESULTS

Healthcare professionals who participated in this study were generally open to patient participation in the healthcare innovation process, highlighting several factors that may influence this process. Participants referred to three types of patient contributions that would usually emerge from informal exchange: (1) bringing in information unknown to staff; (2) reporting problems; and (3) providing concrete suggestions for improvement.

CONCLUSION & PRACTICE IMPLICATIONS

Healthcare professionals' positive view on and experiences with patient participation in the healthcare innovation process provide a fertile ground to further explore ways of fostering this new form of collaboration. Ultimately, it will be important to demonstrate its positive impact on both patients' as well as healthcare professionals' experiences.

Modalities of Generalization Through Single Case Studies

The value of case studies for theory building is still doubted in psychology. The paper argues for the importance of case studies and the possibility of generalizing from these for a specific sociocultural understanding of human development. The paper first clarifies the notion of abduction within case studies, drawing on pragmatists James and Peirce and expanding it with the work of Lewin, and argues that it is the core mechanism that allows generalization from case studies. The second section presents the possibility of generalizing from individual single case studies, for which not only the subjective perspective, but also the dynamics by which the social and cultural environment guide and enable the person's development, have to be accounted for. The third section elaborates the question of institutional case studies, where the challenge is to account both for institutional dynamics, and for persons' trajectories within; this is exemplified with an ongoing study on the process of obtaining citizenship in Switzerland. The paper briefly concludes by highlighting two possible implications of the paper, one concerning the process of theoretical reasoning, the other, the fact that sociocultural psychology could itself be seen as an institution in-the-making.

Employment of patients with multiple sclerosis: the influence of psychosocial-structural coping and context

Patients with multiple sclerosis tend to report higher levels of work difficulties and negative outcomes, such as voluntary and involuntary work termination and reduced work participation. In this article, we discuss the complex interactions of disease, personal coping strategies, and social and structural factors that contribute to their work experiences and outcomes. An overview of the coping strategies and actions that leverage personal and context-level factors and dynamics is also provided to support the overall goal of continued work in patients with MS.

'I do want to ask, but I can't speak': a qualitative study of ethnic minority women's experiences of communicating with primary health care professionals in remote, rural Vietnam

BACKGROUND

Ethnic minority groups in Vietnam experience economic, social and health inequalities. There are significant disparities in health service utilisation, and cultural, interpersonal and communication barriers impact on quality of care. Eighty per cent of the population of Dien Bien Province belongs to an ethnic minority group, and poor communication between health professionals and ethnic minority women in the maternal health context is a concern for health officials and community leaders. This study explores how ethnic minority women experience communication with primary care health professionals in the maternal and child health setting, with an overall aim to develop strategies to improve health professionals' communication with ethnic minority communities.

METHODS

We used a qualitative focused ethnographic approach and conducted focus group discussions with 37 Thai and Hmong ethnic minority women (currently pregnant or mothers of children under five) in Dien Bien Province. We conducted a thematic analysis.

RESULTS

Ethnic minority women generally reported that health professionals delivered health information in a didactic, one-way style, and there was a reliance on written information (Maternal and Child Health handbook) in place of interpersonal communication. The health information they receive (both verbal and written) was often non-specific, and not context-adjusted for their personal circumstances. Women were therefore required to take a more active role in interpersonal interactions in order to meet their own specific information needs, but they are then faced with other challenges including language and gender differences with health professionals, time constraints, and a reluctance to ask questions. These factors resulted in women interpreting health information in diverse ways, which in turn appeared to impact their health behaviours.

CONCLUSIONS

Fostering two-way communication and patient-centred attitudes among health professionals could help to improve their communication with ethnic minority women. Communication training for health professionals could be included along with the nationwide implementation of written information to improve communication.

Expanding protection motivation theory: investigating an application to animal owners and emergency responders in bushfire emergencies

Background

Protection Motivation Theory (PMT) was developed by Rogers in 1975, to describe how individuals are motivated to react in a self-protective way towards a perceived health threat. Rogers expected the use of PMT to diversify over time, which has proved true over four decades. The purpose of this paper is to explore how PMT can be used and expanded to inform and improve public safety strategies in natural hazards. As global climate change impacts on the Australian environment, natural hazards seem to be increasing in scale and frequency, and Emergency Services’ public education campaigns have necessarily escalated to keep pace with perceived public threat. Of concern, is that the awareness-preparedness gap in residents’ survival plans is narrowing disproportionately slowly compared to the magnitude of resources applied to rectify this trend. Practical applications of adaptable social theory could be used to help resolve this dilemma.

Discussion

PMT has been used to describe human behaviour in individuals, families, and the parent-child unit. It has been applied to floods in Europe and wildfire and earthquake in the United States. This paper seeks to determine if an application of PMT can be useful for achieving other-directed human protection across a novel demographic spectrum in natural hazards, specifically, animal owners and emergency responders in bushfire emergencies.

These groups could benefit from such an approach: owners to build and fortify their response- and self-efficacy, and to help translate knowledge into safer behaviour, and responders to gain a better understanding of a diverse demographic with animal ownership as its common denominator, and with whom they will be likely to engage in contemporary natural hazard management. Mutual collaboration between these groups could lead to a synergy of reciprocated response efficacy, and safer, less traumatic outcomes.

Summary

Emergency services’ community education programs have made significant progress over the last decade, but public safety remains suboptimal while the magnitude of the awareness-preparedness gap persists. This paper examines an expanded, other-directed application of PMT to expand and enhance safer mitigation and response behaviour strategies for communities threatened by bushfire, which may ultimately help save human life.

"Don't Just Do Something … Stand There!" Emergency Responders' Peri-Incident Perceptions of Animal Owners in Bushfire

Introduction

Narrowing the awareness–preparedness gap in bushfires (wildfires) means that new strategies and tactics will be needed to improve human safety and survival in this increasingly frequent and severe globally significant natural hazard. One way to do this is to explore the peri-event experiences of novel demographic groups living and working in at-risk areas to determine how best to strengthen a collaborative, mutually beneficial interface with emergency responders. Thus, this study included participants from one novel demographic, animal owners, in combination with emergency responders. Animal owners themselves are a large, diverse group whose preparedness and response behavior has not been assessed with respect to their potential contribution to contemporary natural hazard management.

Method

Data were collected using semi-structured interviews and focus group discussions from four emergency responder classifications who were asked about their perceptions of animal owners in bushfire. Thematic analysis was used for data analysis because of its flexibility and suitability to this pragmatic qualitative study. Results from the first of 10 themes, chosen for its “overview” properties, are discussed in this paper, and indicate that exploring the animal owner—emergency responder interface has the potential to generate useful additions to public policy and expansion of social theory.

Conclusion

Analysis of these data in this paper supports the potential for positive outcomes gained by reciprocal collaboration between animal owners and emergency responders. Some simple practical solutions are evident and two major outcome streams are identified. These are (1) policy development and implementation and (2) etiology of decision-making. Considerations and recommendations for research examining the efficacy of these streams and solutions are provided.

What can we learn from trial decliners about improving recruitment? Qualitative study

Background

Trials increasingly experience problems in recruiting participants. Understanding the causes of poor recruitment is critical to developing solutions. We interviewed people who had declined a trial of an innovative psychological therapy for depression (REFRAMED) about their response to the trial invitation, in order to understand their decision and identify ways to improve recruitment.

Methods

Of 214 people who declined the trial, 35 (16 %) gave permission to be contacted about a qualitative study to explore their decision. Analysis of transcripts of semi-structured interviews was informed by grounded theory.

Results

We interviewed 20 informants: 14 women and six men, aged 18 to 77 years. Many interviewees had prior experience of research participation and positive views of the trial. Interviewees’ decision making resembled a four-stage sequential process; in each stage they either decided not to participate in the trial or progressed to the next stage. In stage 1, interviewees assessed the invitation in the context of their experiences and attitudes; we term those who opted out at this stage ‘prior decliners’ as they had an established position of declining trials. In stage 2, interviewees assessed their own eligibility; those who judged themselves ineligible and opted out at this stage are termed ‘self-excluders’. In stage 3, interviewees assessed their need for the trial therapy and potential to benefit; we term those who decided they did not need the trial therapy and opted out at this stage ‘treatment decliners’. In stage 4, interviewees deliberated the benefits and costs of trial participation; those who opted out after judging that disadvantages outweighed advantages are termed ‘trial decliners’. Across all stages, most individuals declined because they judged themselves ineligible or not in need of the trial therapy. While ‘prior decliners’ are unlikely to respond to any trial recruitment initiative, the factors leading others to decline are amenable to amelioration as they do not arise from a rejection of trials or a personal stance.

Conclusions

To improve recruitment in similar trials, the most successful interventions are likely to address patients’ assessments of their eligibility and their potential to benefit from the trial treatment, rather than reducing trial burden.

Trial registration

International Standard Randomised Controlled Trial Number: ISRCTN85784627. Registration date 10 August 2011.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1626-4) contains supplementary material, which is available to authorized users.

A qualitative method for analysing multivoicedness

'Multivoicedness' and the 'multivoiced Self' have become important theoretical concepts guiding research. Drawing on the tradition of dialogism, the Self is conceptualised as being constituted by a multiplicity of dynamic, interacting voices. Despite the growth in literature and empirical research, there remains a paucity of established methodological tools for analysing the multivoiced Self using qualitative data. In this article, we set out a systematic, practical 'how-to' guide for analysing multivoicedness. Using theoretically derived tools, our three-step method comprises: identifying the voices of I-positions within the Self's talk (or text), identifying the voices of 'inner-Others', and examining the dialogue and relationships between the different voices. We elaborate each step and illustrate our method using examples from a published paper in which data were analysed using this method. We conclude by offering more general principles for the use of the method and discussing potential applications.

Exploring stroke survivor experience of participation in an enriched environment: a qualitative study

BACKGROUND

Data highlight the importance of undertaking intense and frequent repetition of activities within stroke rehabilitation to maximise recovery. An enriched environment (EE) provides a medium in which these activities can be performed and enhanced recovery achieved. An EE has been shown to promote neuroplasticity in animal models of stroke, facilitating enhanced recovery of motor and cognitive function. However, the benefit of enriching the environment of stroke survivors remains unknown.

AIM

To qualitatively explore stroke survivors' experience of implementation of exposure to an EE within a typical stroke rehabilitation setting, in order to identify facilitators and barriers to participation.

METHODS

Semi-structured interviews with 10 stroke survivors (7 females and 3 males, mean age of 70.5 years) exposed to an EE for a 2-week period following exposure to routine rehabilitation within a stroke rehabilitation ward. An inductive thematic approach was utilised to collect and analyse data.

RESULTS

Qualitative themes emerged concerning the environmental enrichment paradigm including: (1) "It got me moving" - perceived benefits of participation in an EE; (2) "You can be bored or you can be busy." - Attenuating factors influencing participation in an EE; (3) "I don't like to make the staff busier" - limitations to use of the EE.

CONCLUSIONS

This study provides preliminary support for the implementation of an EE within a typical stroke rehabilitation setting from a patient perspective. Reported benefits included (1) increased motor, cognitive and sensory stimulation, (2) increased social interaction, (3) alleviation of degree of boredom and (4) increased feelings of personal control. However, participants also identified a number of barriers affecting implementation of the EE. We have previously published findings on perceptions of nursing staff working with stroke survivors in this enriched rehabilitation environment who identified that patients benefited from having better access to physical, cognitive and social activities. Together, results contribute to valuable evidence for future implementation of an EE in stroke rehabilitation settings. Implications for Rehabilitation Stroke survivor access to an enriched environment (EE): RESULTS identified that participation in both individual and communal forms of environment enrichment within the stroke rehabilitation ward resulted in increased access to activities providing increased opportunities for enhanced motor, cognitive and sensory stimulation. Increased access to and participation in activities of the environmental enrichment (individual and communal) interrupted the ongoing cycle of boredom and inactivity experienced by many participants. This study provides preliminary support for the implementation of an EE within a typical stroke rehabilitation setting from a patient perspective.